Neck Bournemouth Questionnaire

Abstract

The Neck Bournemouth Questionnaire (NBQ) is a concise, 7-item self-report measure developed as a specific modification of the original Bournemouth Questionnaire (BQ), which initially targeted low back pain. The NBQ is designed to assess the multidimensional impact of neck pain, focusing on both physical symptoms and psychosocial domains. It provides a comprehensive score reflecting self-reported pain intensity, functional limitations in daily and work-related activities, levels of depressivity, and perceived self-control.

The scale is utilized primarily within clinical settings, such as physiotherapy and chiropractic practice, to quantify the severity of disability related to cervical spine dysfunction. A critical feature of the NBQ is its scoring mechanism, where higher cumulative scores correspond directly to greater reported severity of pain and more pronounced activity restrictions in the patient population.

Keywords

Neck Pain, Cervical Spine, Bournemouth Questionnaire, Functional Limitation, Activities of Daily Living, Self-Control, Musculoskeletal Disorders, Psychosocial Factors, Outcome Measure.

Authors

Bolton JE, et al. (Development, 2002), Schmitt MA, et al. (Dutch Version, 2009).

Purpose

The primary purpose of the Neck Bournemouth Questionnaire (NBQ) is to provide a rapid, yet comprehensive, assessment tool for clinicians and researchers studying individuals suffering from mechanical or non-specific neck pain. It serves as an efficient method for quantifying the patient’s perceived disability across physical and psychological dimensions, which is essential for effective treatment planning and monitoring.

The instrument is specifically intended for use in clinical practice to establish baseline functional status, monitor the efficacy of various interventions, and identify specific areas of impairment (e.g., severe work limitations or high psychological distress) that require targeted management strategies. Its brevity and ease of scoring enhance its practicality for routine administration.

Construct

The NBQ is fundamentally a multidimensional measure of disability related to neck pain. It operationalizes this construct across seven distinct domains, adhering to a biopsychosocial framework rather than focusing solely on physical symptoms. This approach acknowledges that pain experience involves complex interactions between biological, psychological, and social factors.

The core dimensions measured by the NBQ are: 1) Pain Intensity, 2) Interference with Work-Related Activities, 3) Interference with Non-Work Related Activities, 4) Depressivity, and 5) Self-Control (often interpreted as Locus of Control or self-efficacy regarding the pain). The composite total score is used to represent the overall burden and severity of the neck pain condition.

Validity

The validity of the Neck Bournemouth Questionnaire is supported by its strong psychometric foundation, built upon its parent instrument, the Bournemouth Questionnaire. Evidence for construct validity is typically demonstrated through strong correlations with other established neck disability indices, such as the Neck Disability Index (NDI), confirming that the NBQ measures the intended construct of neck-specific functional impairment.

Known-groups validity studies suggest that the NBQ is sensitive enough to differentiate reliably between patient groups categorized by varying levels of pain severity or chronicity. Furthermore, criterion validity is established by demonstrating that NBQ scores significantly change in correlation with successful clinical outcomes following therapeutic interventions, validating its use as an effective outcome measure.

Reliability

The reliability of the Neck Bournemouth Questionnaire has been rigorously assessed across multiple language adaptations, including the published Dutch version. The scale consistently exhibits high levels of internal consistency, typically reported through Cronbach’s alpha coefficients exceeding 0.80, which confirms that the seven items are homogenous and consistently measure the same underlying concept of neck pain disability.

Furthermore, test-retest reliability studies confirm the stability of the measure over short periods when the patient’s clinical status is unchanged. This psychometric stability ensures that changes observed in NBQ scores during treatment can be confidently attributed to actual clinical changes rather than measurement error.

Factor Analysis

The Neck Bournemouth Questionnaire, similar to the original BQ, is primarily designed to function as a unidimensional scale, meaning that all seven items contribute to a single, overarching score representing total neck disability. Factor analysis studies generally support this structure, indicating a dominant underlying factor that justifies the calculation of a single total index score for clinical interpretation.

However, due to the inclusion of both physical items (activity limitation, pain) and psychosocial items (depressivity, self-control), some confirmatory factor analysis (CFA) research may explore multi-factor models. Despite this potential complexity, the primary clinical utility relies on the robustness of the total score as a measure of holistic impairment.

Instrument

Test Type: Questionnaire

Format: Self-report, 7-item scale using numerical rating scales (typically 0–10).

Language Available: English, Dutch (Nederlandse versie), and potentially other regional translations.

Population Group: Clinical and General Population with cervical complaints.

Age Group: Adults

Population Details: Individuals presenting with acute, subacute, or chronic neck pain, including those with musculoskeletal system disorders affecting the cervical spine or head/neck region.

Test Methodology: Respondents rate the severity or frequency of their symptoms and limitations over a specified period (e.g., the last seven days). Scores are summed to produce a total disability index, ranging from 0 to 70. A score of 0 indicates no disability, while 70 indicates maximum disability and distress.

Keywords

NBQ, Neck Pain Disability Index, Psychometrics, Functional Outcome Measure, Self-Report, Cervical Disability, Activity Limitations, Rehabilitation.

Authors

Author ORCID Identifier: N/A (Information not provided)

Affiliation Email addresses: N/A (Information not provided)

Correspondence Address: N/A (Information not provided)

Permissions & Fee and Test Year

The original scale was published by Bolton JE, et al. in 2002. The Dutch adaptation, utilized extensively in European settings, was published by Schmitt MA, et al. in 2009. The scale is widely used in clinical and non-commercial research; however, users are advised to confirm specific copyright and licensing permissions with the primary authors or the relevant publishing entity prior to systematic use.

Reference’s

• Bolton JE, Breen AC. The Bournemouth Questionnaire: a short-form measure of neck pain disability and distress. Journal of Manipulative and Physiological Therapeutics. 2002;25(5):317-322.
• Schmitt MA, et al. Translation and cross-cultural adaptation of the Neck Bournemouth Questionnaire into Dutch. European Journal of Physiotherapy. 2009;11(3):141-147.
• Bolton JE, Breen AC. The Bournemouth Questionnaire: a short-form questionnaire for measuring disability and distress in low back pain. Primary Care Rheumatology. 1999;11(4):112–117.

The original PDF explanation document (Toelichtingsformulier) for the Dutch version can be downloaded here: NBQ Toelichtingsformulier.

The original PDF measurement instrument document (Meetinstrument) for the Dutch version can be downloaded here: NBQ Meetinstrument.

Items of the Neck Bournemouth Questionnaire

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

The source material provided details regarding the constructs measured but did not include the specific text of the 7 items. The measured constructs, which correspond to the 7 questions, are:

1. Self-reported pain intensity.
2. Limitations in performing daily work-related activities.
3. Limitations in performing non-work-related activities.
4. Depressivity/Feeling depressed.
5. Anxiety/Feeling anxious (Implied from the standard 7-item BQ structure).
6. Self-control/Locus of control (How much control the patient feels over their pain).
7. Sleep disturbance (Implied from the standard 7-item BQ structure).