Confirmatory factory analysis of the Neck Disability Index in a general problematic neck population indicates a one-factor model |
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| Authors: | Charles Philip Gabel Antonio I Cuesta-Vargas Jason W Osborne Brendan Burkett Markus Melloh |
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| Institution: | 1. Faculty of Science, Health and Education, Centre for Healthy Activities, Sport and Exercise, University of the Sunshine Coast, Sippy Downs Dve, Sippy Downs, Sunshine Coast Qld 4556 Australia;2. Department of Psychiatry and Physiotherapy, Faculty of Medicine, Malaga University, SpainAvenida Estación de el Palo, Málaga, 29017 Spain;3. Educational and Counseling Psychology, University of Louisville, 2323 S Brook St, Louisville, KY, 40208 USA;4. Centre for Medical Research (CMR), Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Perth, Australia;1. Department of Physical Therapy, Faculty of Physiotherapy, University of Valencia, Spain;2. Department of Human Physiology and Physiotherapy, Faculty of Physical Education & Physiotherapy, Vrije University Brussels, Belgium;3. Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium;4. Duke University, 2200 W. Main St., Durham, NC, USA;1. School of Public Policy, Georgia Institute of Technology, 685 Cherry Street, Atlanta, GA 30332-0345, United States;2. Center for R&D Monitoring (ECOOM) and Department of Managerial Economics, Strategy and Innovation, University of Leuven, Waaistraat 6, 3000 Leuven, Belgium;3. Institute for Research Information and Quality Assurance (iFQ), Schuetzenstrasse 6a, 10117 Berlin, Germany;1. University of British Columbia, 899 West 12th Avenue, Vancouver, British Columbia V5Z 1M9, Canada;2. Department of Radiology, Vancouver General Hospital, University of British Columbia, 899 West 12th Avenue, Vancouver, British Columbia V5Z 1M9, Canada;3. Department of Radiology, St Joseph’s Hospital, 2137 Comox Avenue, Comox, British Columbia V9M 1P2, Canada;4. Zanvyl Krieger School of Arts & Sciences, Johns Hopkins University, 1717 Massachusetts Avenue NW, Washington, DC 20036, USA |
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| Abstract: | Background contextThe Neck Disability Index frequently is used to measure outcomes of the neck. The statistical rigor of the Neck Disability Index has been assessed with conflicting outcomes. To date, Confirmatory Factor Analysis of the Neck Disability Index has not been reported for a suitably large population study. Because the Neck Disability Index is not a condition-specific measure of neck function, initial Confirmatory Factor Analysis should consider problematic neck patients as a homogenous group.PurposeWe sought to analyze the factor structure of the Neck Disability Index through Confirmatory Factor Analysis in a symptomatic, homogeneous, neck population, with respect to pooled populations and gender subgroups.Study designThis was a secondary analysis of pooled data.Patient sampleA total of 1,278 symptomatic neck patients (67.5% female, median age 41 years), 803 nonspecific and 475 with whiplash-associated disorder.Outcome measuresThe Neck Disability Index was used to measure outcomes.MethodsWe analyzed pooled baseline data from six independent studies of patients with neck problems who completed Neck Disability Index questionnaires at baseline. The Confirmatory Factor Analysis was considered in three scenarios: the full sample and separate sexes. Models were compared empirically for best fit.ResultsTwo-factor models have good psychometric properties across both the pooled and sex subgroups. However, according to these analyses, the one-factor solution is preferable from both a statistical perspective and parsimony. The two-factor model was close to significant for the male subgroup (p<.07) where questions separated into constructs of mental function (pain, reading headaches and concentration) and physical function (personal care, lifting, work, driving, sleep, and recreation).ConclusionsThe Neck Disability Index demonstrated a one-factor structure when analyzed by Confirmatory Factor Analysis in a pooled, homogenous sample of neck problem patients. However, a two-factor model did approach significance for male subjects where questions separated into constructs of mental and physical function. Further investigations in different conditions, subgroup and sex-specific populations are warranted. |
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| Keywords: | Outcome Clinimetrics Neck Measurement Factor analysis |
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