title: The Qualification of Outcome after Cervical Spine Surgery by Patients Compared to the Neck Disability Index.
abstract: OBJECTIVE
  The Neck Disability Index (NDI) is a patient self-assessed outcome measurement tool to assess disability, and that is frequently used to evaluate the effects of the treatment of neck-related problems. In individualized medicine it is mandatory that patients can interpret data in order to choose a treatment. A change of NDI or an absolute NDI is generally meaningless to a patient. Therefore, a correlation between the qualification of the clinical situation rated by the patient and the NDI score was evaluated.
  
  
  METHODS
  Patients who completed an NDI after anterior surgery because of symptomatic single level degenerative cervical disc disease were asked one month after completion of the NDI to qualify their clinical situation of a 5-item Likert scale varying from excellent to bad. Since a clear distinction between the categories was not possible based on the total NDI score, a ROC-curve was built, and the AUC computed in order to estimate best dichotomization in qualification of the clinical situation. The best corresponding cut-off point for the NDI total score was found by studying sensitivity and specificity for all possible cut-off points.
  
  
  RESULTS
  102 patients were included. The highest AUC was obtained by dichotomizing the qualification into a group with good outcome and less-good outcome. The highest sensitivity and specificity for the dichotomized qualification as good outcome corresponded to a NDI ≤ 7. Sensitivity was 81.08% and specificity was 78.57%.
  
  
  CONCLUSIONS
  This is the first study that correlated the qualification of the situation by the patients themselves and NDI. An NDI ≤ 7 corresponded to a good outcome according to the patients. This is valuable information to inform patients in their decision for any treatment.
authors.affiliation: Department of Orthopedic Surgery, Via Sana Clinics, Hoogveldseweg 1, 5451 AA, Mill, the Netherlands.
authors.forename: Roland
authors.initials: R
authors.lastname: Donk
authors.affiliation: Department for Health Evidence, Radboud university medical center, Geert Groote Plein-zuid 10, 6525 GA, Nijmegen, the Netherlands.
authors.forename: Andre
authors.initials: A
authors.lastname: Verbeek
authors.affiliation: Department of Neurology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands.
authors.forename: Wim
authors.initials: W
authors.lastname: Verhagen
authors.affiliation: Department for Health Evidence, Radboud university medical center, Geert Groote Plein-zuid 10, 6525 GA, Nijmegen, the Netherlands.
authors.forename: Hans
authors.initials: H
authors.lastname: Groenewoud
authors.affiliation: Department for Orthopedic Surgery, Radboud university medical center, Geert Groote Plein-zuid 10, 6525 GA, Nijmegen, the Netherlands.
authors.forename: Allard
authors.initials: A
authors.lastname: Hosman
authors.affiliation: Department of Neurosurgery, Radboud university medical center, Geert Groote Plein-zuid 10, 6525 GA, Nijmegen, the Netherlands.|Canisius Wilhelmina Hospital, Department of Neurosurgery, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands.
authors.forename: Ronald
authors.identifier: http://orcid.org/0000-0002-8638-4660
authors.initials: R
authors.lastname: Bartels
mesh_terms: D002574:Cervical Vertebrae / Q000503:physiopathology* / Q000601:surgery*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D010147:Pain Measurement; D063868:Patient Outcome Assessment; D011184:Postoperative Period; D057234:Preoperative Period; D011788:Quality of Life; D012372:ROC Curve; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires