Psychometric characteristics of the Spanish version of instruments to measure neck pain disability

Background: The NDI, COM and NPQ are evaluation instruments for disability due to NP. There was no Spanish version of NDI or COM for which psychometric characteristics were known. The objectives of this study were to translate and culturally adapt the Spanish version of the Neck Disability Index Questionnaire (NDI), and the Core Outcome Measure (COM), to validate its use in Spanish speaking patients with non-specific neck pain (NP), and to compare their psychometric characteristics with those of the Spanish version of the Northwick Pain Questionnaire (NPQ). Methods: Translation/re-translation of the English versions of the NDI and the COM was done blindly and independently by a multidisciplinary team. The study was done in 9 primary care Centers and 12 specialty services from 9 regions in Spain, with 221 acute, subacute and chronic patients who visited their physician for NP: 54 in the pilot phase and 167 in the validation phase. Neck pain (VAS), referred pain (VAS), disability (NDI, COM and NPQ), catastrophizing (CSQ) and quality of life (SF-12) were measured on their first visit and 14 days later. Patients' self-assessment was used as the external criterion for pain and disability. In the pilot phase, patients' understanding of each item in the NDI and COM was assessed, and on day 1 test-retest reliability was estimated by giving a second NDI and COM in which the name of the questionnaires and the order of the items had been changed. Results: Comprehensibility of NDI and COM were good. Minutes needed to fill out the questionnaires [median, (P25, P75)]: NDI. 4 (2.2, 10.0), COM: 2.1 (1.0, 4.9). Reliability: [ICC, (95%CI)]: NDI: 0.88 (0.80, 0.93). COM: 0.85 (0.75,0.91). Sensitivity to change: Effect size for patients having worsened, not changed and improved between days 1 and 15, according to the external criterion for disability: NDI: -0.24, 0.15, 0.66; NPQ: -0.14, 0.06, 0.67; COM: 0.05, 0.19, 0.92. Validity: Results of NDI, NPQ and COM were consistent with the external criterion for disability, whereas only those from NDI were consistent with the one for pain. Correlations with VAS, CSQ and SF-12 were similar for NDI and NPQ (absolute values between 0.36 and 0.50 on day 1, between 0.38 and 0.70 on day 15), and slightly lower for COM (between 0.36 and 0.48 on day 1, and between 0.33 and 0.61 on day 15). Correlation between NDI and NPQ: r = 0.84 on day 1, r = 0.91 on day 15. Correlation between COM and NPQ: r = 0.63 on day 1, r = 0.71 on day 15. Conclusion: Although most psychometric characteristics of NDI, NPQ and COM are similar, those from the latter one are worse and its use may lead to patients' evolution seeming more positive than it actually is. NDI seems to be the best instrument for measuring NP-related disability, since its results are the most consistent with patient's assessment of their own clinical status and evolution. It takes two more minutes to answer the NDI than to answer the COM, but it can be reliably filled out by the patient without assistance

Deep roots delay flowering and relax the impact of floral traits and associated pollinators in steppe plants.

Strong seasonality in abiotic harshness and pollinator availability shape the reproductive success of plants. Plant species can avoid or can tolerate harsh abiotic conditions and can attract different pollinators, but it remains unknown (i) which of these capacities is most important for flowering phenology, (ii) whether tolerance/avoidance of abiotic harshness reinforces or relaxes the phenological differentiation of species attracting different pollinators. We assembled possibly the first functional trait database for a North African steppe covering 104 species. We inferred avoidance of harshness (drought) from dormancy, i.e. annual life-span and seed size. We inferred tolerance or resistance to harshness from small specific leaf area, small stature, deep roots and high dry matter content. We inferred the type of pollinators attracted from floral colour, shape and depth. We found that avoidance traits did not affect flowering phenology, and among tolerance traits only deep roots had an effect by delaying flowering. Flower colour (red or purple), and occasionally flower depth, delayed flowering. Dish, gullet and flag shape accelerated flowering. Interactive effects however were at least as important, inversing the mentioned relationship between floral characters and flowering phenology. Specifically, among drought-tolerant deep-rooted species, flowering phenologies converged among floral types attracting different pollinators, without becoming less variable overall. Direct and interactive effects of root depth and floral traits explained at least 45% of the variance in flowering phenology. Also, conclusions on interactive effects were highly consistent with and without including information on family identity or outliers. Overall, roots and floral syndromes strongly control flowering phenology, while many other traits do not. Surprisingly, floral syndromes and the related pollinators appear to constrain phenology mainly in shallow-rooted, abiotically little tolerant species. Lack of abiotic tolerance might hence constrain accessible resources and thereby impose a stronger synchronization with biotic partners such as pollinators