Neck pain can affect more than local discomfort. It may influence daily activity, work, training, social participation, mood, confidence, fear of movement and perceived control.
The Neck Bournemouth Questionnaire was adapted from the original Bournemouth Questionnaire to provide a short, multidimensional measure for people with non-specific neck pain. It captures physical, social and psychological dimensions that can influence how neck pain affects the client.
The NBQ may be useful for clients with:
non-specific neck pain
persistent neck symptoms
neck-related activity limitation
work-related neck symptoms
neck pain with psychosocial impact
recurrent neck pain episodes
neck pain being monitored over time
The NBQ should support assessment reasoning and monitoring. It should not be used as a stand-alone diagnostic or decision-making tool.
Outcome measure: Neck Bournemouth Questionnaire
Abbreviation: NBQ
Body region: Neck / cervical spine
Type: Client-reported outcome measure
Number of items: 7
Score range: 0–70
Higher score means: Greater neck pain-related impact
Lower score means: Less neck pain-related impact
Best used for: Non-specific neck pain monitoring and multidimensional progress tracking
Key limitation: NBQ does not identify the cause of neck pain or replace physical assessment
The NBQ is a short questionnaire for neck pain.
It includes 7 items that reflect a multidimensional view of pain and disability.
The items commonly cover:
pain intensity
physical function
social activity
anxiety
depression
work-related fear or avoidance
pain control or perceived coping
Each item is scored from 0 to 10.
The total score ranges from 0 to 70.
A higher score indicates greater neck pain-related impact. A lower score indicates less impact.
The NBQ is used because neck pain can affect multiple domains.
A client may report:
neck pain intensity
difficulty with daily activities
reduced work tolerance
reduced social participation
concern about symptoms
low mood or frustration
fear of movement or work activity
reduced sense of control
The NBQ may help professionals:
establish a baseline
monitor change over time
identify domains most affected
support goal-setting conversations
compare client-reported impact with physical findings
track progress across a training or rehabilitation period
improve outcome reporting
The score should be interpreted alongside symptoms, goals, range of motion, strength, movement tolerance, neurological findings where relevant and professional judgement.
The NBQ measures the multidimensional impact of neck pain.
It may provide insight into:
pain intensity
activity limitation
social limitation
emotional impact
anxiety or concern
low mood
fear-avoidance beliefs
perceived control over pain
change over time
It does not directly measure:
cervical spine diagnosis
disc or joint pathology
nerve root involvement
imaging findings
tissue healing
muscle strength
range of motion
work capacity with certainty
sport readiness
treatment requirement
The NBQ may be useful for:
exercise professionals
rehabilitation practitioners
allied health support teams
movement assessment professionals
performance coaches
students learning outcome measures
professionals tracking neck pain-related function
It may be relevant for clients with:
non-specific neck pain
recurrent neck pain
persistent neck symptoms
neck pain affecting work or study
neck pain affecting training
neck pain with psychosocial impact
reduced confidence with neck movement
activity limitation related to neck symptoms
Use the NBQ when you want to understand how neck pain affects the client across physical, social and psychosocial domains.
It may be useful at:
initial assessment
onboarding
reassessment
progress review
neck pain monitoring
return-to-training planning
work or study participation monitoring
discharge or follow-up review
The NBQ is especially useful when pain intensity alone does not explain the client’s full experience.
Use caution when:
the client has red flags or serious pathology concerns
neurological symptoms are severe or worsening
the client cannot complete the questionnaire independently
the wrong language version is used
many items are missing
the client’s main limitation is not neck-related
the score is being used as a diagnosis
the result is interpreted without physical assessment context
The NBQ should not be used to:
diagnose a neck condition
confirm disc, joint or nerve involvement
determine tissue healing
explain symptoms on its own
clear someone for sport
clear someone for work
replace physical assessment
replace professional judgement
You need:
Neck Bournemouth Questionnaire
scoring instructions
baseline and retest dates
client-reported symptom notes
Optional related measures may include:
neck pain rating
neck range of motion
neurological screen where relevant
headache notes
work or study tolerance notes
training exposure notes
activity confidence rating
Explain the purpose of the questionnaire before the client completes it.
Example wording:
“This questionnaire helps us understand how your neck pain is affecting pain, activity, social participation, mood, work-related confidence and control. It does not diagnose the cause of pain, but it helps us monitor change over time.”
The NBQ can be completed:
on paper
digitally
independently
verbally if assistance is required
before a session
during reassessment
as part of a progress review
Ask the client to:
answer based on their neck symptoms
choose the response that best matches their experience
answer every item where possible
avoid overthinking each question
ask for clarification if they do not understand the wording
complete the same version at each retest
Record whether the NBQ was completed:
independently
digitally
on paper
verbally
with assistance
This helps with repeatability and interpretation.
If assistance is needed:
explain instructions without leading the answer
avoid telling the client which response to choose
record that assistance was provided
use the same assistance approach at retest where possible
Do not guess missing responses.
Use the scoring guidance for the version being used. If items are missing, record the result as incomplete unless the scoring method for that version allows valid calculation.
Each of the 7 items is scored from 0 to 10.
Total score range:
0–70
Higher scores indicate greater neck pain-related impact.
Lower scores indicate less neck pain-related impact.
Retest at meaningful time points, such as:
baseline
after a training or rehabilitation block
after a symptom flare-up
after changes in work or study load
progress review
discharge or follow-up
For consistency, record:
date
current symptoms
recent flare-ups
work, study or training exposure
changes in medication or management context where relevant
major changes in life load or stress
The NBQ is a self-report questionnaire, so it does not create physical testing risk.
However, worsening scores or new neurological symptoms may support further assessment.
The NBQ is scored from 0 to 70.
Higher scores indicate greater neck pain-related impact.
Lower scores indicate less neck pain-related impact.
A higher NBQ score may suggest:
greater pain intensity
more activity limitation
more social limitation
greater emotional impact
more anxiety or low mood related to symptoms
more fear or concern about work activity
lower perceived control
A high score does not identify the exact cause of neck pain.
A lower NBQ score may suggest:
less pain-related impact
fewer functional limitations
less social limitation
lower psychosocial impact
greater perceived control
A low score does not exclude important symptoms, especially if symptoms are intermittent or activity-specific.
An NBQ score does not prove:
the diagnosis
disc, joint or nerve involvement
imaging findings
tissue healing
work capacity
sport readiness
treatment requirement
whether one intervention caused the change
Example wording:
“Your NBQ score gives us a structured view of how neck pain is affecting pain, activity, social participation, mood and confidence. We will compare it with your baseline and combine it with your symptoms, goals and physical assessment findings.”
For general fitness clients, the NBQ may help show how neck symptoms affect:
exercise participation
gym training
running or walking comfort
sleep and recovery
daily activity
confidence with movement
Recent workload, stress and training changes may influence responses.
For sport and performance clients, the NBQ may help monitor whether neck pain affects:
training availability
contact or non-contact sport participation
confidence with head and neck movement
concentration
recovery
competition preparation
It should not be used to clear someone for sport.
For older adults, interpretation should consider general health, balance, vision, neurological symptoms, coexisting pain and activity level.
New or changing symptoms should be approached cautiously.
For youth clients, consider reading level, comprehension and whether support was provided.
If assistance is provided, record it clearly.
For persistent neck symptoms, NBQ can help monitor broader impact over time.
Scores may be influenced by fear of aggravation, reduced confidence, work demands, sleep, stress, activity avoidance and symptom flare-ups.
For workplace populations, NBQ may help capture the effect of neck pain on work-related confidence and activity.
Interpretation should include actual work demands, posture variation, load exposure, breaks, task tolerance and psychosocial context.
Meaningful change helps determine whether a score change is likely to matter.
Key terms:
MCID / MIC: the smallest change that may be meaningful to clients or professionals, depending on method
MDC: the amount of change likely needed to exceed measurement error
SEM: the estimated measurement error around a score
Responsiveness: the ability of the measure to detect change over time
Common NBQ scoring guidance reports that a 34% improvement from baseline is estimated to be clinically significant for the neck version.
This percentage-based approach means that the number of points required for meaningful change depends on the client’s baseline score.
Meaningful change should be interpreted with:
baseline score
repeated testing
symptom change
activity change
client goals
work or training exposure
physical assessment findings
professional judgement
When no directly matching MCID, MDC or SEM value is available for the client’s population, avoid over-interpreting small score changes.
Broad normative values for the NBQ are not universally applicable across all neck pain populations.
Scores may vary depending on:
symptom duration
pain intensity
work demands
activity level
psychosocial context
age
health status
recent flare-ups
language version
cultural context
Practical comparison guidance:
compare the client with their own baseline
use the same version at retest
interpret score change alongside symptom behaviour
consider work, training and daily exposure
avoid using one score as a pass/fail threshold
use population-specific values only when they closely match the client
The NBQ was developed as a short-form comprehensive outcome measure for neck pain and has been studied for psychometric properties in neck pain populations.
Research supports its use as a multidimensional neck pain outcome measure, and it has been translated and validated in multiple languages.
Reliability and validity are strongest when:
the correct version is used
the same version is repeated
all items are completed
the client understands the questions
the score is interpreted in a neck-relevant population
the result is compared with related symptoms and physical findings
Interpret cautiously when:
many items are missing
symptoms involve multiple body regions
the client’s main limitation is not neck-related
activity or work exposure has changed greatly between tests
the score is used as a stand-alone decision
Common errors include:
treating NBQ as a diagnosis
using the score as sport or work clearance
ignoring psychosocial domains
over-interpreting small changes
not recording baseline score
comparing scores without considering work or training exposure
ignoring red flags or neurological symptoms
failing to use the same version at retest
not combining NBQ with physical assessment
Limitations include:
self-report can be influenced by recent symptoms, mood, stress and work exposure
it does not identify the cause of neck pain
it does not measure strength or range of motion directly
meaningful-change values may vary by population
it should not replace medical assessment where indicated
it should not be interpreted without assessment context
The NBQ may help professionals:
document baseline neck pain impact
monitor neck pain over time
capture physical and psychosocial domains
support client education
track response across a training or rehabilitation period
improve progress reporting
compare neck pain impact with physical assessment findings
For general fitness clients, it may help monitor how neck pain affects training, sleep, confidence and daily function.
For workplace clients, it may help capture work-related fear, participation and perceived control.
For persistent symptoms, it can show whether neck pain continues to affect mood, activity and confidence.
The NBQ measures the multidimensional impact of neck pain, including pain intensity, function, social activity, emotional factors, work-related fear and perceived control.
The NBQ has 7 items.
Each item is scored from 0 to 10, giving a total score from 0 to 70.
A higher score indicates greater neck pain-related impact.
No. The NBQ does not diagnose the cause of neck pain or confirm a specific condition.
Common scoring guidance estimates that a 34% improvement from baseline is clinically significant for the neck version.
No. It should be combined with symptoms, goals, physical assessment findings and professional judgement.
It can be repeated at baseline, reassessment, after a symptom flare-up, after a training block and at key progress reviews.
NBQ is a 7-item neck pain outcome measure.
It assesses physical, social and psychosocial impact.
Scores range from 0 to 70.
Higher scores indicate greater neck pain-related impact.
NBQ does not diagnose the cause of neck pain.
A 34% improvement from baseline is commonly used as an estimated clinically significant change.
Interpretation is strongest when combined with symptoms, goals, physical testing and activity context.
Bolton, J. E., & Humphreys, B. K. (2002). The Bournemouth Questionnaire: A short-form comprehensive outcome measure. II. Psychometric properties in neck pain patients. Journal of Manipulative and Physiological Therapeutics, 25(3), 141–148. https://doi.org/10.1067/mmt.2002.123333
Bolton, J. E. (2004). Sensitivity and specificity of outcome measures in patients with neck pain: Detecting clinically significant improvement. Spine, 29(21), 2410–2417. https://doi.org/10.1097/01.brs.0000143493.22092.18
Kamper, S. J., Maher, C. G., & Mackay, G. (2009). Global rating of change scales: A review of strengths and weaknesses and considerations for design. Journal of Manual & Manipulative Therapy, 17(3), 163–170. https://doi.org/10.1179/jmt.2009.17.3.163
Van der Velde, G., Beaton, D., Hogg-Johnson, S., Hurwitz, E., Tennant, A., & Nordin, M. (2009). Measuring pain and function in neck pain patients: The Neck Disability Index and the Neck Bournemouth Questionnaire. Spine, 34(4 Suppl), S79–S92.
