|
| Questionnaire section | Question per section | Choices |
|
| Demographic data | Gender | Male |
| Female |
| Age | 25–35 years |
| 36–45 years |
| 46–56 years |
| >56 years |
| Type of practice | Governmental |
| Private |
| Both |
| Specialty | General dentist |
| Periodontist endodontist |
| Prosthodontist |
| Pedodontist |
| Maxillofacial surgeon |
| Orthodontist |
| Hours of work per week | 15–30 |
| 31–40 |
| 41–50 |
| Regular exercise | Yes |
| No |
| Experiencing pain using vibrating instruments | Yes |
| No |
| Cervical flexion for better vision while working | Yes |
| No |
| Do you have any history of those mentioned below? If yes, please select which one (s) | Congenital spinal disease |
| Spine trauma |
| Spine surgery |
| None |
|
| Ergonomics | Do you have muscular pain due to dental practice? | Yes |
| No |
| Are you familiar with the ergonomic posture to perform clinical procedures in your dental practice? | Yes |
| No |
| Which activities of your clinical practice produce muscular pain? Mark the main activities | Surgery |
| Endodontics periodontics |
| Restorative |
| Reference the previous question: mark in which zone you feel the pain | Lumbar zone (lower back) |
| Dorsal zone (mid-back) |
| Cervical zone (upper back) |
| Neck |
| Shoulders |
| Forearm |
| Arm |
| Wrist |
| Hand |
| Other: |
| Are you able to change your work posture, seating or standing, during your practice? | Yes |
| No |
| Do you frequently change positions during your clinical practice? | Yes |
| No |
| After finishing clinical practice, do you perform stretching exercises? | Yes |
| No |
| Are the instruments within hand reach without making strenuous movements? | Yes |
| No |
| Do you perform torsions or cervical flexions to improve vision when working in the oral cavity? | Yes |
| No |
| Do you cross your legs while working? | Yes |
| No |
| On a scale of 0 to 10, what is the intensity of the neck pain? | No pain |
| 0 |
| 1 |
| 2 |
| 3 |
| 4 |
| 5 |
| 6 |
| 7 |
| 8 |
| 9 |
| 10 |
| Worst pain possible |
|
| Neck Disability Index (NDI) | NDI subsection | Response | Score |
| NDI 1: pain intensity | I have no neck pain now | 0 |
| The pain is very mild now | 1 |
| The pain is moderate now | 2 |
| The pain is severe now | 3 |
| The pain is very severe now | 4 |
| The pain is the worst imaginable now | 5 |
| NDI 2: personal care | I can look after myself normally without causing extra neck pain | 0 |
| I can look after myself normally, but it causes extra neck pain | 1 |
| It is painful to look after myself, and I am slow and careful | 2 |
| I need some help but manage most of my personal care | 3 |
| I need help every day in most aspects of self-care | 4 |
| I do not get dressed, I wash with difficulty, and stay in bed | 5 |
| NDI 3: lifting | I can lift heavy weights without causing extra neck pain | 0 |
| I can lift heavy weights, but it gives me extra neck pain | 1 |
| Neck pain prevents me from lifting heavy weights off the floor but I can manage if items are conveniently positioned, i.e., on a table | 2 |
| Neck pain prevents me from lifting heavy weights, but I can manage light weights if they are conveniently positioned | 3 |
| I can lift only very light weights | 4 |
| I cannot lift or carry anything at all | 5 |
| NDI 4: reading | I can read as much as I want with no neck pain | 0 |
| I can read as much as I want with slight neck pain | 1 |
| I can read as much as I want with moderate neck pain | 2 |
| I cannot read as much as I want because of moderate neck pain | 3 |
| I cannot read as much as I want because of severe neck pain | 4 |
| I cannot read at all | 5 |
| NDI 5: headaches | I have no headaches at all | 0 |
| I have slight headaches that come infrequently | 1 |
| I have moderate headaches that come infrequently | 2 |
| I have moderate headaches that come frequently | 3 |
| I have severe headaches that come frequently | 4 |
| I have headaches almost all the time | 5 |
| NDI 6: concentration | I can concentrate fully without difficulty | 0 |
| I can concentrate fully with sight difficulty | 1 |
| I have a fair degree of difficulty concentrating | 2 |
| I have a lot of difficulty concentrating | 3 |
| I have a great deal of difficulty concentrating | 4 |
| I cannot concentrate at all | 5 |
| NDI 7: work | I can do as much work as I want | 0 |
| I can only do my usual work, but no more | 1 |
| I can do most of my usual work, but no more | 2 |
| I cannot do my usual work | 3 |
| I can hardly do any work at all | 4 |
| I cannot do any work at all | 5 |
| NDI 8: driving | I can drive as long as I want without neck pain | 0 |
| I can drive as long as I want with only slight neck pain | 1 |
| I can drive as long as I want with moderate neck pain | 2 |
| I cannot drive as long as I want because of moderate neck pain | 3 |
| I can hardly drive at all because of severe neck pain | 4 |
| I cannot drive my car at all because of neck pain | 5 |
| NDI 9: sleeping | I have no trouble sleeping | 0 |
| My sleep is slightly disturbed for less than 1 hour | 1 |
| My sleep is mildly disturbed for up to 1-2 hours | 2 |
| My sleep is moderately disturbed for up to 2-3 hours | 3 |
| My sleep is greatly disturbed for up to 3–5 hours | 4 |
| My sleep is completely disturbed for up to 5–7 hours | 5 |
| NDI 10: recreation | I am able to engage in all my recreational activities with no neck pain at all | 0 |
| I am able to engage in all my recreational activities with some neck pain | 1 |
| I am able to engage in most, but not all of my recreational activities because of the pain in my neck | 2 |
| I am able to engage in a few of my recreational activities because of the pain in my neck | 3 |
| I can hardly do recreational activities due to neck pain | 4 |
| I cannot do any recreational activities due to neck pain | 5 |
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