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COMI-neck

EUROSPINE's measure of choice for neck pain and function evaluation

The Core Outcome Measures Index – neck (COMI-neck) is a validated 6-item tool for neck pain evaluation and surveillance of cervical spine injury. It is part of EUROSPINE’s spine tango, an international registry for patient-reported outcome data collection. The items cover several dimensions: pain intensity, neck-related function, symptom-specific well-being, general quality of life, and social and work disability.

As a neck-specific instrument, the COMI-neck has been used in patients with cervical brachialgia and discogenic neck or shoulder pain due to degenerative disc disease. Moreover, surgical treatments such as cervical total disc replacements can be evaluated using the COMI-neck.

Indication

The COMI-neck has been developed for neck pain evaluation and for use as an outcome tool after cervical spine surgery. In recent publications, the questionnaire has been administered to patients with cervical brachialgia, discogenic neck or shoulder pain, and early-stage cervical myelopathy due to degenerative disc disease and to patients undergoing cervical total disc replacement. 1 2

Items - Dimensions - Completion time

In the core COMI-neck, 1 question consists of 2 numerical rating scales to be answered from 0 to 10 and 5 questions to be answered by selecting 1 of 5 response options.

The EUROSPINE version has 5 additional questions on pain quality and patient satisfaction with the treatment and outcome. The additional questions do not influence the COMI-neck score. 3

The 6 items cover 5 dimensions: pain intensity (neck and arm/shoulder pain), neck-related function, symptom-specific well-being, general quality of life and disability (social and work). The patient is asked to answer based on how he or she has felt for the last week , except for the disability dimensions, for which the patient is asked to answer based on how he or she has felt for the last 4 weeks.

There is no information in the literature on completion time. We estimate a time of approximately 5 minutes.

Scoring method

Each dimension receives a subscore. The higher of the 2 pain intensity scores forms the pain intensity dimension subscore. Each response for each of the other 5 questions is scored from 0 to 10:

response 1 (associated with the best possible health status): 0 points

response 2: 2.5 points

response 3: 5 points

response 4: 7.5 points

response 5 (associated with the most health limitations): 10 points

The average of the 2 disability scores forms the disability dimension subscore.
A total COMI score is determined by averaging the 5 dimension scores. There is no information about how to deal with missing data or skipped questions. 1

Scoring example:

Question 1: 5 and 4 points respectively (the higher value of 5 is used for scoring)

Question 2: response 4 (7.5 points)

Question 3: response 2 (2.5 points)

Question 4: response 2 (2.5 points)

Question 5: response 1 (0 points)

Question 6: response 4 (7.5 points)

COMI score: (5+7.5+2.5+2.5+((0+7.5)/2))/5 = 4.25

Score interpretation

The lower the score, the better the patient’s health.

The lowest possible score of 0 points is associated with no loss of health or function and no pain, whereas the maximum score of 10 points represents the most severe neck pain and loss of function.

The COMI-neck has been validated in several languages. 1 4 5 An English source document is available on EUROSPINE’s website.
The questionnaire is available in several publications that have developed or validated the COMI-neck. 6 Versions with additional questions can be obtained on EUROSPINE’s website. 7
The EUROSPINE version is accessible for everyone via the spine tango program. For usage, the user has to be a registered EUROSPINE member, but this is not linked to any registration costs or license fees. 7
The intention of the COMI-neck was to create a standardized outcome measure that could improve the comparability of studies. 3 Therefore, the items were scientifically chosen based on meta-analysis of neck pain questionnaires and different generic instruments. The administration and completion of the tool are easy and time-saving, allowing easy implementation in the clinical routine.
International publications using the COMI-neck are rare. Ceiling and floor effects have been observed. 1 Because of the small number of questions, it has to be assumed that the measure offers a superficial but not a detailed health evaluation.

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References

  1. Fankhauser, Christian Daniel, et al. “Validity and responsiveness of the Core Outcome Measures Index (COMI) for the neck.” European spine journal 21.1 (2012): 101-114.
  2. Finkenstaedt, S., et al. “Does neck pain as chief complaint influence the outcome of cervical total disc replacement?.” European Spine Journal (2019): 1-8.
  3. Deyo, Richard A., et al. “Outcome measures for low back pain research: a proposal for standardized use.” Spine 23.18 (1998): 2003-2013.
  4. Monticone, Marco, et al. “Reliability, validity and responsiveness of the cross-culturally adapted Italian version of the core outcome measures index (COMI) for the neck.” European Spine Journal 23.4 (2014): 863-872.
  5. Damasceno, L. H. F., et al. “Cross-cultural adaptation and assessment of the reliability and validity of the Core Outcome Measures Index (COMI) for the Brazilian-Portuguese language.” European Spine Journal 21.7 (2012): 1273-1282.
  6. Mannion, Anne F., et al. “Could less be more when assessing patient-rated outcome in spinal stenosis?.” Spine 40.10 (2015): 710-718.
  7. https://www.eurospine.org/forms.htm
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