Occupational Medicine 2007;57:300301

doi:10.1093/occmed/kqm036

The Nordic Musculoskeletal Questionnaire

A brief history
The Nordic Musculoskeletal Questionnaire (NMQ) was
developed from a project funded by the Nordic Council
of Ministers [1]. The aim was to develop and test a standardized questionnaire methodology allowing comparison of low back, neck, shoulder and general complaints
for use in epidemiological studies. The tool was not
developed for clinical diagnosis.

The NMQ can be used as a questionnaire or as a structured interview. However, significantly higher frequencies of musculoskeletal problems were reported when
the questionnaire was administered as part of a focused
study on musculoskeletal issues and work factors than
when administered as part of a periodic general health
examination [2].

Key research
Items
Section 1: a general questionnaire of 40 forced-choice
items identifying areas of the body causing musculoskeletal problems. Completion is aided by a body map to
indicate nine symptom sites being neck, shoulders, upper
back, elbows, low back, wrist/hands, hips/thighs, knees
and ankles/feet. Respondents are asked if they have had
any musculoskeletal trouble in the last 12 months and last
7 days which has prevented normal activity.
Section 2: additional questions relating to the neck,
the shoulders and the lower back further detail relevant
issues. Twenty-five forced-choice questions elicit any
accidents affecting each area, functional impact at home
and work (change of job or duties), duration of the problem, assessment by a health professional and musculoskeletal problems in the last 7 days.

Validity
The reliability of the NMQ, using a testretest methodology, found the number of different answers ranged from
0 to 23%. Validity tested against clinical history and the
NMQ found a range of 0 to 20% disagreement. The
authors concluded this was acceptable in a screening tool
[1]. Further trials identified that the number of different
answers between questionnaires ranged from 7 to 26%

The NMQ has been applied to a wide range of occupational groups to evaluate musculoskeletal problems, including computer and call centre workers [6,7], car
drivers [8], coopers in the whisky industry [9], nursing
[10] and forestry workers [11].
The questionnaire is available from the original paper
by Kuorinka et al. [1] and from Evaluation of Human
Work, a Practical Ergonomics Methodology [12].

Joanne O. Crawford

References
1. Kuorinka I, Jonsson B, Kilbom A et al. Standardized Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon 1987;18:233237.
2. Andersson K, Karlehagen S, Jonsson B. The importance of
variations in questionnaire administration. Appl Ergon 1987;
18:229232.
3. Dickinson CE, Campion K, Foster AF et al. Questionnaire
developmentan examination of the Nordic Musculoskeletal Questionnaire. Appl Ergon 1992;23:197201.
4. Ohlsson K, Attewell RG, Johnsson B et al. An assessment
of neck and upper extremity disorders by questionnaire and
clinical examination. Ergonomics 1994;37:891897.

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Description

for annual prevalence and 6 to 19% for weekly prevalence

[3]. This research also led to a number of improvements
within the questionnaire including changing wording,
layout and administration for use in the UK.
Comparing pain in the last 7 days and clinical examination found sensitivity ranged between 66 and 92% and
specificity between 71 and 88% [4]. In a further study of
outpatients with a range of upper limb disorders, participants completed a Nordic style questionnaire on two
occasions 1 week apart. The study identified that symptoms reporting for pain were highly repeatable and in
terms of sensitivity, 0.90 for cervical spondylosis, 1.00
for shoulder capsulitis, 0.90 for lateral epicondylitis,
1.00 for carpal tunnel syndrome and 0.78 for Raynauds
phenomenon [5]. Both papers conclude that the NMQ is
repeatable, sensitive and useful as a screening and surveillance tool. However, medical examination is essential
to establish a clinical diagnosis.

THE NORDIC MUSCULOSKELETAL QUESTIONNAIRE 301

5. Palmer K, Smith G, Kellingray S et al. Repeatability and

validity of an upper limb and neck discomfort questionnaire: the utility of the standardized Nordic questionnaire.
Occup Med (Lond) 1999;49:171175.
6. Bergqvist U, Wolgast E, Nilsson B et al. The influence of
VDT work on musculoskeletal disorders. Ergonomics 1995;
38:754762.
7. Cook C, Burgess-Limerick R, Chang SW. The prevalence
of neck and upper extremity musculoskeletal symptoms in
computer mouse users. Int J Ind Ergon 2000;26:347356.
8. Porter JM, Gyi DE. The prevalence of musculoskeletal
troubles among car drivers. Occup Med (Lond) 2002;52:
412.

9. Macdonald F, Waclawski E. Upper limb disorders among

coopers in the Scotch whisky industry. Occup Med (Lond)
2006;56:232236.
10. Smith DR, Wei N, Zhao L et al. Musculoskeletal complaints and psychosocial risk factors among Chinese hospital nurses. Occup Med (Lond) 2004;54:579582.
11. Hagen KB, Magnus P, Vetlesen K. Neck/shoulder and lowback disorders in the forestry industry: relationship to work
tasks and perceived psychosocial job stress. Ergonomics
1998;41:15101518.
12. Wilson JR, Corlett EN. Evaluation of Human Work: A Practical Ergonomics Methodology, 1st edn. London: Taylor and
Francis, 1992; 563568.

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