OBJECTIVES:: To develop and evaluate a new measure of neck disability. METHODS:: WE conducted developmental work evaluating current measures including a systematic review and cognitive interviews. The following revealed problems occured with respect to the most comonly used measure: lack of unidimensionality (focus on function), challenges in readability, lack of clarity/relevance of some items. We generated items through this literature review and patient interviews, while retaining some legacy concepts. A simple, consistent 0-10 response and low burden item reponses was devised for the new Neck Difficulty outcome measure, with 10-items . Reliability was assessed on 40 patients who completed ND10 twice within one week; tested by intraclass correlation coefficients (ICC 2,1). Construct validity was assessed by comapring the ND10 and NDI and DASH in 55 English-speaking patients and 40 Hindi-speaking patients (cross-cultural translation). Responsiveness was determined by administering the ND10 at a baseline physical therapy visit and at 6-weeks or a preceding discharge visit. SRM and ES were calculated for responders RESULTS::  Patients found the items of ND10 easy to understand. Construct validity indicated high correlation between the ND10 and the NDI >0.72 and the DASH >0.81 in both English and Hindi versions. The ND10-H displayed very high internal consistency (alpha = 0.96) and test-retest reliability (ICC = 0.93; 95% CI: 0.90-0.95). The ND10-H was strongly correlated with the NDI (r = 0.78; 95% CI: 0.68-0.85) and the DASH (r = 0.86; 95% CI: 0.74-0.92), and was weakly correlated with the Single Assessment Numeric Evaluation (r = -0.23; 95% CI: 0.01-0.42). The responsive indices indicate high responsiveness. CONCLUSIONS:: The ND10 performed as well or better than the DASH or NDI. ND10 advantages were simplicity and focus on function, wheras the other options include both symptoms and function in one index.