Shoulder Pain And Disability Index (SPADI)

The index explained

This is a self-assessment questionnaire addressed to patients suffering from shoulder conditions, which evaluates both the pain and the disability component.

Each of the 13 items is to be rated with a number from 0 to 10:

■ For the pain score (first 5 items): 0 means no pain and 10 means worst pain imaginable;

■ For the disability score (last 8 items): 0 means no impairment and 10 means the patient requires help to perform that action.

The following table introduces the items in both components of the SPADI:

The SPADI evaluates severity of pain and the lack of functional skills in the outpatient setting for a variety of conditions (each summarized below with their validation study):

■ Joint replacement surgery (Angst et al 2007);

■ Adhesive capsulitis (Staples et al 2010, Tveita et al 2008);

■ Rotator cuff disease (Ekeberg et al 2008);

■ Rheumatoid arthritis (Christie et al 2010);

■ Study of shoulder symptoms (Hill et al 2011).

This shoulder pain model has been praised for its administration rapidity and the fact that it correlates well with other region-specific shoulder questionnaires.

The model has shown responsivity to changes in time and has enough discriminatory capacity to differentiate between patients with improving and deteriorating conditions.

On the other hand, the SPADI has been deemed less comprehensive than other similar scales for the fact that it does not appear to adequately distinguish between pain and dysfunction.

Compared to the other tools available for shoulder disability, the SPADI remains the most recommended because of its strong psychometric properties.

Score interpretation

There are three numeric results provided by the above tool:

■ A pain scale calculated as sum of points from the 5 pain items, divided by 50 and multiplied by 100;

■ A disability scale computed as sum of points from the 8 disability items, divided by 80 and multiplied by 100;

■ A total SPADI score calculated as sum of points from all items, divided by 130 and multiplied by 100.

Neither the original SPADI study, nor the subsequent validations provide specific cut off points that could potentially classify patients in disability degrees (for example: limited, medium, high or extreme disability).

The Minimal Detectable Changes at 90% confidence are:

■ 18% for the pain scale;

■ 13% for the disability scale;

■ 11% for the total score.

It is important that the patient answer at least 12 of the 13 items. In case the patient skips more than 1 question, the score cannot be calculated accurately.

About the study

The shoulder pain and disability index was created by Roach et al. in 1991, to be used in patients with shoulder pathology.

The study cohort consisted in thirty-seven male patients with shoulder pain. This version of the SPADI uses a visual analogue scale (VAS) to evaluate the patient answers, similar to that used by the BASFI score (Bath Ankylosing Spondylitis Functional Index).

Test-retest reliability of the SPADI total and subscale scores ranged from 0.6377 to 0.6552.

Internal consistency ranged from 0.8604 to 0.9507.

High negative correlations between changes in SPADI scores and changes in shoulder range of motion (ROM) indicated that the model can detect changes in clinical status over short time intervals.

In 1995, Williams et al. modified the SPADI and validated a new version (same items but a numerical rating scale NRS) as to accommodate administration of the questionnaire over the telephone and to allow it to be compared (convergent validity) with other health status measures. The NRS version is also set to be more responsive to clinical change.

The study consisted in 102 male patients, 96 of which completed at least one follow-up assessment whilst at last 75 completed all follow-up assessments, during the three months of the follow-up period.

At baseline the visual analog (VAS) and numeric scaled SPADI were highly concordant (intraclass correlation coefficient = 0.86). The SPADI delta (baseline-followup) discriminated accurately between subjects that improved and those who remained the same or worsened.

Both versions of the SPADI, the VAS and NRS, are highly correlated, both for the evaluation of patient pain and disability and in terms of responsiveness to status changes.

Original source

Roach KE, Budiman-Mak E, Songsiridej N, Lertratanakul Y. Development of a shoulder pain and disability index. Arthritis Care Res. 1991; 4(4):143-9.

Other references

1. Williams JW Jr, Holleman DR Jr, Simel DL. Measuring shoulder function with the Shoulder Pain and Disability Index. J Rheumatol. 1995;22(4):727-32.

2. Breckenridge JD, McAuley JH. Shoulder Pain and Disability Index (SPADI). J Physiother. 2011; 57(3):197.

3. MacDermid JC, Solomon P, Prkachin K. The Shoulder Pain and Disability Index demonstrates factor, construct and longitudinal validity. BMC Musculoskelet Disord. 2006; 7:12.