Shoulder Pain and Disability Index (SPADI)

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Objective

The Shoulder Pain and Disability Index (SPADI) is a patient completed questionnaire with 13 items assessing pain level and extent of difficulty with ADLs requiring the use of the upper extremities. The pain subscale has 5-items and the Disability subscale has 8-items.

The original version was published in 1991 and has its items scored on the Visual analogue scale while the second version scores its items on the Numerical rating scale(NRS)

SPADI has been translated in many languages including Spanish, Greek, Dutch, Hindi, Thai and Italian each with its own validity and reliability.

Intended Population

SPADI can be used in the following patient population:

• Shoulder pain
• Rotator cuff disease
• Osteoarthritis
• Rheumatoid arthritis
• Adhesive Capsulitis
• Shoulder arthroplasty

Method of Use

The patient is instructed to choose the number that best describes their level of pain and extent of difficulty using the involved shoulder. Each subscale is summed up and a total SPADI score is expressed as a percentage.

Total pain score : --/50 ×100 = %

Total disability score: --/80 × 100 = %

Total SPADI score: --/130 × 100 = %

A score of 0 indicates best 100 indicates worst. A higher score shows more disability.

In scoring SPADI, any question missed should be taken out of the total score of each subscale. i.e if 1 question is omitted in the pain section, the total score is divided by 40.

Evidence

Reliability

SPADI was found to have reliability coefficients of ICC ≥ 0.89 in a variety of patient populations (Roy et al 2009). Internal consistency is high with Cronbach α typically exceeding 0.90 (Roy et al 2009, Hill et al 2011). 

Validity

The SPADI demonstrates good construct validity, correlating well with other region-specific shoulder questionnaires (Paul et al 2004, Bot et al 2004, Roy et al 2009). It has been shown to be responsive to change over time, in a variety of patient populations and is able to discriminate adequately between patients with improving and deteriorating conditions (Beaton et al 1996, Williams et al 1995, Roy et al 2009).

Responsiveness

The minimal clinically important difference has been reported to be 8 points; this represents the smallest detectable change that is important to the patient (Paul et al 2004). However, when SPADI is used repeatedly on the same subject the minimal detectable change is 18 points (Angst et al 2008, Schmitt et al 2004).