The Shoulder Pain and Disability Index (SPADI) is a patient-reported outcome (PRO) tool developed in 1991 by Roach et al. to “provide a self-administered instrument that would reflect the disability and pain associated with the clinical syndrome of painful shoulder.” [1]

Its original developers essentially wanted to design a joint-specific instrument that would do a better job than current global health assessment measures of measuring the impact of joint-specific problems [3].

The SPADI questionnaire covers pain and functional activities. The pain dimension subscale asks five different questions regarding the severity of pain. Meanwhile, the functional activities subscale ask eight questions designed to measure the degree of difficulty a patient has while carrying out the activities such as putting on clothing, carrying heavy objects and specific arm movements like washing hair or removing an item from their back pocket [4].

All question items in the survey are presented on a 10cm visual analog scale (VAS). The verbal anchors for the pain dimension are ‘no pain at all’ and “worst pain imaginable.” As for the functional activities, it’s “no difficulty” and “so difficult it requires help” [4]. The scores from both dimensions are averaged to derive a total score with 0 being the best outcome (less disability) and 100 the worst (greater disability).

The SPADI Shoulder Score is a reliable and valid tool and compares well with the Disabilities of the Arm, Shoulder and Hand (DASH) across various shoulder conditions [2].

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Strengths

Evidence supports the use of the SPADI following shoulder arthroplasty and in adhesive capsulitis [2]. It takes about 2-3 minutes to complete and correlates well with other region-specific shoulder questionnaires [5]. Additionally, it’s also 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 [5].

 

Weaknesses

Although the time to complete the SPADI questionnaire is reasonable, the scoring can be time consuming.  Research suggests that SPADI does not appear to adequately distinguish between pain and dysfunction, thereby making it less comprehensive than other similar scales [6].

However, findings from systematic reviews generally show that the SPADI (along with the DASH and QuickDASH), is one of the most recommended functional assessment tools, with strong psychometric properties, making it a good outcome tool for consideration of use in a variety of shoulder disorders [2].

 

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References

  1. Kirkley, A., Griffin, S., & Dainty, K. (2003). Scoring systems for the functional assessment of the shoulder. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 19(10), 1109-1120.
    https://www.researchgate.net/publication/5656975_Scoring_Systems_for_the_Functional_Assessment_of_the_Shoulder
  2. MEASURING SHOULDER FUNCTION – WHICH INDICES TO USE? Shoulder community of practice http://www.shouldercommunity.com/uncategorized/measuring-shoulder-function-which-indices-to-use/
  3. Tveitå, E., Ekeberg, O., Juel, N., & Bautz-Holter, E. (2008). Responsiveness of the shoulder pain and disability index in patients with adhesive capsulitis. BMC musculoskeletal disorders, 9(1), 1. http://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-9-161
  4. https://www.worksafe.qld.gov.au/__data/assets/pdf_file/0008/77084/shoulder-pain-and-disability-index-spadi1.pdf
  5. Breckenridge, J. D., & McAuley, J. H. (2011). Shoulder pain and disability index (SPADI). Journal of physiotherapy, 57(3), 197. http://www.ncbi.nlm.nih.gov/pubmed/21843839