Shoulder Pain and Disability Index (SPADI)
The Shoulder Pain and Disability Index (SPADI) is a patient-reported outcome measure 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.” The developers of the SPADI wanted to design a joint-specific instrument that would do a better job of measuring the impact of joint-specific problems than current global health assessment measures.
The SPADI questionnaire consists of two dimensions: pain and functional activities. The pain dimension has five questions regarding the severity of an individual’s pain, and the functional activities dimension has eight questions. The functional activities items are 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.
There are two versions of the SPADI that exist, one that includes a Visual Analogue Scale (VAS) and one that includes a Numeric Rating Scale (NRS). The VAS version is not commonly used – however in this version the verbal anchors for the pain dimension are “no pain at all” and “worst pain imaginable”, while the verbal anchors for the functional activities are “no difficulty’ and “so difficult it requires help”. In the more commonly used NRS version of the SPADI, patients are asked to circle the number that best describes their pain on a scale from 0-10.
To score either version of the SPADI, the total score is calculated by averaging the pain and disability subscale scores to find a score out of 100. On this scale, 0 represents less disability while 100 represents greatest disability.
The SPADI Shoulder Score is a reliable and valid measure and compares well with the Disabilities of the Arm, Shoulder and Hand (DASH) across various shoulder conditions.
Strengths
Evidence supports the use of SPADI following shoulder arthroplasty and in adhesive capsulitis. The tool takes about 5-10 minutes to complete and correlates well with other region-specific shoulder questionnaires. Additionally, it has also 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.
Considerations
Although the time to complete the SPADI questionnaire is reasonable, the scoring can be time-consuming. Research suggests that the SPADI does not appear to adequately distinguish between pain and dysfunction, thereby making it less comprehensive than other similar scales.
However, findings from systematic reviews generally show that the SPADI (along with the DASH and Quick DASH), is one of the most recommended functional assessment measures, with strong psychometric properties, making it a good outcome measure for consideration of use in a variety of shoulder disorders.
Licensing and Cost
The SPADI Shoulder Score does not require a license. You can learn more about the development of the SPADI here: https://pubmed.ncbi.nlm.nih.gov/11188601/.
