Shoulder Pain and Disability Index


International Knee Documentation Committee (IKDC)

SPADI | Shoulder Pain and Disability Index

The Shoulder Pain and Disability Index (SPADI) is a 13-item questionnaire divided into pain and activity limitation categories. It focuses on the degree of pain or disability caused by shoulder problems during the last week. The patient answers the questions themselves using a VAS or NRS scale. The higher a patient scores on the SPADI the greater the pain/restriction in activities.


Validity and Reliability

With an intraclass correlation value (ICC) of 0.66, the SPADI’s original description had a poor level of reproducibility. In various patient populations, a more recent systematic review discovered reliability coefficients of ICC 0.89 (Roy et al. 2009). Cronbach’s alpha often exceeds 0.90, indicating a high level of internal consistency (Roy et al. 2009, Hill et al. 2011). The SPADI exhibits strong construct validity and good agreement with other shoulder-specific questions (Paul et al. 2004, Bot et al. 2004, Roy et al. 2009). It has been demonstrated to be adaptable to change over time in a range of patient groups and to be able to distinguish patients with better and deteriorating diseases with sufficient accuracy (Beaton et al. 1996, Williams et al. 1995, Roy et al. 2009).

For the SPADI, no significant floor or ceiling impacts have been seen (Bot et al. 2004, Roy et al. 2009). The smallest observable change that is significant to the patient is 8 points, which has been regarded as the minimal clinically meaningful difference (Paul et al. 2004).

The minimal detectable change (MDC 95%) is 18 points when the SPADI is used more than once on the same subject, such as at the initial consultation and then at discharge (Angst et al. 2007, Schmitt et al. 2004). Therefore, using the instrument on the same patient more than once is discouraged. A change score below this one can be the result of a measurement error.


Scoring and Interpretation

Each subscale’s score is derived by adding up all of the subscale’s individual scores and dividing the result by the subscale’s maximum score. The normalized score is converted to a scale of 0 to 100, with 100 denoting no problems and 0 denoting severe problems.

The nearest box is picked if a mark is outside of a box. If two boxes are checked, the one that showed the most serious issues is chosen. Missing data are considered as such; The average value for that subscale is used to replace one or two missing data. A response is deemed invalid and no subscale score is generated if more than two items are left out.

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Breckenridge, J. D., & McAuley, J. H. (2011). Shoulder Pain and Disability Index (SPADI). Journal of physiotherapy, 57(3), 197.

Roy, J. S., MacDermid, J. C., & Woodhouse, L. J. (2009). Measuring shoulder function: a systematic review of four questionnaires. Arthritis and rheumatism, 61(5), 623–632. 

Hill, C.L., Lester, S., Taylor, A.W. et al. Factor structure and validity of the shoulder pain and disability index in a population-based study of people with shoulder symptoms. BMC Musculoskelet Disord 12, 8 (2011).

Paul, A., Lewis, M., Shadforth, M. F., Croft, P. R., Van Der Windt, D. A., & Hay, E. M. (2004). A comparison of four shoulder-specific questionnaires in primary care. Annals of the rheumatic diseases, 63(10), 1293–1299. 

Bot, S. D., Terwee, C. B., van der Windt, D. A., Bouter, L. M., Dekker, J., & de Vet, H. C. (2004). Clinimetric evaluation of shoulder disability questionnaires: a systematic review of the literature. Annals of the rheumatic diseases, 63(4), 335–341.

Beaton, D. E., & Richards, R. R. (1996). Measuring function of the shoulder. A cross-sectional comparison of five questionnaires. The Journal of bone and joint surgery. American volume, 78(6), 882–890. 

Williams, J. W., Jr, Holleman, D. R., Jr, & Simel, D. L. (1995). Measuring shoulder function with the Shoulder Pain and Disability Index. The Journal of rheumatology, 22(4), 727–732.

Schmitt, J. S., & Di Fabio, R. P. (2004). Reliable change and minimum important difference (MID) proportions facilitated group responsiveness comparisons using individual threshold criteria. Journal of clinical epidemiology, 57(10), 1008–1018.

Angst, F., Goldhahn, J., Pap, G., Mannion, A. F., Roach, K. E., Siebertz, D., Drerup, S., Schwyzer, H. K., & Simmen, B. R. (2007). Cross-cultural adaptation, reliability and validity of the German Shoulder Pain and Disability Index (SPADI). Rheumatology (Oxford, England), 46(1), 87–92. 


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