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RehabMeasures Instrument

Shoulder Pain And Disability Index

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Purpose

The SPADI was developed to assess pain and disability related to shoulder problems. It was designed to measure the impact of shoulder pathology on pain and disability in an outpatient setting.

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Instrument Details

Acronym SPADI

Area of Assessment

Activities of Daily Living
Functional Mobility
Life Participation
Pain
Range of Motion
Strength
Upper Extremity Function

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Cost Description

Potential cost of postage if mailed to patient at home and cost of printed form.

Diagnosis/Conditions

  • Arthritis + Joint Conditions
  • Pain Management

Key Descriptions

  • The SPADI is a 13-item self-report questionnaire.
  • It is divided into 2 subscales:
    1) Pain - 5 items
    2) Disability - 8 items
  • 2 versions of scoring the SPADI exist:
    1) Visual analogue scale
    2) Numeric rating scale
  • The visual analogue scale is not commonly used.
  • A minimum of 2/3 of items in each subscale must be answered in order to compute a subscale score.
  • Total score is calculated by averaging the pain and disability subscale scores.

Number of Items

13

Equipment Required

  • Printed form
  • Writing utensil

Time to Administer

5-10 minutes

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by Stephen Kareha, PT, DPT, OCS, ATC, CMP, CSCS in March 2014 and Maggie Holland, Melana Tysowsky, Rebecka Shafer, Lauren Alexander, Caleb Bromley, Emily Smoak, Hannah Zhang, Chelsea Myers, Matthew O’Connell, Jacqueline McNeill, Norah Cetin, and Sarabeth Fordin 7/2014.

Body Part

Upper Extremity

ICF Domain

Body Function
Activity

Measurement Domain

Activities of Daily Living
Motor

Considerations

Cognition of patient, possible systematic bias given the subjective nature of the instrument, language, For use in outpatient settings – clinical practice and research (Roach et al.,1991)

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Joint Pain and Fractures

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Minimal Detectable Change (MDC)

Shoulder Arthroplasty:

(Angst F, Goldhahn J, Pap G, et al., n = 118)

  • MDC = 18

 

Adhesive Capsulitis:

(Tveita E.K., Ekeberg O.M., Juel N.G., Bautz-Holter E., n = 76)

  • MDC = 17.0

 

Shoulder Disorders:

(Roddey T.S., Olson S.L., Cook K.F., Gartsman G.M., Hanten W., n = 192)

  • MDC = 21.5

Minimally Clinically Important Difference (MCID)

Rotator Cuff Disease:

(Ekeberg O.M., Bautz-Holter E., Keller A., Tveita E.K., Juel N.G., Brox J.I., n = 121) 

  • MCID = 15.4

Normative Data

Total SPADI Scores at Baseline: 

Neurogenic/MSK origin: 

  • 42.82 (21.80 ) (MacDermid et al, 2006 ) 
  • 40.1 (26.1) (Heald 1997 ) 

 

Shoulder Arthroplasty: 

  • Mean of 71 for SPADI in patients >1 year post hemi-arthroplasty (Angst, 2007) 

 

Adhesive Capsulitis: 

  • 61.3 (mean), 20 (SD) (Tveitå et al., 2008) 

 

RA: 

  • 50 (28) (Bruyn, 2010).

Internal Consistency

Shoulder Arthroplasty:

(Angst F., Goldhahn J., Pap G., et al.)

  • Cronbach's alpha = 0.95

 

Shoulder Disorders:

(Roddey T.S., Olson S.L., Cook K.F., Gartsman G.M., Hanten W.)

  • Cronbach's alpha = 0.96

Construct Validity

Adhesive Capsulitis:

(Staples M.P., Forbes A., Green S., Buchbinder R.)

  • Correlation with Disabilities of Arm Shoulder and Hand (DASH) = 0.55
  • Correlation with HAQ = 0.55

(Tveita E.K., Ekeberg O.M., Juel N.G., Bautz-Holter E.)

  • Correlation with Active ROM = -0.38

 

Shoulder Arthroplasty:

(Angst F., Goldhahn J., Pap G., et al.)

  • Correlation with DASH = 0.88
  • Correlation with ASES = 0.92

(Angst F., Pap G., Mannion A.F., et al.)

  • Correlation with DASH = 0.93
  • Correlation with ASES = 0.81
  • Correlation with SF-36 Physical Component Score (PCS) = 0.63
  • Correlation with SF-36 Mental Component Score (MCS) = 0.08
  • Correlation with Constant (Murley) Score = 0.82

 

Shoulder Disorders:

(Heald S.L., Riddle D.L., Lamb R.L.)

  • Correlation with Sickness Impact Profile = 0.57

(Roddey T.S., Olson S.L., Cook K.F., Gartsman G.M., Hanten W.)

  • Correlation of disability subscale with SST = -0.80

 

Rotator Cuff Disease:

(Ekeberg O.M., Bautz-Holter E., Tveita E.K., Keller A., Juel N.G., Brox J.I.)

  • Correlation with Oxford Shoulder Score (OSS) = 0.57

 

Subacromial Impingement:

(Cloke D.J., Lynn S.E., Watson H., Steen I.N., Purdy S., Williams J.R.)

  • Correlation with OSS = 0.85

Floor/Ceiling Effects

Shoulder Arthroplasty:

(Angst F., Goldhahn J., Pap G., et al.)

  • Very low floor effects
  • Low ceiling effects

(Angst F., Pap G., Mannion A.F., et al.)

  • No floor or ceiling effects

Responsiveness

Shoulder Arthroplasty:

(Angst F., Goldhahn J., Drerup S., Aeschlimann A., Schwyzer H.K., Simmen B.R.)

  • Effect Size = 2.10, large

 

Rotator Cuff Surgery or TSA:

(Beaton D., Richards R.R.)

  • SRM = 1.23, large

 

Adhesive Capsulitis:

(Staples M.P., Forbes A., Green S., Buchbinder R.) 

  • Effect Size = 1.20-1.64, large

Musculoskeletal Conditions

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Minimal Detectable Change (MDC)

Musculoskeletal Upper Extremity Problems:

(Schmitt J.S., Di Fabio R.P., n = 211, 50% male, mean age 47.5 (14))

  • MDC = 18.1

Minimally Clinically Important Difference (MCID)

Musculoskeletal Upper Extremity Problems:

(Schmitt J.S., Fabio R.P.)

  • MCID = 13.2

Internal Consistency

Musculoskeletal Conditions and Joint Pain:

(Hill C.L., Lester S., Taylor A.W., Shanahan M.E., Gill T.K.)

  • Cronbach's alpha = 0.92

Construct Validity

Musculoskeletal Upper Extremity Problems:

(Schmitt J.S., Di Fabio R.P.)

  • Correlation with Global Disability Rating = 0.64-0.69

 

Musculoskeletal Conditions and Joint Pain:

(Hill C.L., Lester S., Taylor A.W., Shanahan M.E., Gill T.K.)

  • Correlation with Active ROM = -0.32 to -0.52
  • Correlation with SF-36 PCS = -0.46
  • Correlation with SF-36 MCS = -0.24

Chronic Pain

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Minimally Clinically Important Difference (MCID)

New Shoulder Pain:

(Paul A., Lewis M., Shadforth M., Croft P., Van der Windt D., Hay E., n = 180)

  • MCID = 8

Internal Consistency

Shoulder Pain:

(MacDermid J.C., Solomon P., Prkachin K.)

  • Cronbach's alpha > 0.95

Construct Validity

New Shoulder Pain:

(Paul A., Lewis M., Shadforth M., Croft P., Van der Windt D., Hay E.)

  • Correlation with Active ROM = -0.090-0.251
  • Correlation with Dutch Shoulder Disability Questionnaire (SDQ-NL) = 0.330
  • Correlation with United Kingdom Shoulder Disability Questionnaire (SDQ-UK) = 0.573
  • Correlation with Shoulder Rating Questionnaire (SRQ) = 0.829

Responsiveness

New Shoulder Pain:

(Paul A., Lewis M., Shadforth M., Croft P., Van der Windt D., Hay E.)

  • Effect Size = 1.52, large
  • SRM = 1.17, large

Non-Specific Patient Population

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Standard Error of Measurement (SEM)

SEM is 8.9 for pain, 7.2 for function and 6.2 overall when comparing English to German versions of the SPADI (Angst, 2007) 

The SEM values for the multi-item scales ranged from 4.75 to 11.65 (Roddey et al., 2000)

Minimally Clinically Important Difference (MCID)

(McClure P., Michener L.)

  • MCID = 10

(Roy J.S., MacDermid J.C., Woodhouse L.J., analysis of 71 published primary studies)

  • MCID = 8-13

Test/Retest Reliability

  • Test-retest reliability of the SPADI total combined subscale scores ranged from 0.64 to 0.66 (Roach et al., 1991)
  • Approximately 95% of the pairs of observations did not differ by more than 17 points (Tveitå et al., 2008). 
  • ICC- 0.65 (MacDermid et al, 2006)
  • Pearson product-moment correlation coefficients (r) of 0.75 to 0.92 for the overall score (Heald et al., 1997) ]
  • ICC for the disability subscale ranged from 0.57 to 0.84. (BOT, 2004)

Criterion Validity (Predictive/Concurrent)

SPADI score (both subscales) and AROM show moderate to high correlation. Correlations ranged from -0.55 to -0.80 (Roach et al., 1991).

Construct Validity

(Roach K.E., Budiman-Mak E., Songsiridej N., Lertratanakul Y.)

  • Correlation with Active ROM = 0.54-0.80

(Williams Jr J.W., Holleman Jr D.R., Simel D.)

  • Correlation with Health Assessment Questionnaire (HAQ) = 0.61

 

Face Validity

  • Addressed by selecting items that the panel thought reflected pain and disability associated shoulder problems (Roach et al.,1991) 
  • When comparing the English to German versions, face validity was established for both using an expert committee for the translation (Angst, 2007)

Floor/Ceiling Effects

(Bot S., Terwee C., Van der Windt D., Bouter L., Dekker J., De Vet H.)

  • No floor or ceiling effects

(Roy J.S., MacDermid J.C., Woodhouse L.J.)

  • No floor or ceiling effects

Bibliography

Roach, K., Budiman-Mak, E., Songrsiridej, N., & Lertratanakul, Y. Development of a Shoulder Pain and Disability Index. Arthritis Health Profession Association, 4, 143-149. 1991

Bruyn, G.A.W., Pineda, C., Hernandez-Diaz, C., Ventura-Rios, I., Moya, C., Garrido, J., Groen, H., Pena, A., Espinosa, R., Moller, I., Filippucci, E., Iagnocco, A., Balint, P., Kane, D., D’Agostina, M., Angulo, M., Ponte, R., Fernandez-Gallardo, J.M. & Naredo, E. Validity of Ultrasonography and Measures of Adult Shoulder Function and Reliability of Ultrasonography in Detecting Shoulder Synovitis in Patients with Rheumatoid Arthritis Using Magnetic Resonance Imaging as a Gold Standard. Arthritis Care & Research, 62, 1079-1086.

Angst, F., Goldhahn, J., Pap, G., Mannion, A.F., Roach, K.F., Siebertz, D., Drerup, S., Schwyzer, H.K., Simmen, B.R.Cross-cultural Adaptation, Reliability and Validity of the Germany Shoulder Pain and Disability Index. Rheumatology, 46, 87-92.

Beaton, D., Bombardier, C., Fossel, A., Kurtz, J., Tarasuk, V., and Wright, J. Measuring the whole or the parts. 128-142. Year Published 2001

Bot, S., Terwee, C., Van Der Windt, D., Bouter, L., Dekker, J., and De Vet, H. Clinimetric evaluation of shoulder disability questionnaires. 335-341. Year Published 2004 Angst, F., Scwyzer, H., Aeschlimann, A., Simmen, B., & Goldhahn, J. Measures of Adult Shoulder Function. Arthritis Care and Research, 11, 174-188.

Tveitå, E. K., Ekeberg, O. M., Juel, N. G., & Bautz-Holter, E. (2008). Responsiveness of the Shoulder Pain and Disability Index in patients with adhesive capsulitis. BMC Musculoskeletal Disorders, 9(161). doi:10.1186/1471-2474-9-161

MacDermid, J. C., Solomon, P., and Prkachin, K. (2006). The Shoulder Pain and Disability Index demonstrates factor, construct and longitudinal validity. BMC Musculoskeletal Disorders, 7:12 doi:10.1186/1471-2474-7-12

Roddey, T., Olsen, S., Cook, K., Gartsman, G., & Hanten, W. Comparison of the University of California−Los Angeles Shoulder Scale and the Simple Shoulder Test With the Shoulder Pain and Disability Index: Single-Administration Reliability and Validity. Physical Therapy Journal of the American Physical Therapy Association, 80, 759-768. Retrieved July 8, 2014

Heald, Susan, Daniel Riddle, and Robert Lamb. "The Shoulder Pain and Disability Index: The Construct Validity and Responsiveness of a Region-Specific Disability Measure." Physical Therapy 77.10 (1997): 1079-1089.

Haldorsen, B., Svege, I., Roe, Y., & Bergland, A. (2014). Reliability and validity of the Norwegian version of the Disabilities of the Arm, Shoulder and Hand questionnaire in patients with shoulder impingement syndrome. BMC Musculoskeletal Disorders 15(78), 1-7.

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