Shoulder Pain And Disability Index (SPADI) Calculator

How does this Shoulder Pain And Disability Index (SPADI) calculator work?

This is a health tool that evaluates both the pain and disability components of shoulder conditions based on the SPADI model.

This can be used as a self assessment questionnaire and the main instruction is that the patient should assess different situation on a scale from 0 to 10, for the pain component 0 being no pain and 10 being worst pain imaginable while for the disability component, 0 means no impairment and 10 means that the actions is so difficult to perform that it requires help.

The two scales and their instruction are explained below:

A) Pain Scale

■ At its worst?

■ When lying on the involved side?

■ Reaching for something on a high shelf?

■ Touching the back of your neck?

■ Pushing with the involved arm?

B) Disability Scale

■ Washing your hair?

■ Washing your back?

■ Putting on an undershirt or a jumper?

■ Putting on a shirt that buttons down the front?

■ Putting on your pants?

■ Placing an object on a high shelf?

■ Carrying a heavy object of 10lbs/4.5kg?

■ Removing something from your back pocket?

Therefore the Shoulder Pain And Disability Index (SPADI) calculator assesses pain and lack of functional skills on the 0 to 10 scale in the outpatient setting.

The original version used to have a visual analogue scale (VAS) just like that in the BASFI score but the second version, the one based on a numerical rating scale (NRS) has settled better as it oversteps the clinician interpretation during scoring and therefore proves to be a lot faster and more straightforward.

The original study researched a male population in ambulatory care for shoulder pain. Subsequent validation studies have involved populations with a range of other conditions such as:

■ Joint replacement surgery (Angst et al 2007);

■ Rotator cuff disease(Ekeberg et al 2008);

■ Adhesive capsulitis (Staples et al 2010, Tveita et al 2008);

■ Rheumatoid arthritis (Christie et al 2010);

■ Study of shoulder symptoms (Hill et al 2011).

Alongside this shoulder disability scale there are 3 more commonly used models which all present satisfactory psychometric properties for large scale usage:

■ Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire;

■ American Shoulder and Elbow Surgeons (ASES) score;

■ Simple Shoulder Test (SST).

Score interpretation

Given that the two components have 5 and respectively 8 items, the preliminary results range between 0 to 50 and 0 to 80, the overall result ranging from 0 to 130. The SPADI score is often presented as a percentage thus the following calculations are performed.

■ Pain score in points / 50 x 100.

■ Disability score in points / 80 x 100.

■ Total SPADI score in points /130 x 100.

The original SPADI research and the subsequent validations do not provide specific cut off points to separate the results into limited, medium, high or extreme disability. It is considered that the higher the score in each scale, the higher the impairment to the shoulder function.

The Minimal Detectable Changes at 90% confidence are 18% for the first scale, 13% for the second scale and 11% for the total score.

A 10 point change is usually said to be clinically relevant in distinguishing between relevant improvements after treatment in patients with shoulder conditions. The patient is allowed to skip an answer but the overall advice is to answer all questions. If more that 2 answers are skipped, the score cannot be calculated accurately and the questionnaire should be started again.

References

1) Roach KE, Budiman-Mak E, Songsiridej N, Lertratanakul Y. (1991) Development of a shoulder pain and disability index. Arthritis Care Res; 4(4):143-9.

2) Breckenridge JD, McAuley JH. (2011) Shoulder Pain and Disability Index (SPADI). J Physiother; 57(3):197.

3) Tveitå EK, Ekeberg OM, Juel NG, Bautz-Holter E. (2008) Responsiveness of the shoulder pain and disability index in patients with adhesive capsulitis. BMC Musculoskelet Disord; 9:161.

4) MacDermid JC, Solomon P, Prkachin K. (2006) The Shoulder Pain and Disability Index demonstrates factor, construct and longitudinal validity. BMC Musculoskelet Disord; 7:12.

5) Roy JS, MacDermid JC, Woodhouse LJ. (2009) Measuring shoulder function: a systematic review of four questionnaires. Arthritis Rheum; 61(5):623-32.