Shoulder Pain and Disability Index

What is the Shoulder Pain and Disability Index?

If you have a new patient who sets up an appointment with you to discuss pains in their shoulder, or if you are already handling a patient who is dealing with a specific shoulder condition (e.g. shoulder inflammation, rotator cuff tears, arthritis in the shoulder area, frozen shoulder), then the is a nifty clinical assessment tool that allows you to assess shoulder pain and/or shoulder condition.

The Shoulder Pain and Disability Index (or SPADI, for short), is a self-administered clinical assessment that’s usually handed out to patients for them to answer on their own. It comes in the form of a two-part questionnaire with a total of thirteen items!

The first part of the questionnaire revolves around the pain in their shoulder(s). It has a total of five questions that are about how frequently they feel shoulder pain and how intense their pain usually is.

The second part of the questionnaire has a total of eight questions, and it focuses on the impact that their shoulder pain has had on their functional abilities, specifically their capability to perform certain activities of daily living.

How to use the Shoulder Pain and Disability Index

If you’re a healthcare professional, there are two ways for you to administer this clinical assessment. You can either:

1. Conduct this clinical assessment in an interview format. You will read each question to the patient, and they have to rate themselves based on how they perceive their pain severity of their pain and how bad their pain has impacted functional status. This is a time-consuming way of administering this assessment. However, the upside is that you can have patients expound on their self-ratings, which should be beneficial to you in terms of determining the next steps for the patient’s treatment.
2. Or, you can do it as intended, which is to hand out a sheet for them to answer on their own.

Whichever method you choose, the patient will still do the same thing. They will be rating themselves on a scale of zero to ten for the following items:

1. How severe is your pain?

• 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?

2. How much difficulty do you have?

• Washing your hair?
• Washing your back?
• Putting on an undershirt or 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 10 pounds (4.5 kilograms)?
• Removing something from your back pocket?

How to score the Shoulder Pain and Disability Index

The patient simply needs to rate themselves between zero to ten. Here’s what they mean for both parts of the questionnaire:

1. For the first part, 0 means “there is no pain,” while 10 means “the worst pain imaginable.”
2. For the second part, 0 means “no difficulty,” while 10 means that “it’s so difficult that it requires help.”

Once the patient answers all questions, you need to calculate the scores. You will compute three scores: one for the first part, one for the second part, and one for the entire index. Just follow these equations:

1. Total Pain Score:

(Total Score ÷ 50) x 100 = ____ %

If the patient does not answer all questions under this section, divide by the total possible score. So, if the patient didn’t answer one question, the total score will be divided by 40 instead of 50.

2. Total Disability Score

(Total Score ÷ 80) x 100 = ____ %

If the patient does not answer all questions under this section, you’ll do the same thing as the previous section, which is divide by the total possible score. So, if the patient didn’t answer one question, the total score will be divided by 70 instead of 80.

3. Total SPADI Score

(Total Score ÷ 130) x 100 = ____ %

Same thing as the previous two: divide by the total possible score based on how many questions they didn’t answer. So, if the patient didn’t answer one question, the total score will be divided by 120 instead of 130.

There are no score range designations for this. Just for your reference, a total SPADI score of 0 means “best” and 100 means “worst.” Higher scores mean that the patient’s shoulder pain is terrible, and this pain is impacting certain activities of daily living to a severe degree.

As for your next steps, you can run some tests and determine what the specific problem is if the patient hasn’t undergone examinations yet. If they already have specific shoulder problems, you can construct or tweak a treatment plan that takes into account their self-ratings.

When is it best to issue the Shoulder Pain and Disability Index?

There are two appropriate times to use the Shoulder Pain and Disability Index.

The first one is when a patient attends an appointment they scheduled with you and they talk about shoulder pain. To properly gauge their pain, hand them the Shoulder Pain and Disability Index, then have them expound on their answers so you can get a better picture of how they are feeling beyond the numbers. That way, you can determine what particular tests and physical examination techniques you should conduct to determine the possible problem their shoulders are going through.

The SPADI can also be used during the treatment plan-making phase. Let’s say that the patient already has a specific shoulder condition diagnosis. You can use the index to determine how bad the condition has been affecting them, and then, based on their self-ratings, you can determine what might be best to add to their treatment plan. Will you prescribe medication? Will you have them undergo a shoulder rehabilitation program? Do they need to undergo surgery? Do you think they need someone to assist them with certain activities of daily living? These are just some of the questions that you will be able to answer using the results of the Shoulder Pain and Disability Index, and the results of other tests that were conducted on the patient.

Who can administer the Shoulder Pain and Disability Index?

Since the Shoulder Pain and Disability Index is for gauging shoulder pain and disability, the following healthcare professionals can add this to their roster of tools:

1. Orthopedists - These professionals specialize in assessing and treating musculoskeletal issues, so they are well-equipped to deal with shoulder pains. They can include this as part of their series of tests to see how their patient’s shoulder pain has impacted their lives. If they have to perform surgery on the patient, they can re-administer the index to see how their patients are doing down the line.

2. Physical therapists and occupational therapists - These therapists will be a big help when it comes to the rehabilitation of a patient’s shoulder, especially after an operation. They can develop rehabilitation and exercise programs that will help restore the shoulder to a good state. If ever their shoulder can’t make a full recovery, they can plan the necessary interventions and support that the patient needs to help them regain functional independence.

The use of the index is not exclusive to these professionals, though. Even sports physicians can use this clinical assessment to gauge the athletes they are handling so they can determine what alterations they should make with their training, and determine if they need to be on the bench for a while so they can recuperate.

So long as the person using it is highly trained in assessing and treating musculoskeletal problems, they can use this index.

What are the benefits of using the Shoulder Pain and Disability Index?

It helps healthcare professionals understand their patients better.

The Shoulder Pain and Disability Index is a self-assessment, so it relies on a patient’s perspective regarding their pain and how it affects their daily life. It gives the patient the opportunity to communicate how they feel, and you can have them explain themselves better by expounding on their self-ratings. This can establish rapport between the healthcare professional and the patient, in the sense that there can be shared decision-making regarding treatment and how it can be tailor-fitted to the patient.

It is a comprehensive and standardized assessment of shoulder pain.

If there are two words that you can use to describe the Shoulder Pain and Disability Index, that would be comprehensive and consistent.

The SPADI is comprehensive because it doesn’t just ask about how often patients feel their shoulder pain and how bad it feels. It also asks about how the pain has impacted them. Their self-ratings will help healthcare professionals determine what to do next in order to cover all bases related to their shoulder pain.

It also has a standardized scoring system. Since the answers are based on the patient’s perspectives and experiences, you can definitely say that the answers are subjective. But with the SPADI’s scoring system, the index gains a semblance of objectivity because it assigns a score to the totality of their self-ratings. This can be used down the line to track changes and compare results.

It can be used to monitor patients and evaluate treatment plans.

Speaking of tracking changes over time and comparing results, the Shoulder Pain and Disability Index can be used to monitor patients who are undergoing a rehabilitation plan or a treatment plan. It’s a way for healthcare professionals to check if they are getting better (the scores based on their self-ratings should reflect this) and if the implemented plans are working or not. If the patient’s shoulder is feeling better (less pain or no pain) and if their quality of life has improved (their functional independence is getting better and they require less or no support/supervision). If they are getting better, then you can also say that your treatment or rehabilitation plan is working. If not, then perhaps you should tweak or overhaul it, and see if the changes will do the trick.