Shoulder Pain and Disability Index (SPADI)

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The Shoulder Pain and Disability Index (SPADI) is a patient completed questionnaire with 13 items assessing pain level and extent of difficulty with ADLs requiring the use of the upper extremities. The pain subscale has 5-items and the Disability subscale has 8-items.

The original version[1] was published in 1991 and has its items scored on the Visual analogue scale while the second version scores its items on the Numerical rating scale(NRS)

SPADI has been translated in many languages including Spanish, Greek, Dutch, Hindi, Thai and Italian each with its own validity and reliability.

Intended Population

SPADI can be used in the following patient population:

Method of Use

The patient is instructed to choose the number that best describes their level of pain and extent of difficulty using the involved shoulder. The pain scale is summed up to a total of 50 while the disability scale sums up to 80. The total SPADI score is expressed as a percentage.

A score of 0 indicates best 100 indicates worst. A higher score shows more disability.

In scoring SPADI, any question missed should be taken out of the total score of each subscale. i.e if 1 question is omitted in the pain section, the total score is divided by 40.



SPADI was found to have reliability coefficients of ICC ≥ 0.89 in a variety of patient populations.[4] Internal consistency is high with Cronbach α typically exceeding 0.90[4]  


The SPADI demonstrates good construct validity, correlating well with other region-specific shoulder questionnaires.[5][4][6] It has 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.[7][8][4]


The minimal clinically important difference has been reported to be 8 points; this represents the smallest detectable change that is important to the patient.[5] However, when SPADI is used repeatedly on the same subject the minimal detectable change is 18 points.[9][10]


  1. 1.0 1.1 Roach KE, Budiman‐Mak E, Songsiridej N, Lertratanakul Y. Development of a Shoulder Pain and Disability Index. Arthritis Care Res 1991; 4: 143–9.
  2. Tveitå, E. K., Ekeberg, O. M., Juel, N. G., & Bautz-Holter, E. Responsiveness of the Shoulder Pain and Disability Index in patients with adhesive capsulitis. BMC Musculoskeletal Disorders. 2008: 9(161)
  3. Staples MP, Forbes A, Green S, Buchbinder R. Shoulder‐specific disability measures showed acceptable construct validity and responsiveness. J Clin Epidemiol 2010; 63: 163–70.
  4. 4.0 4.1 4.2 4.3 Roy JS, MacDermid JC, Woodhouse LJ: Measuring shoulder function: a systematic review of four questionnaires. Arthritis Rheum. 2009, 61 (5): 623-632.
  5. 5.0 5.1 Paul A, Lewis M, Shadforth MF, Croft PR, Van Der Windt DA, Hay EM: A comparison of four shoulder-specific questionnaires in primary care. Ann Rheum Dis. 2004, 63 (10): 1293-1299.
  6. Bot SD, Terwee CB, van der Windt DA, Bouter LM, Dekker J, de Vet HC: Clinimetric evaluation of shoulder disability questionnaires: a systematic review of the literature. Ann Rheum Dis. 2004, 63 (4): 335-341. 
  7. Williams JW, Holleman DR, Simel DL: Measuring shoulder function with the Shoulder Pain and Disability Index. J Rheumatol. 1995, 22 (4): 727-732.
  8. Beaton DE, Richards RR: Measuring function of the shoulder. A cross-sectional comparison of five questionnaires. J Bone Joint Surg Am. 1996, 78 (6): 882-890.
  9. Angst F, Goldhahn J, Drerup S, Aeschlimann A, Schwyzer HK, Simmen BR: Responsiveness of six outcome assessment instruments in total shoulder arthroplasty. Arthritis Rheum. 2008, 59 (3): 391-398.
  10. Schmitt JS, Di Fabio RP: Reliable change and minimum important difference (MID) proportions facilitated group responsiveness comparisons using individual threshold criteria. J Clin Epidemiol. 2004, 57 (10): 1008-1018.