Patient-reported outcome measure

SPADI Calculator

Shoulder Pain and Disability Index

The SPADI is a 13-item patient-reported questionnaire that measures shoulder pain and disability over the past week on two subscales — 5 pain items and 8 disability items — each rated 0–10 and transformed to a 0–100% score in which a higher score means more pain and greater disability.

Free to use13 items~5 min0–100, lower is better

Pain scale

Please rate the severity of your shoulder pain during the last week, where 0 is no pain at all and 10 is the worst pain imaginable. How severe is your pain?

1At its worst?

/10

2When lying on the involved side?

/10

3Reaching for something on a high shelf?

/10

4Touching the back of your neck?

/10

5Pushing with the involved arm?

/10

Disability scale

Please rate the difficulty you had during the last week, where 0 is no difficulty and 10 is so difficult it required help. How much difficulty do you have?

6Washing your hair?

/10

7Washing your back?

/10

8Putting on an undershirt or jumper?

/10

9Putting on a shirt that buttons down the front?

/10

10Putting on your pants?

/10

11Placing an object on a high shelf?

/10

12Carrying a heavy object of 10 pounds (4.5 kilograms)?

/10

13Removing something from your back pocket?

/10

What the SPADI score means

SPADI scores run from 0 to 100, where a lower score is better. The bands below are conventional reporting categories, not diagnostic cut-offs.

Minimal pain and disability0–19.9
Descriptive grouping only — the developers did not define severity categories for the SPADI.
Mild pain and disability20–39.9
Moderate pain and disability40–59.9
Severe pain and disability60–79.9
Extreme pain and disability80–100

Clinically important thresholds

A change in score only matters if it exceeds the smallest difference patients actually notice. Every threshold below is reported with the population it was derived in — a threshold quoted without its population is not usable.

Type	Value	Subscale	Population	Follow-up	Source
MCID	8–13.2 points	—	Mixed shoulder pathology in orthopaedic and physiotherapy outpatients	4 weeks to 6 months	Roy JS 2009
MDC	Approximately 18 points (90% confidence)	—	Patients with shoulder pain, stable between assessments	—	Roy JS 2009
MCID	13.2 points	—	Shoulder pain managed in primary care and physiotherapy	6 weeks	Schmitt JS 2004

MCID is the smallest change a patient perceives as meaningful. PASS is the score above which patients consider their state acceptable. SCB is a substantial rather than minimal benefit. MDC is the smallest change exceeding measurement error.

How the score is calculated

Stated in full so the calculation can be independently checked, and reproduced by hand if needed.

Each of the 13 items is rated 0 to 10, where a higher rating means more pain or more difficulty. The pain subscale score is the sum of its 5 items divided by 50 and multiplied by 100. The disability subscale score is the sum of its 8 items divided by 80 and multiplied by 100. The total SPADI score is the mean of those two subscale percentages, so pain and disability contribute equally regardless of the different numbers of items. Scores run from 0% (no pain, no disability) to 100% (worst pain, complete disability); the direction is the opposite of most shoulder scores, where a higher figure is better. A second convention, seen in some papers and online calculators, sums all 13 items and divides by 130; that yields a slightly different number whenever pain and disability diverge, because it weights the 8 disability items more heavily.

Missing data

An unanswered item is dropped from both the numerator and the denominator of its own subscale, so each subscale is expressed as a percentage of the maximum possible for the items actually answered. A subscale with no answered items is not calculated, and the total is not calculated unless both subscales have at least one answered item. The developers do not specify a maximum number of missing items; treat a subscale resting on fewer than half its items as unreliable.

Instrument profile

Developer: Kathryn E. Roach, Eddy Budiman-Mak, Nuntawan Songsiridej, Yuparat Lertratanakul
Institution: University of Miami and Hines Veterans Affairs Hospital, United States
First published: 1991
Items: 13
Response format: 11-point numerical rating scale, 0–10 per item (originally a 10 cm visual analogue scale)
Score range: 0 to 100
Direction: Lower score = better
Recall period: The last week
Completion time: About 5 minutes
Age range: Adults
Regions: Shoulder
Conditions: Rotator cuff disease, Subacromial pain syndrome, Adhesive capsulitis, Shoulder osteoarthritis, Non-specific shoulder pain
Procedures: Rotator cuff repair, Subacromial decompression, Shoulder arthroplasty
Languages: English, Dutch, Norwegian, Danish, Turkish, Persian, Brazilian Portuguese, Spanish, Greek, Chinese, Korean
Test–retest (ICC): 0.89–0.95 over intervals of a few days in stable patients
Internal consistency: Cronbach's alpha 0.86–0.95 for the total score
Validity: Correlates strongly with the DASH, the ASES score and shoulder-specific pain ratings, and moderately with objective range of motion — pain and self-rated disability track each other more closely than either tracks measured movement.
Responsiveness: Among the most responsive of the shoulder patient-reported measures, with standardised response means comparable to or better than the DASH in rotator cuff disease and adhesive capsulitis.
Ceiling effect: Ceiling effects are uncommon; few patients score at or near 100%.
Floor effect: Marked floor effect in recovered or asymptomatic patients, who cluster at 0% — the SPADI cannot distinguish good outcomes from excellent ones.

Normative values

Reference values from published cohorts, for comparison against the score you calculated.

Population	Age	Mean	SD
Untreated shoulder pain presenting to primary care or physiotherapy	—	Typically 40–65%	—
Asymptomatic shoulders	—	Close to 0%, with a pronounced floor effect	—

When to use the SPADI

Well suited to

Following a patient with rotator cuff disease, subacromial pain or adhesive capsulitis through a course of physiotherapy or injection, where pain and function change at different rates.
When a short, self-administered shoulder measure is needed and pain must be reported separately from disability.
Comparing groups in shoulder research, where its responsiveness and the availability of published change thresholds make it a common primary endpoint.

Limitations and poor fits

Assessing shoulder instability in young athletes, where the items do not capture apprehension or sport-specific demand — use the WOSI instead.
Detecting further improvement in patients who are already near-recovered, because of the floor effect at 0%.
As a measure of impairment rather than symptom burden — it records what the patient reports, not measured range or strength, and should not be substituted for examination findings.

SPADI compared with other instruments

Instruments measuring a related construct, with the practical difference between them.

Instrument	Items	Range	What it adds
Constant Score	10	0–100	The Constant-Murley score is a 100-point clinician-administered shoulder assessment combining 35 subjective points for pain and daily activities with 65 objective points for measured range of motion and abduction strength, where 100 represents a normal, pain-free shoulder.
UCLA Shoulder Score	5	2–35	The UCLA Shoulder Rating Scale is a 35-point shoulder assessment scoring pain and function out of 10 each, active forward flexion and forward-flexion strength out of 5 each, and patient satisfaction as either 0 or 5, where a higher total is better and 34–35 is graded excellent.
SST	12	0–12	The Simple Shoulder Test asks twelve yes-or-no questions about everyday shoulder functions and scores the number answered yes, giving a total from 0 to 12 where 12 means all twelve functions are retained.
ASES Score	11	0–100	The ASES score is a patient-reported shoulder index running from 0 to 100 in which a single 0–10 pain rating supplies 50 points and ten activities of daily living rated 0–3 supply the other 50, so that 100 represents a pain-free shoulder with no functional difficulty.
Oxford Shoulder Score	12	0–48	The Oxford Shoulder Score is a 12-item patient-reported questionnaire about shoulder pain and everyday function over the past four weeks, each item scored 0 to 4 and summed to a total of 0 to 48 in which 48 represents the best possible shoulder — it is licensed by Oxford University Innovation, so the item wording is not reproduced here.
QuickDASH	11	0–100	The QuickDASH is an 11-item shortened form of the DASH that measures physical function and symptoms across the whole upper limb on a single 0 to 100 scale, where a higher score means greater disability.

Copyright and permitted use

Published openly because it is the question every clinician and researcher asks before using an instrument, and almost nobody answers it.

Free to use

The SPADI was published in the peer-reviewed literature in 1991 with its items and scoring in full, is not subject to an active commercial licensing programme, and is reproduced freely in clinical practice and research. Attribution to Roach and colleagues is expected.

References

Roach KE, Budiman-Mak E, Songsiridej N, Lertratanakul Y. Development of a shoulder pain and disability index. Arthritis Care and Research. 1991.
Breckenridge JD, McAuley JH. Shoulder Pain and Disability Index (SPADI). Journal of Physiotherapy. 2011.
Roy JS, MacDermid JC, Woodhouse LJ. Measuring shoulder function: a systematic review of four questionnaires. Arthritis and Rheumatism (Arthritis Care and Research). 2009.
Schmitt JS, Di Fabio RP. Reliable change and minimum important difference (MID) proportions facilitated group responsiveness comparisons using individual threshold criteria. Journal of Clinical Epidemiology. 2004.
Williams JW, Holleman DR, Simel DL. Measuring shoulder function with the Shoulder Pain and Disability Index. Journal of Rheumatology. 1995.

Editorial status

Not yet reviewedQueued for clinical review by Sam Tuffun, PT, DPT. Sign-off has not taken place — this is a placeholder assignment, not a completed review.