One question might be capable of replacing the Shoulder Pain
and Disability Index (SPADI) when measuring disability:
a prospective cohort study
Marloes Thoomes-de Graaf
Accepted: 29 August 2017 / Published online: 7 September 2017
Ó The Author(s) 2017. This article is an open access publication
Questions Is it possible to replace the Shoulder Pain and
Disability Index (SPADI) with a single substitute question
for people with shoulder pain, when measuring disability
and how well does this substitute question perform as a
predictor for recovery.
Design A prospective cohort study.
Participants A total of 356 patients with shoulder pain in
Analyses Convergent, divergent, and ‘‘known’’ groups
validity were assessed by using hypotheses testing.
Responsiveness was assessed using the Receiver Operating
Curve and hypothesis testing. In addition, we performed
multivariate regression to assess if the substitute question
showed similar properties as the SPADI and if it affected
the model itself, using recovery as an outcome.
Results The Spearman correlation coefﬁcient between the
total SPADI score and the substitute question was high, and
moderate with the Shoulder Disability Questionnaire. The
correlation between the substitute question and the EQ-5D-
3L was low and the responsiveness was acceptable. The
substitute question did not signiﬁcantly contribute to both
prognostic prediction models as opposed to the SPADI.
Regardless all models showed poor to fair discrimination.
Conclusion The single question is a reasonable substitute
for the SPADI and can be used as a screening instrument
for shoulder disability in primary clinical practice. It has
slightly poorer predictive power and should therefore not
be used for prognosis.
Keywords SPADI Á Single question Á Disability Á
Shoulder Á Questionnaire
Activity limitations are one of the most important health
consequences for patients with shoulder pain . Activity
limitations can range from difﬁculties with opening a jar
and getting dressed, to impeding sleep . Shoulder pain
presents an economic burden on society due to costs of sick
leave and health care and also impacts patient’s quality of
life . As such, health-related patient-reported outcome
measures (PROMs) that assess perceived activity limita-
tions are useful in terms of assessing the physical impair-
ment in patients with shoulder pain [1, 4].
Both the Shoulder Pain and Disability Index (SPADI) as
the Shoulder Disability Questionnaire (SDQ) are PROMs
focusing on activity limitations. Several (systematic)
reviews have encouraged the use of the SPADI in both
clinical and research settings [5–7].
A survey among physical therapists (PTs) concluded
that PROMs are most often used to ensure quality of care,
to communicate with other health care providers, and to
determine progress (outcomes) of individual patients .
These ﬁndings are consistent among other health care
professionals . Apart from this, a PROM can be used to
& Marloes Thoomes-de Graaf
Department of General Practice, Erasmus Medical Centre,
Rotterdam, The Netherlands
Research group diagnostics, Avans University of Applied
Science, Breda, The Netherlands
Department of Human Movement Sciences, Faculty of
Behaviour and Movement Sciences, Vrije Universiteit
Amsterdam, MOVE Research Institute, Amsterdam, The
Qual Life Res (2018) 27:401–410