The Shoulder Pain and Disability Index demonstrates factor, construct and longitudinal validity

Joy C MacDermid, Patty Solomon, Kenneth Prkachin, Joy C MacDermid, Patty Solomon, Kenneth Prkachin

Abstract

Background: The Shoulder Pain and Disability Index (SPADI) is a self-report measure developed to evaluate patients with shoulder pathology. While some validation has been conducted, broader analyses are indicated. This study determined aspects of cross-sectional and longitudinal validity of the SPADI.

Methods: Community volunteers (n = 129) who self-identified as having shoulder pain were enrolled. Patients were examined by a physical therapist using a standardized assessment process to insure that their pain was musculoskeletal in nature. This included examination of pain reported during active and passive shoulder motion as reported on a visual analogue pain scale. Patients completed the SPADI, the Coping Strategies Questionnaire (CSQ) and the Sickness Impact Profile (SIP) at a baseline assessment and again 3 and 6 months later. Factor analysis with varimax rotation was used to assess subscale structure. Expectations regarding convergent and divergent subscales of CSQ and SIP were determined a priori and analysed using Pearson correlations. Constructed hypotheses that patients with a specific diagnosis or on pain medication would demonstrate higher SPADI scores were tested. Correlations between the observed changes recorded across different instruments were used to assess longitudinal validity.

Results: The internal consistencies of the SPADI subscales were high (alpha > 0.92). Factor analysis with varimax rotation indicated that the majority of items fell into 2 factors that represent pain and disability. Two difficult functional items tended to align with pain items. Higher pain and disability was correlated to passive or negative coping strategies, i.e., praying/hoping, catastrophizing on the CSQ. The correlations between subscales of the SPADI and SIP were low with divergent subscales and low to moderate with convergent subscales. Correlations, r > 0.60, were observed between the SPADI and pain reported on a VAS pain scale during active and passive movement. The two constructed validity hypotheses (on diagnosis and use of pain medications) were both supported (p < 0.01). The SPADI demonstrated significant changes over time, but these were poorly correlated to the SIP or CSQ suggesting that these scales measure different parameters.

Conclusion: The SPADI is a valid measure to assess pain and disability in community-based patients reporting shoulder pain due to musculoskeletal pathology.

Figures

Figure 1
Figure 1
The Shoulder Pain and Disability Index (SPADI). This is a numeric version of the SPADI, used with permission of the developer K Roach.
Figure 2
Figure 2
SPADI scores over time according to diagnostic subgroups. This graph shows the SPADI score in patients that had a specific diagnosis for their shoulder pain and those who did not. Significant improvements occurred across time in both groups. Patients with a specific diagnosis had higher pain and disability at all 3 time-points (p < 0.001).
Figure 3
Figure 3
SPADI scores over time according to pain medication subgroups. This graph shows the SPADI score in patients that had were using pain medication (at baseline evaluation) as compared to those who were not. Significant improvements in SPADI scores occurred across time in both groups. Patients that were using pain medication had higher pain and disability at all 3 time-points (p < 0.001).

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