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Shoulder Pain & Disability Index Form

This document appears to be a shoulder pain and disability index (SPADI) questionnaire for a patient at Advance Physical Therapy. The SPADI measures shoulder pain and disability through two scales - a pain scale that rates pain from 0-10 for various motions and activities, and a disability scale that rates difficulty from 0-10 for various functional activities. Scores on each scale are calculated as a percentage, with higher percentages indicating greater impairment. The SPADI will be used to assess this patient's shoulder pain and functional limitations.

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Chai Rani
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448 views1 page

Shoulder Pain & Disability Index Form

This document appears to be a shoulder pain and disability index (SPADI) questionnaire for a patient at Advance Physical Therapy. The SPADI measures shoulder pain and disability through two scales - a pain scale that rates pain from 0-10 for various motions and activities, and a disability scale that rates difficulty from 0-10 for various functional activities. Scores on each scale are calculated as a percentage, with higher percentages indicating greater impairment. The SPADI will be used to assess this patient's shoulder pain and functional limitations.

Uploaded by

Chai Rani
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Advance Physical Therapy

Patient Name ________________________________________________________ Date ______________________

Shoulder Pain & Disability Index (SPADI)

Pain Scale: How severe is your pain?


0 10
No Pain Worst Pain Imaginable

For each question below, circle the number that best describes your pain based on the scale above

At its worst? 0 1 2 3 4 5 6 7 8 9 10
When lying on the involved side? 0 1 2 3 4 5 6 7 8 9 10
Reaching for something on a high shelf? 0 1 2 3 4 5 6 7 8 9 10
Touching the back of your neck? 0 1 2 3 4 5 6 7 8 9 10
Pushing with the involved arm? 0 1 2 3 4 5 6 7 8 9 10

Disability Scale: How much difficulty do you have?


0 10
No Difficulty Unable to Perform

For each question below, circle the number that best describes your difficulty based on the scale above

Washing your hair? 0 1 2 3 4 5 6 7 8 9 10


Washing your back? 0 1 2 3 4 5 6 7 8 9 10
Putting on an undershirt or pullover sweater? 0 1 2 3 4 5 6 7 8 9 10
Putting on a shirt that buttons down the front? 0 1 2 3 4 5 6 7 8 9 10
Putting on your pants? 0 1 2 3 4 5 6 7 8 9 10
Placing an object on a high shelf? 0 1 2 3 4 5 6 7 8 9 10
Carrying a heavy object of 10 pounds? 0 1 2 3 4 5 6 7 8 9 10
Removing something from your back pocket? 0 1 2 3 4 5 6 7 8 9 10

Pain Scale Score: ____ /50 x 100 = _____ %


TOTAL SCORE: _____ /130 x 100 = _____ %
Disability Scale Score: ____ /80 x 100 = _____ %
Scoring: Summate the scores and divide by the number of scores possible. If an item is deemed not applicable,
no score is calculated. Multiply total score by 100. The higher the score, the greater the impairment.

Source: From Roach, KE, Buudimanmak, E, Songsirideg, N, Yongsuk, L. (1991).

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