SPADI Survey

Question Title

* 2. Who is your Physiotherapist?

Mandi Hayes

Jennifer Duke

Anthony Giorgianni

Jeanine Stott

Beata Sadowska

Heather Clegg

Chris Cosby

I cannot remember

Please place a mark on the line that best represents your experience during the last week attributable to your shoulder problem.

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* 3. Pain scale - How severe is your pain? Circle the number that best describes your pain where: 0 = no pain and 10 = the worst pain imaginable.

	0 None	1	2	3	4	5	6	7	8	9	10 The worst pain imaginable
At its worst?	At its worst? 0 None	At its worst? 1	At its worst? 2	At its worst? 3	At its worst? 4	At its worst? 5	At its worst? 6	At its worst? 7	At its worst? 8	At its worst? 9	At its worst? 10 The worst pain imaginable
When lying on the involved side?	When lying on the involved side? 0 None	When lying on the involved side? 1	When lying on the involved side? 2	When lying on the involved side? 3	When lying on the involved side? 4	When lying on the involved side? 5	When lying on the involved side? 6	When lying on the involved side? 7	When lying on the involved side? 8	When lying on the involved side? 9	When lying on the involved side? 10 The worst pain imaginable
Reaching for something on a high shelf?	Reaching for something on a high shelf? 0 None	Reaching for something on a high shelf? 1	Reaching for something on a high shelf? 2	Reaching for something on a high shelf? 3	Reaching for something on a high shelf? 4	Reaching for something on a high shelf? 5	Reaching for something on a high shelf? 6	Reaching for something on a high shelf? 7	Reaching for something on a high shelf? 8	Reaching for something on a high shelf? 9	Reaching for something on a high shelf? 10 The worst pain imaginable
Touching the back of your neck?	Touching the back of your neck? 0 None	Touching the back of your neck? 1	Touching the back of your neck? 2	Touching the back of your neck? 3	Touching the back of your neck? 4	Touching the back of your neck? 5	Touching the back of your neck? 6	Touching the back of your neck? 7	Touching the back of your neck? 8	Touching the back of your neck? 9	Touching the back of your neck? 10 The worst pain imaginable
Pushing with the involved arm?	Pushing with the involved arm? 0 None	Pushing with the involved arm? 1	Pushing with the involved arm? 2	Pushing with the involved arm? 3	Pushing with the involved arm? 4	Pushing with the involved arm? 5	Pushing with the involved arm? 6	Pushing with the involved arm? 7	Pushing with the involved arm? 8	Pushing with the involved arm? 9	Pushing with the involved arm? 10 The worst pain imaginable

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* 4. Disability scale - How much difficulty do you have? Circle the number that best describes your experience where: 0 = no difficulty and 10 = so difficult it requires help.

	0 No difficulty	1	2	3	4	5	6	7	8	9	10 So difficult it requires help
Washing your hair?	Washing your hair? 0 No difficulty	Washing your hair? 1	Washing your hair? 2	Washing your hair? 3	Washing your hair? 4	Washing your hair? 5	Washing your hair? 6	Washing your hair? 7	Washing your hair? 8	Washing your hair? 9	Washing your hair? 10 So difficult it requires help
Washing your back?	Washing your back? 0 No difficulty	Washing your back? 1	Washing your back? 2	Washing your back? 3	Washing your back? 4	Washing your back? 5	Washing your back? 6	Washing your back? 7	Washing your back? 8	Washing your back? 9	Washing your back? 10 So difficult it requires help
Putting on an undershirt or jumper?	Putting on an undershirt or jumper? 0 No difficulty	Putting on an undershirt or jumper? 1	Putting on an undershirt or jumper? 2	Putting on an undershirt or jumper? 3	Putting on an undershirt or jumper? 4	Putting on an undershirt or jumper? 5	Putting on an undershirt or jumper? 6	Putting on an undershirt or jumper? 7	Putting on an undershirt or jumper? 8	Putting on an undershirt or jumper? 9	Putting on an undershirt or jumper? 10 So difficult it requires help
Putting on a shirt that buttons down the front?	Putting on a shirt that buttons down the front? 0 No difficulty	Putting on a shirt that buttons down the front? 1	Putting on a shirt that buttons down the front? 2	Putting on a shirt that buttons down the front? 3	Putting on a shirt that buttons down the front? 4	Putting on a shirt that buttons down the front? 5	Putting on a shirt that buttons down the front? 6	Putting on a shirt that buttons down the front? 7	Putting on a shirt that buttons down the front? 8	Putting on a shirt that buttons down the front? 9	Putting on a shirt that buttons down the front? 10 So difficult it requires help
Putting on your pants?	Putting on your pants? 0 No difficulty	Putting on your pants? 1	Putting on your pants? 2	Putting on your pants? 3	Putting on your pants? 4	Putting on your pants? 5	Putting on your pants? 6	Putting on your pants? 7	Putting on your pants? 8	Putting on your pants? 9	Putting on your pants? 10 So difficult it requires help
Placing an object on a high shelf?	Placing an object on a high shelf? 0 No difficulty	Placing an object on a high shelf? 1	Placing an object on a high shelf? 2	Placing an object on a high shelf? 3	Placing an object on a high shelf? 4	Placing an object on a high shelf? 5	Placing an object on a high shelf? 6	Placing an object on a high shelf? 7	Placing an object on a high shelf? 8	Placing an object on a high shelf? 9	Placing an object on a high shelf? 10 So difficult it requires help
Carrying a heavy object of 10 pounds (4.5 kilograms)?	Carrying a heavy object of 10 pounds (4.5 kilograms)? 0 No difficulty	Carrying a heavy object of 10 pounds (4.5 kilograms)? 1	Carrying a heavy object of 10 pounds (4.5 kilograms)? 2	Carrying a heavy object of 10 pounds (4.5 kilograms)? 3	Carrying a heavy object of 10 pounds (4.5 kilograms)? 4	Carrying a heavy object of 10 pounds (4.5 kilograms)? 5	Carrying a heavy object of 10 pounds (4.5 kilograms)? 6	Carrying a heavy object of 10 pounds (4.5 kilograms)? 7	Carrying a heavy object of 10 pounds (4.5 kilograms)? 8	Carrying a heavy object of 10 pounds (4.5 kilograms)? 9	Carrying a heavy object of 10 pounds (4.5 kilograms)? 10 So difficult it requires help
Removing something from your back pocket?	Removing something from your back pocket? 0 No difficulty	Removing something from your back pocket? 1	Removing something from your back pocket? 2	Removing something from your back pocket? 3	Removing something from your back pocket? 4	Removing something from your back pocket? 5	Removing something from your back pocket? 6	Removing something from your back pocket? 7	Removing something from your back pocket? 8	Removing something from your back pocket? 9	Removing something from your back pocket? 10 So difficult it requires help

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* 5. Interpretation of scores (for office use only)

PAIN SCORE : add up pain scores / 50 x 100 = %
(Note: If a person does not answer all questions divide by the total possible score, eg. if 1 question missed divide by 40) DISABILITY SCORE : / 80 x 100 = %
(Note: If a person does not answer all questions divide by the total possible score, eg. if 1 question missed divide by 70) TOTAL SPADI SCORE : / 130 x 100 = _%
(Note: If a person does not answer all questions divide by the total possible score, eg. if 1 question missed divide by 120) MDC = 13 SCORE RANGE: 0 (worst), 100 (best)

This questionnaire is taken from: Roach KE, Budiman-Mak E, Songsiridej N, Lertratanakul Y. Development of a shoulder pain and disability index. Arthritis Care Res. 1991 Dec;4(4):143-9.

SPADI

Shoulder Pain and Disability Index

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* 1. Please type your name. Surname, First Name

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* 2. Who is your Physiotherapist?

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* 3. Pain scale - How severe is your pain? Circle the number that best describes your pain where: 0 = no pain and 10 = the worst pain imaginable.

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* 4. Disability scale - How much difficulty do you have? Circle the number that best describes your experience where: 0 = no difficulty and 10 = so difficult it requires help.

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