Shoulder Pain and Disability Index: Italian cross-cultural validation in patients with non-specific shoulder pain

Cross-cultural adaptation and psychometric properties of the Argentine version of the shoulder pain and disability index (SPADI) in patients with shoulder disorders

Background

Shoulder disorders are some of the leading causes of musculoskeletal conditions with a significant economic impact worldwide. The Shoulder Pain and Disability Index (SPADI) questionnaire has proved to be a valid and useful tool for the assessment of disability; however, reporting of properties in several languages has been inconsistent, and the quality of the studies available is low. Moreover, there is only one version in Spanish, designed in Spain, which does not consider the linguistic differences existing in Argentina. Therefore, the aim of the present study was to conduct the cross-cultural adaptation of the SPADI and assess its reliability, validity, responsiveness, and interpretability in subjects with shoulder disorders.

Materials and methods

The study was conducted following the COSMIN Guidelines (COnsensus-based Standards for the Selection of health Measurement INstruments). We included Argentine residents, older than 18 years of age, referred to physiotherapy for shoulder disorders.

Results

A total of 101 patients were evaluated. Reliability was acceptable with an intraclass correlation coefficient of 0.89. The standard error of measurement and minimal detectable change were 2.18 and 6.05, respectively. Construct validity was excellent, and responsiveness was high. Also, the minimal clinically important difference was 18.46 points, the substantial clinical benefit was 27.69 points, and the symptom acceptable level value was 21.35 points.

Conclusion

A cross-cultural adaptation of the Argentine version of the SPADI was conducted. This version proved to be valid, reliable, and responsive with interpretability values.

Translation, Validity, and Reliability of the Indonesian Version of the Shoulder Pain and Disability Index (SPADI)

Background

The Shoulder Pain and Disability Index (SPADI) is a widely used 13-item shoulder-specific patient-reported outcome measure for shoulder pain disorders. The English version of SPADI is easy to use and demonstrates excellent measurement properties for clinical and research settings.

Purpose

To translate and culturally adapt an Indonesian version of SPADI (SPADI-IDN) and then validate its use in Indonesian patients.

Study Design

Cohort study (Diagnosis); Level of evidence, 2.

Methods

Through a forward and a backward translation process, the validity of the questionnaire was investigated. The study population was 100 patients with shoulder pain who were treated in a hospital in Indonesia. The patients were asked to fill out the SPADI-IDN during their visit. To evaluate the validity of SPADI-IDN, the patients were also asked to fill out the Medical Outcomes Study 12-Item Short-Form Health Survey and the Oxford Shoulder Score. To assess the test-retest reliability, the same patients were asked to fill out the SPADI-IDN questionnaire again 1 week later. The assessment of construct validity, test-retest reliability, internal consistency, floor and ceiling effect, and measurement of error followed the COSMIN (Consensus-based Standards for the selection of health Measurement Instruments) guidelines. The Bland-Altman method was used to explore absolute agreement.

Results

Of the 100 eligible patients, all were used to assess construct validity, and 87 patients (87%) were used to assess test-retest reliability. Almost every established hypothesis about the correlations between SPADI-IDN and other questionnaires could be confirmed, implying good construct validity. No floor or ceiling effects were found. The intraclass correlation value was 0.99, indicating strong test-retest reliability. A Cronbach α was 0.95, indicating a good internal consistency. The Bland-Altman analysis did not reveal any bias. The standard error of measurement and the minimal detectable change at the individual and group levels were 2.65, 7.3, and 0.7, respectively.

Conclusion

The SPADI-IDN represents a valid and reliable tool for measuring pain and disability in patients with shoulder pain disorders.

Shoulder Proprioception and Its Correlation with Pain Intensity and Functional Disability in Individuals with Subacromial Impingement Syndrome-A Cross-Sectional Study

Subacromial Impingement Syndrome (SAIS) is a common shoulder condition characterized by pain and functional impairment. Proprioception, the sense of joint position and movement, is crucial in maintaining joint stability and coordinating movements. The relationship between shoulder proprioception, pain intensity, and functional disability in individuals with SAIS remains unclear, with conflicting findings in the literature. This cross-sectional study aimed to evaluate shoulder proprioception, examine its correlation with pain intensity and functional disability, and contribute to our understanding of the clinical implications of proprioceptive deficits in individuals with SAIS. Forty-two individuals were diagnosed with SAIS, and an equal number of asymptomatic controls were recruited. Shoulder proprioception was assessed using a digital inclinometer, measuring joint position sense at various angles of flexion and rotation. Pain intensity was measured using the Visual Analog Scale (VAS), and functional disability was assessed using the Shoulder Pain and Disability Index (SPADI). Results: Individuals with SAIS exhibited significantly higher joint position error (JPE) values compared to asymptomatic controls in all measured angles of flexion and rotation (p < 0.001). Strong positive correlations were observed between JPE and pain intensity (r = 0.61 to 0.71, p < 0.01) and disability (r = 0.56 to 0.68, p < 0.01). These findings suggest impaired shoulder proprioception is associated with higher pain intensity and functional disability in SAIS. This study provides evidence of impaired shoulder proprioception in individuals with SAIS and its correlation with pain intensity and functional disability. The results highlight the clinical relevance of proprioceptive deficits in SAIS and emphasize the importance of incorporating proprioceptive assessment and targeted rehabilitation interventions into managing this condition. Future research should focus on longitudinal studies with larger and more diverse samples to further understand the underlying mechanisms and evaluate the effectiveness of proprioceptive interventions in improving outcomes for individuals with SAIS.

Reliability and validity of the Shoulder Pain and Disability Index in a sample of patients with frozen shoulder

BACKGROUND

The Shoulder and Pain Disability Index (SPADI) is a widely used outcome measure. The aim of this study is to explore the reliability and validity of SPADI in a sample of patients with idiopathic frozen shoulder.

METHODS

The SPADI was administered to 124 patients with idiopathic frozen shoulder. A sub-group of 29 patients were retested after 7 days. SPADI scores were correlated with other outcome measures (i.e., Disabilities of the Arm, Shoulder and Hand Questionnaire - DASH; Numerical Pain Rating Scale-NPRS; and 36-item Short Form Health Survey-SF-36) to examine construct validity. Structural validity was assessed by a Two-Factors Confirmatory Factor Analysis (CFA). Internal consistency, test-retest reliability, and measurement error were also analyzed.

RESULTS

The construct validity was satisfactory as seven out of eight of the expected correlations formulated (≥ 75%) for the subscales were satisfied. The CFA showed good values of all indicators for both Pain and Disability subscales (Comparative Fit Index = 0.999; Tucker-Lewis Index = 0.997; Root Mean Square Error of Approximation = 0.030). Internal consistency was good for pain (α = 0.859) and disability (α = 0.895) subscales. High test-retest reliability (Intraclass correlation coefficient [ICC]) was found for pain (ICC = 0.989 [95% Confidence Interval (CI = 0.975-0.995]) and disability (ICC = 0.990 [95% CI = 0.988-0.998]). Standard Error of Measurement values of 2.27 and 2.32 and Minimal Detectable Change values of 6.27 and 6.25 were calculated for pain and disability subscales, respectively.

CONCLUSION

The SPADI demonstrated satisfactory reliability and validity properties in a sample of patients with idiopathic frozen shoulder.

Parsonage-Turner Syndrome mimicking musculoskeletal shoulder pain: A case report during the SARS-CoV-2 pandemic era

Parsonage-Turner Syndrome or neuralgic amyotrophy is a peripheral neuropathy typically characterized by an abrupt onset of pain, followed by progressive neurological deficits (e.g. weakness, atrophy, occasionally sensory abnormalities) that involve the upper limb, mainly the shoulder, encompassing an extensive spectrum of clinical manifestations, somehow difficult to recognize. This case report describes the proper management of a 35-year-old, bank employee and sports amateur who reported subtle and progressive upper limb disorder with previous history of neck pain. SARS-CoV-2 pandemic era made patient's access to the healthcare system more complicated. Nevertheless, proper management of knowledge, relevant aspects of telerehabilitation-based consultation for musculoskeletal pain, advanced skills, tools and technologies led the physiotherapist to suspect an atypical presentation of Parsonage-Turner Syndrome. Further, neurologist consultation and electromyography suggested signs of denervation in the serratus anterior and supraspinatus muscle. Therefore, an appropriate physiotherapist's screening for referral is conducted to correct diagnosis and thorough treatment.

Intracranial Epidermoid Cyst Mimics Musculoskeletal Shoulder Disease: Findings from a Case Report in Physiotherapy Clinical Practice

Shoulder pain is often attributable to a musculoskeletal disorder, but in some instances, it may be linked to pathologies outside the physiotherapist's area of expertise. Specifically, some intracranial problems can cause pain and disability to the shoulder complex. This case report aims to describe the clinical presentation, history taking, physical examination, and clinical decision-making procedures in a patient with an intracranial epidermoid cyst mimicking a musculoskeletal disorder of the shoulder girdle. A 42-year-old man complained of pain and disability in his left shoulder. Sudden, sharp pain was reported during overhead movements, associated with intermittent tingling of the left upper trapezius and left scapular area. Moreover, the patient reported reduced hearing in his left ear and left facial dysesthesia. The physical examination led the physiotherapist to hypothesize a pathology outside the physiotherapist's scope of practice and to refer the patient to another health professional to further investigate the patient through imaging. It is essential for the physiotherapist to recognize when the patient's clinical condition requires a referral to another healthcare professional. Therefore, the physiotherapist must be able to, in a timely manner, identify signs and symptoms suggesting the presence of medical pathology beyond his expertise, through appropriate medical history collection and physical evaluation.