Nepali translation, cross-cultural adaptation and measurement properties of the Shoulder Pain and Disability Index (SPADI)

Sudarshan Kc,Saurab Sharma,Karen Ginn,Darren Reed,Tawfiq Almadi

doi:10.1186/s13018-019-1285-8

Abstract

BackgroundThe Shoulder Pain and Disability Index (SPADI) is a 13-item shoulder-specific patient-reported outcome measure (PROM). The English version is easy to use and has demonstrated excellent measurement properties for both clinical and research settings. The availability of the SPADI in Nepali would facilitate shoulder research and enhance management of patients with shoulder pain in Nepal. Therefore, the purpose of this study was to translate and cross-culturally adapt the SPADI into Nepali (SPADI-NP) and evaluate its measurement properties.MethodsThe translation and adaptation process followed international guidelines. Participants completed SPADI-NP on two assessments (N = 150 at initial and 119 at follow-up assessment). A Nepali version of the Global Rating of Change score was completed at follow-up. Assessment of measurement properties included analysis of internal consistency (Cronbach’s α), minimal detectable change (MDC) with standard error of measurement (SEM), test-retest reliability (intraclass correlation coefficient; ICC), validity (factor structure, construct using Pearson’s correlation with the Disability of Arm and Hand [DASH]) and responsiveness (area under the curve; AUC) with minimal important change (MIC).ResultsMinor changes were integrated in the adaptation process to improve cultural relevance such as dress items. Items were largely loaded under two factors (pain and disability), internal consistencies were good for the pain construct (α = 0.82) and disability (α = 0.88) and test-retest reliability was excellent (pain = 0.89, disability = 0.96). MDC was 5.7 (out of 100) with SEM = 2.1. Strong associations with the DASH (r = 0.63 pain, r = 0.81 disability) demonstrated its construct validity. The AUC was 0.68 and MIC was 12.3 (out of 100).ConclusionThe Nepali version of the SPADI demonstrated excellent reliability and validity. It can be used for the assessment of shoulder pain and disability in patients with shoulder pain in Nepal in both clinical practice and research.

Highlights

Health-related patient-reported outcome measures (PROMs) are an important component of clinical assessments, providing the patients’ perspective of their health status and functional capacity
The study was completed in two phases: translation and adaptation of the English version of the Shoulder Pain and Disability Index (SPADI) as recommended by the American Association of Orthopaedic Surgeons (AAOS) Outcomes Committee [8] and measurement property testing of the Nepali version of the SPADI as per the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist [9]
After exclusion of invalid questionnaires with > 2 items left blank, 150 completed SPADI-NP questionnaires were available from the initial assessment (66 by interview, 84 by self-report) and at follow-up assessment 119 (79%; 84 by interview over the phone, 25 by interview at a hospital, 10 by selfreporting)

Summary

Introduction

Health-related patient-reported outcome measures (PROMs) are an important component of clinical assessments, providing the patients’ perspective of their health status and functional capacity. PROMs can direct treatment and provide valuable feedback of progress of clinical conditions. They are increasingly used as primary outcome measures in research. The Shoulder Pain and Disability Index (SPADI) is one of the most commonly used shoulder-specific heath status questionnaires [2] and has been described as the most responsive shoulder pain and disability tool for shoulder conditions [3] It has been ranked as one of the most relevant questionnaires by shoulder patients being easy to complete and the least time consuming [4]. The Shoulder Pain and Disability Index (SPADI) is a 13-item shoulder-specific patient-reported outcome measure (PROM). The purpose of this study was to translate and crossculturally adapt the SPADI into Nepali (SPADI-NP) and evaluate its measurement properties

Objectives

Methods

Results

Discussion

Conclusion