|Year : 2021 | Volume
| Issue : 2 | Page : 58-62
Translation of shoulder pain and disability index in Gujarati language and analysis of its psychometric properties in persons with shoulder pain
Vidhi Paras Bhatt, Nehal Shah, Krishna M Bhrambhatt, Dharti Kapadia
Department of Orthopedic, SBB College of Physiotherapy, V.S. General Hospital Campus, Ahmedabad, Gujarat, India
|Date of Submission||18-May-2021|
|Date of Decision||22-Oct-2021|
|Date of Acceptance||07-Nov-2021|
|Date of Web Publication||15-Feb-2022|
Dr. Vidhi Paras Bhatt
8/B Veenakunj Society, Near Vastrapur Railway Crossing, Opposite R.R. Dwivedi High School, Vejalpur, Ahmedabad - 380 051, Gujarat
Source of Support: None, Conflict of Interest: None
BACKGROUND: Shoulder pain and disability index (SPADI) is a joint specific tool that helps to estimate the pain and disability in persons with shoulder pain. It is a self-administered index consisting of 13 items divided into two subscales: pain and disability. The study aims to find inter- and intra-rater reliability and concurrent validity of Gujarati version of SPADI (SPADI-G) in persons with shoulder pain in Gujarati population. SPADI-G can prove to be helpful in objectively defining the pain and disability in persons with shoulder pain.
MATERIALS AND METHODS: A prior permission was taken from original author for translation of SPADI into Gujarati language. The translation procedure was carried out according to the guidelines provided by the WHO with forward and backward translation. The psychometric properties were analyzed in 20 persons (mean age of 52.65 ± 7.76) with different shoulder pathologies. Informed oral consent was taken from persons before the study. The validity was obtained by correlating SPADI-G and visual analog scale (VAS). The intrarater reliability was established by test–retest method within a span of 2 days. The questionnaire was again administered after 1 week by two different investigators to test the interrater reliability.
RESULTS: The concurrent validity was established with a positive correlation with moderate strength between SPADI-G and VAS (Pearson's coefficient of correlation: r = 0.587, P < 0.01). The intrarater reliability was found between 0.853 and 0.977 (intraclass correlation coefficient [ICC] = 0.943) and interrater reliability was found between 0.914 and 0.983 (ICC = 0. 959). There was a high internal consistency with Cronbach's alpha = 0.967. The Bland–Altman plot analysis was performed for SPADI-G scores in between the two raters, which showed agreement between the two scores within the limits of agreement with 95% confidence interval. The linear regression showed no proportional bias.
CONCLUSION: The results show good validity with moderate correlation between VAS and SPADI-G and excellent inter- and intra-rater reliability for SPADI-G in persons with shoulder pain.
Keywords: Gujarati version, inter- and intra-rater reliability, translated shoulder pain and disability index, validity
|How to cite this article:|
Bhatt VP, Shah N, Bhrambhatt KM, Kapadia D. Translation of shoulder pain and disability index in Gujarati language and analysis of its psychometric properties in persons with shoulder pain. Physiother - J Indian Assoc Physiother 2021;15:58-62
|How to cite this URL:|
Bhatt VP, Shah N, Bhrambhatt KM, Kapadia D. Translation of shoulder pain and disability index in Gujarati language and analysis of its psychometric properties in persons with shoulder pain. Physiother - J Indian Assoc Physiother [serial online] 2021 [cited 2022 May 21];15:58-62. Available from: https://www.pjiap.org/text.asp?2021/15/2/58/337726
| Introduction|| |
Shoulder pain is a common and disabling condition reported with an annual incidence of 14.7 per 1000 patients and with a lifetime prevalence of up to 70%. The shoulder pain is an umbrella term with many underlying conditions, such as bicipital tendinitis, rotator cuff impingement syndrome, adhesive capsulitis, and rotator cuff tendinitis. Recovery from shoulder pain can be slow, and recurrence rates are high with 25% of those affected by shoulder pain reporting previous episodes and 40%–50% reporting persisting pain or recurrence at 12-month follow-up.
The major impairments in patients with shoulder pathology are pain, decreased range of motion, and disability. Therefore, it is essential to use a valid and reliable method for assessment of pain and disability in the persons with shoulder pain. For musculoskeletal conditions such as shoulder pain, appropriately designed, self-reported questionnaires and scales can help objectively assess the pain and disability. In the clinical settings, many such scales are used such as the Disability of the Arm, Shoulder, and Hand (DASH) Questionnaire, the Shoulder Pain and Disability Index (SPADI), the American Shoulder and Elbow Surgeons (ASES), and Constant (Murley) Score.
SPADI is a joint specific tool that helps to estimate the pain and disability in persons with shoulder pain. The literature review shows SPADI as a highly valid and reliable scale for various shoulder joint pathologies. Moreover, SPADI is easy to administer with quick scoring on pain and disability, making it suitable for clinical settings and research purpose.
SPADI has been translated into many languages such as German, Arabic, Italian, Dutch, and Thai. However, SPADI is not translated into Gujarati language. Robust research on various shoulder joint ailments arises a need for translation and psychometric analysis of SPADI into Gujarati language. This can help clinicians and researchers to objectively assess and define pain and disability in persons with shoulder pain in Gujarati-speaking population.
Therefore, the present study aims to translate SPADI scale into Gujarati language and to find out concurrent validity and inter- and intra-rater reliability in persons with various shoulder joint pathologies in Gujarati population.
| Materials and Methods|| |
Before the commencement of the study, ethical clearance was taken from the institutional review board of Suresh Brahmakumar Bhatt College of Physiotherapy. Informed oral consent was taken from the persons involved in the study.
A cross-sectional study was carried out in the outpatient department (OPD) setting, physiotherapy department of Suresh Brahmakumar Bhatt College of Physiotherapy, Sardar Vallabhbhai Patel (SVP) Hospital, Ahmedabad, Gujarat. The study was conducted in two phases; phase 1 of translation into Gujarati language followed by phase 2 of psychometric analysis of the scale. For translation of scale, a prior permission was obtained from the original author Roach et al. (Department of Physical Therapy, University of Miami) of SPADI scale. Thereafter, the psychometric properties of the scale were analyzed.
For this, persons with the age group of 20–60 years, well acquainted to Gujarati language, and with various shoulder pathologies such as adhesive capsulitis, bicipital tendinitis, impingement syndrome, and rotator cuff tendinitis were included in the study. The persons unable to read and understand Gujarati language were excluded. Persons with malignancy, pregnancy, lactation, cognitive impairment, and neurological disorder were excluded from the study.
Shoulder pain and disability index
SPADI measures pain and disability associated with shoulder pathology. The SPADI is a self-administered index consisting of 13 items divided into two subscales: pain and disability. It is designed to measure the impact of shoulder pathology in terms of pain and disability, for both current status and change in status over time in OPD settings.
The process of translation of SPADI scale was carried out in accordance to the guidelines by WHO.
The translation and validation of the SPADI scale were done by following steps.
Step 1 – Forward translation
For the forward translation of scale, an official university-accredited translator was approached who was fluent in both English and Gujarati language. The scale was translated from English to Gujarati language.
Step 2 – Expert panel
The scale was then given to an expert panel that constituted of two orthopedic surgeons with more than 10 years of experience and three senior physiotherapists working in the field of musculoskeletal rehabilitation with more than 10 years of experience. The panel was given the original as well as translated version of the scale. Their inputs regarding the corrections and modifications were provided, which were put into the final version of the scale.
Step 3 – Backward translation
The scale was then backward translated from Gujarati to English by another translator. He was blinded from the original English version. Both the original and backward translated scales were compared if there was any change in the original interpretation.
Step 4 – Pretesting and final version preparation
In this step, a small population of 10 patients with shoulder pathologies were administered the scale. They were explained how to fill up the questionnaire. An in-detail interview with following questions was taken:
- How well they understood the components of the scale?
- Was there any interpretation difficulty for the activities put in scale?
- Were they able to score their pain and activity limitation at ease?
They were to give a generalized impression on the clarity of translated components of scale. Their inputs were regarded and the scale was modified accordingly. This made the final version of Gujarati-translated SPADI scale (SPADI-G).
In the present study, SPADI-G was self-administered. The therapist acquainted patient about the purpose and marking of the score. All items were rated using visual analog scale (VAS). Verbal anchors representing opposite extremes of the dimension being measured were placed at either end of the line. The patient was instructed to place a mark on the line in the position that best represented his/her experience during activity attributable to the shoulder problem. The subscale scores were calculated by adding the item scores for that subscale and dividing this number by the maximum score possible for the items that are deemed applicable by the subject. This number was then multiplied by 100. Any item marked by the patient as not applicable was not included in the maximum possible score. If a subject marked more than two items not applicable, no score was calculated. Therefore, scores could theoretically range from 0 to 100 with higher scores indicating greater impairment. The total SPADI score was calculated by averaging the pain and disability subscale scores. The scoring pattern was kept similar to the original English version of SPADI.
After translating the scale, psychometric properties were established by finding concurrent validity and intra- and inter-rater reliability.
Steps for establishing concurrent validity
For establishing concurrent validity, SPADI-G scale was compared with standardized VAS. The persons were administered SPADI-G along with VAS.
The pain VAS is a unidimensional measure of pain intensity, which has been widely used in diverse adult populations to know the intensity of pain. For pain intensity, the scale is most commonly anchored by “no pain” (score of 0) and “pain as bad as it could be” or “worst imaginable pain” (score of 100 (100-mm scale]). A higher score indicates greater pain intensity. For the present study, pain intensity was marked on activity for statistical analysis.
For psychometric analysis of SPADI-G, the sample size was calculated with 80% power and alpha = 0.05. A total of 20 persons with mean age of 52.65 ± 7.76 years were recruited with different shoulder joint pathologies to establish the concurrent validity and inter-and intra-rater reliability. There were 9 persons with adhesive capsulitis, 8 with bicipital tendinitis, and 3 with rotator cuff impingement.
To find the intrarater reliability, the test–retest reliability was assessed by administering the same scale to same patient after 48 h. The interrater reliability was determined by administering the scale to the same patient by two different raters, who were blinded by the initial readings after 1 week. This 1-week time period made sure that the persons do not remember their original scores.
The data obtained were statistically analyzed using Statistical Package for the Social Sciences (SPSS version 20 by IBM, Bangalore) and Microsoft Excel 2007.
| Results|| |
The present study was undertaken with 20 persons consisting of 10 males and 10 females with a mean age (standard deviation) of 52.65 (±7.76) years. Out of these, 9 persons had adhesive capsulitis, 8 with bicipital tendinitis, and 3 with rotator cuff impingement.
The concurrent validity was established by correlating the SPADI-G and VAS scores. There was a moderate strength positive correlation with Pearson's correlation coefficient (r = 0.587, P = 0.006). This indicated a good concurrent validity.
The intra- and inter-rater reliability was found with intraclass correlation coefficient (ICC). The intrarater reliability was ICC = 0.943 and interrater reliability was ICC = 0.959. This showed excellent inter- and intra-rater reliability. There was a high internal consistency with Cronbach's alpha = 0.967.
A high correlation value does not signify a good agreement between two set of scores. Hence, Bland–Altman test was applied to know the agreement between the scores of two different raters. The Bland–Altman plot showed agreement with the confidence interval of 95% between the SPADI-G scores of two different raters [Figure 1].
|Figure 1: Bland–Altman plot analysis for interobserver reliability scores|
Click here to view
The linear regression was done to know any proportional bias between the SPADI-G scores of two different raters. This helps signify if values of any one rater were higher or lower in proportion to another rater. The linear regression was with the dependent variable as difference between the scores of SPADI-G by two different raters, and independent variable was mean of SPADI-G scores. The test showed t score = 0.622, P = 0.542; t score = 0.54, P = 0.957. The linear regression with P > 0.05 showed no proportional bias in the interrater scores.
| Discussion|| |
The SPADI scale is a self-reported, patient outcome measure. The 13-item in SPADI scale measures various components of pain and disability in patients with shoulder joint pathology. The SPADI demonstrates good construct validity, correlating well with other region-specific shoulder questionnaires. It has been shown to be responsive to change over time, in a variety of patient populations, and is able to discriminate adequately between patients with improving and deteriorating conditions. No large floor or ceiling effects for the SPADI have been observed. This makes SPADI a valid and reliable measuring instrument in the clinical settings and research purpose.
The results of the present study with translation of SPADI to Gujarati language showed good concurrent validity and excellent inter- and intra-rater reliability.
The concurrent validity of SPADI-G was obtained by correlating the VAS score (on activity) with SPADI-G scores. VAS score on activity gave a generalized impression of pain and disability in shoulder which was then correlated with SPADI-G subscales. VAS can be considered as valid, reliable, and responsive as multi-itemed scales assessing the quality of life. Moreover, test–retest reliability of VAS has been shown to be good, but higher among literate (r = 0.94, P < 0.001) than illiterate patients (r = 0.71, P < 0.001). The present study showed moderate positive correlation between VAS and SPADI-G (Pearson's coefficient of correlation: r = 0.587, P < 0.01), suggesting a good concurrent validity. Unlike the present study, the other versions of SPADI established construct validity. The correlation coefficient was found higher in German SPADI (r = 0.6) and Thai SPADI (r = 0.7) while lower in Tamil SPADI (r = −0.45) compared to the present study.
The internal consistency of SPADI-G scale was excellent with Cronbach's alpha = 0.967 and similar to the original version (English) of Roach et al., Cronbach's alpha = 0.95 and other versions including German, Cronbach's alpha = 0.95 and Thai, Cronbach's alpha = 0.95.
The Bland–Altman plot analysis showed a good agreement between the two rater scores analysis, with mean of 3.146 and upper limit of 19.482 and lower limit of −13.190. The plot showed scores to be within the limits of agreement with 95% confidence interval.
Future studies can include patients with shoulder pathologies of a different age group. The SPADI-G can be validated in persons with traumatic shoulder pain and in shoulder arthroplasty. Future research work can also investigate the association of SPADI-G with other outcome measures such as DASH Questionnaire and the ASES.
| Conclusion|| |
The original SPADI was translated in Gujarati language, with forward and backward translation as per the WHO guidelines. The psychometric analysis was done for SPADI-G to find concurrent validity and inter- and intra-rater reliability. SPADI-G showed good concurrent validity and excellent test–retest reliability and internal consistency. Henceforth, it is a valid and highly reliable scale that can be used to assess patients with various shoulder pathologies. It can help to objectively define patient's pain and disability among Gujarati-speaking population in Gujarat.
The authors are very thankful to the original author of English version of SPADI, Roach KE et al. for her kind approval for translation of SPADI into Gujarati language. The authors are very grateful to the patients who willingly participated in the study. The authors provide sincere thanks to the expert panel member as follows for sharing their knowledge and experience in the research work:
- Dr. Neel Bhavsar (Orthopedic surgeon)
- Dr. Tarkin Amin (Orthopedic surgeon)
- Dr. Nipa Shah (PT) (Senior physiotherapist)
- Dr. Binal Gajjar (PT) (Senior physiotherapist)
- Dr. Komal Shah (PT) (Senior physiotherapist).
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Cadogan A, Laslett M, Hing WA, McNair PJ, Coates MH. A prospective study of shoulder pain in primary care: Prevalence of imaged pathology and response to guided diagnostic blocks. BMC Musculoskelet Disord 2011;12:119.
Roy JS, MacDermid JC, Woodhouse LJ. Measuring shoulder function: A systematic review of four questionnaires. Arthritis Rheum 2009;61:623-32.
Roach KE, Budiman-Mak E, Songsiridej N, Lertratanakul Y. Development of a shoulder pain and disability index. Arthritis Care Res 1991;4:143-9.
Bujang MA, Mohamad Adam M, Baharum N. A simplified guide to determination of sample size requirements for estimating the value of intra class correlation coefficient: A review. Arch Orofac Sci 2017;12.
Akoglu H. User's guide to correlation coefficients. Turk J Emerg Med 2018;18:91-3.
Giavarina D. Understanding Bland Altman analysis. Biochem Med (Zagreb) 2015;25:141-51.
Breckenridge JD, McAuley JH. Shoulder pain and disability index (SPADI). J Physiother 2011;57:197.
de Boer AG, van Lanschot JJ, Stalmeier PF, van Sandick JW, Hulscher JB, de Haes JC, et al
. Is a single-item visual analogue scale as valid, reliable and responsive as multi-item scales in measuring quality of life? Qual Life Res 2004;13:311-20.
Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual analog scale for pain (VAS Pain), numeric rating scale for pain (NRS Pain), McGill pain questionnaire (MPQ), short-form McGill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), short form-36 bodily pain scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP). Arthritis Care Res (Hoboken) 2011;63 Suppl 11:S240-52.
Jeldi AJ, Aseer AL, Dhandapani AG, Roach KE. Cross-cultural adaption, reliability and validity of an Indian (Tamil) version for the shoulder pain and disability index. Hong Kong Physiother J 2012;30:99-104.
Angst F, Goldhahn J, Pap G, Mannion AF, Roach KE, Siebertz D, et al
. Cross-cultural adaptation, reliability and validity of the German Shoulder Pain and Disability Index (SPADI). Rheumatology (Oxford) 2007;46:87-92.
Phongamwong C, Choosakde A. Reliability and validity of the Thai version of the shoulder pain and disability index (Thai SPADI). Health Qual Life Outcomes 2015;13:136.