Which questionnaire to choose for the assessment of the shoulder in physiotherapy?

DASH, QuickDASH, SPADI or Constant score?

Caught up in our pace and our habits, we rarely take the time to make a truly informed choice of our assessment tools.

However, these shoulder questionnaires used in physiotherapy do not measure the same constructs and do not address the same clinical objectives.

In just a few minutes, this article offers an overview to help you choose the questionnaire that is best suited to your patient’s situation.

There are currently several dozen questionnaires dedicated to shoulder assessment (Angst et al., 2011).

Among the many tools available, only some are truly usable in daily practice, particularly because of their accessibility, their simplicity, and their conditions of use.

This article deliberately focuses on the tools most commonly used in practice and integrated into ABAK.

It is based on a selection of articles drawn from the scientific literature (PubMed) and from reference databases in rehabilitation.

What criteria should be used to choose a shoulder questionnaire in physiotherapy?

What do you want to measure?

Before choosing a questionnaire, the first question to ask is simple: what are you really trying to assess?

Despite similar wording, shoulder questionnaires do not measure the same dimensions. Some focus on pain, others on function, and still others on the overall disability of the upper limb. This difference is a determining factor when selecting the appropriate tool.

The SPADI (Shoulder Pain and Disability Index), for example, is structured around two main dimensions: pain and function. It is therefore particularly suitable when the objective is to monitor the symptomatic evolution of a shoulder condition (Desai et al., 2010).

Conversely, the DASH and its shorter version, the QuickDASH, assess the overall impact of upper limb disorders. They include activities involving the entire arm, and not only the shoulder. This positioning makes them relevant tools in situations where the impairment is more diffuse, or when the aim is to assess overall functional impact (Desai et al., 2010).

The Constant-Murley score adopts a different approach. It combines subjective elements (pain, activities of daily living) and clinical measurements (range of motion, strength). It is therefore not only a questionnaire, but a composite clinical assessment tool, integrating both the patient’s perception and the clinician’s examination (Desai et al., 2010).

👉 In practice, it is not a matter of choosing the “best” questionnaire, but the one that corresponds to the dimension you wish to monitor.

Monitoring pain and shoulder-specific disability → SPADI
Global functional assessment of the upper limb → DASH / QuickDASH
Clinical assessment integrating objective measures → Constant

This first step already allows a large part of the decision to be guided.

Who performs the assessment: the patient or the clinician?

Another essential criterion in choosing a questionnaire is the origin of the assessment:
is it a patient-reported score, or a measure that integrates clinical examination?

Questionnaires such as the DASH, the QuickDASH, or the SPADI are PROMs (Patient-Reported Outcome Measures). They rely exclusively on the patient’s perception: pain, difficulty in activities, and perception of their own capacities.
This type of tool presents several advantages: it is simple to administer, reproducible, and directly reflects the impact of the condition on daily life.

The Constant-Murley score, by contrast, is a composite tool. It combines:

a subjective component (pain, activities),
and an objective component based on clinical examination (range of motion, strength).

This hybrid positioning significantly modifies its use. It requires equipment, standardization of measurements, and introduces a degree of variability related to the examiner.

👉 This choice is not neutral.

PROMs allow an easy follow-up of the evolution as perceived by the patient, with good reproducibility.
Scores that integrate clinical measurements provide additional information, but at the cost of greater complexity and potential variability.
These two approaches do not oppose each other, but respond to different logics.

👉 In practice, the key is to determine what you wish to prioritize:

a measure centered on the patient’s experience,
or an assessment combining subjective perception and clinical data.

This criterion directly influences feasibility, reproducibility, and the interpretation of results.

In what clinical context?

The choice of a questionnaire also depends on the context in which it is used.
The same tool does not have the same relevance depending on the clinical situation, the stage of progression, or the objectives of the assessment.

Several elements must be taken into account.

Stage of progression

In the acute phase, when pain is significant and fluctuating, some questionnaires may be less relevant or more difficult to interpret.
Conversely, in the chronic phase or during follow-up, they allow the functional evolution and the impact of treatment to be objectified.

Type of pathology

Not all questionnaires are equally suited to all shoulder pathologies.
Some tools have been developed for broad use (upper limb disorders), while others are more specific to the shoulder.
This difference can influence their sensitivity to change and the relevance of the information collected.

Context of care

The setting in which the tool is used also influences the choice:

daily practice,
post-operative follow-up,
clinical research.

Expectations are not the same in terms of precision, standardization, or comparability of results.

Some questionnaires offer specific adaptations for particular contexts.
The DASH and the QuickDASH, for example, include optional modules intended for populations with high functional demands, such as athletes, performing artists, or certain exposed professions. These modules are scored separately and allow the assessment to be refined in specific contexts (Institute for Work and Health, DASH Outcome Measure).

👉 Their use remains, however, more limited in routine practice and does not concern all clinical situations.

Limitations specific to certain tools

Some questionnaires present limitations in specific situations.
For example, scores that include functional measurements may be less suitable when pain prevents the performance of certain tests, or when measurement conditions are not standardized.

👉 The clinical context alone does not determine the choice of the questionnaire, but it strongly conditions its relevance and interpretation.

What are the practical constraints?

Beyond theoretical considerations, the choice of a questionnaire is strongly influenced by practical constraints.
Time available, ease of use, and required equipment: these elements directly determine whether the tool can be integrated into daily practice.

Administration time

Not all questionnaires involve the same workload.
The DASH, with its 30 items, is more comprehensive but also longer to administer and to analyze.
The QuickDASH or the SPADI, being shorter, are often more compatible with use in routine consultations.

The time required is not limited to administration: it also includes checking the responses and calculating the score.

Ease of use

A tool that is easy to understand, quick to complete, and simple to score will be more easily integrated into clinical routine.
Conversely, a questionnaire perceived as complex or burdensome is likely to be abandoned, even if it has good measurement properties.

Required equipment

Some questionnaires are self-administered and do not require any specific equipment.
Others, such as the Constant-Murley score, involve clinical measurements (range of motion, strength) requiring equipment and standardized testing conditions.

This requirement may limit their use in certain contexts.

Acceptability for the patient

The length of the questionnaire, the clarity of the questions, and the relevance of the items influence patient adherence.
A tool that is too long or perceived as poorly adapted may lead to incomplete responses or a reduction in data quality.

👉 In practice, a questionnaire that is imperfect but easy to use will often be more relevant than a theoretically superior tool that is difficult to integrate.

What level of precision is expected?

The choice of a questionnaire ultimately depends on the level of precision sought and the objective of the assessment.

All the tools presented have overall satisfactory measurement properties.
However, they are not used in the same way depending on whether the aim is to monitor an individual patient, compare groups, or produce data suitable for research.

Individual follow-up

In clinical practice, the objective is most often to monitor the evolution of a patient over time.
In this context, the tool must be:

sensitive to change,
easy to repeat,
simple to interpret.

Short and reproducible questionnaires are generally well suited to this use.

Comparison and research

In a research or comparative evaluation setting, the requirements are different.
Standardization of administration conditions, precision of measurements, and comparability of results become essential.

More comprehensive tools or those integrating clinical measurements may then offer additional value.

Interpretation of scores

The interpretation of results often relies on indicators such as the MCID (Minimal Clinically Important Difference) or the MDC (Minimal Detectable Change).
These values make it possible to estimate whether a change in score is clinically meaningful or simply related to measurement variability.

Not all questionnaires have the same level of documentation regarding these indicators, which may influence their use, particularly for individual follow-up.

👉 In practice, the choice of questionnaire must be consistent with the objective pursued:
monitoring a patient, objectifying an evolution, or producing comparable data.

Some recommendations from the literature suggest adapting the choice of tools according to the objective.

In a clinical setting, short and patient-centered questionnaires such as the QuickDASH or the SPADI are often preferred.
Conversely, in a research context, more comprehensive tools such as the DASH, possibly combined with clinical measurements, may be used to obtain more detailed data (Angst et al., 2011).

Synthetic comparison of questionnaires

Before going into the details of each tool, a rapid comparison makes it possible to visualize their main differences.
This table summarizes the essential characteristics of the questionnaires most commonly used in shoulder assessment.

📊 Summary table

Questionnaire	Type	Main target	Number of items	Time	Equipment	Specificity
DASH	PROM	Upper limb function	30	~10 min + ~2 min (check & scoring)	None	Upper limb (global)
QuickDASH	PROM	Upper limb function	11	~8 min (admin)	None	Upper limb (global)
SPADI	PROM	Pain + shoulder function	13	~2–5 min (admin) + ~2 min (scoring)	None	Shoulder (specific)
Constant-Murley	Mixed	Global clinical assessment	10	~5–7 min (incl. measurements)	Yes (goniometer; dynamometer)	Shoulder (clinical)

📊 A simplified visual version of this table is available below.

This visual can be shared to facilitate decision-making in clinical practice.

👉 The times indicated correspond to use in a paper-based format, including administration, response checking, and score calculation when required.

With a digital support, these steps (checking and calculation) are automated, which significantly reduces the time required and the risk of error.

Quick reading

DASH / QuickDASH: overall view of the upper limb
SPADI: focused on shoulder pain and disability
Constant-Murley: clinical approach combining patient perception and objective measures

👉 The main differences are based on:

the dimension measured (global vs specific),
the type of assessment (patient vs clinician),
and practical constraints.

Beyond the general characteristics, score interpretation is a key element in patient follow-up.
Certain indicators, such as the MCID or the MDC, help estimate whether a change in score is clinically relevant.

How should scores be interpreted?

The populations used to establish the metrics of these questionnaires are highly heterogeneous, making any direct comparison of SEM, MDC or MCID difficult.

Rather than juxtaposing figures that are difficult to compare, we have chosen to translate them into thresholds that are directly useful for clinical practice.

These reference points are derived from a synthesis of the literature, in particular from the Shirley Ryan AbilityLab database, complemented by more recent publications.

The values below should not be interpreted as strict thresholds, but as clinical reference points to help assess a patient’s evolution.

Three zones are proposed to facilitate interpretation:

🟡 Perceived change: improvement reported by the patient, but possibly below the measurement error
🟠 Uncertainty zone: change that is difficult to interpret with certainty
🟢 Real change: improvement large enough to exceed measurement error and be considered reliable

📊 Reference thresholds

Score	🟡 Perceived change	🟠 Uncertainty zone	🟢 Real change
Constant-Murley	5–10	10–15	≥15
DASH	≈10	10–15	≥15
QuickDASH	≈8	8–11	≥11 (or ≥15 conservative)
SPADI	8–10	10–17	≥18

The values presented are indicative and may vary depending on populations and clinical contexts.
They should be interpreted with caution and always considered in relation to the individual patient (Angst et al., 2011; Roy et al., 2009).

A reference resource for the measurement properties of questionnaires is the Shirley Ryan AbilityLab database, which provides detailed syntheses of validated rehabilitation tools.

📊 A simplified visual version of this table is available below.
This visual can be shared to facilitate decision-making in clinical practice.

Which questionnaire for which situation?

Rather than searching for an “ideal” tool, it is often more relevant to adapt the choice of questionnaire to the clinical situation and to the objective of the assessment.

The following decision tree proposes a simple framework to guide this choice.

Decision tree

👉 1. What do you want to assess as a priority?

Global impact of the upper limb
→ DASH or QuickDASH
Pain and shoulder-specific disability
→ SPADI
A clinical assessment integrating objective measures
→ Constant-Murley score

👉 2. If you choose a global questionnaire (DASH / QuickDASH)

Limited time available
→ QuickDASH
Need for a more comprehensive assessment
→ DASH

👉 3. Do you want to include clinical measurements (strength, mobility)?

Yes
→ Constant-Murley score
No
→ DASH / QuickDASH / SPADI

👉 4. Does the context require a high level of simplicity?

Yes
→ prioritize QuickDASH or SPADI
No
→ all tools can be considered

📊 A visual version of this decision tree is proposed below to facilitate its use in clinical practice.

Key point

This decision tree does not aim to identify a “best” questionnaire, but to adapt the tool to the clinical situation, the available time, and the objective pursued.

Limitations and points of attention

Despite their good measurement properties, these questionnaires present a number of limitations that are important to be aware of in order to use them appropriately.

Influence of patient perception

Self-administered questionnaires (PROMs) are based on the patient’s perception.
They may be influenced by factors that are not specific to the shoulder, such as:

emotional state,
catastrophizing,
or the overall health context.

These elements may modulate the scores independently of the actual clinical evolution.

Variable specificity depending on the tools

The DASH and the QuickDASH assess the upper limb as a whole.
They may therefore be influenced by conditions located outside the shoulder, which may limit their specificity in certain situations.

Conversely, more targeted tools such as the SPADI are centered on the shoulder but may be less relevant for capturing a global functional impact.

Limitations specific to the Constant score

The Constant-Murley score presents several particularities:

inter-examiner variability related to clinical measurements,
difficulties in standardization, particularly for strength assessment,
the existence of several versions, making comparisons sometimes difficult.

Furthermore, data concerning certain measurement properties (such as thresholds for clinically meaningful change) remain limited, which requires a degree of caution when interpreting individual results.

Finally, this tool may be less appropriate in certain situations, particularly when pain severely limits the performance of tests, and it was not designed for the evaluation of unstable shoulders, for which other specific tools are more appropriate (Constant et al., 2008; Wolfensberger et al., 2016).

Interpretation remains clinical

Scores should not be interpreted in isolation.
A change in score, even when quantified, does not always reflect a clinically meaningful evolution.

👉 These tools should be considered as aids to decision-making, and not as substitutes for clinical reasoning.

Conclusion

There is no “best” questionnaire, only tools that are appropriate — or misused.

Choosing the right tool, at the right time, remains a key element of structured clinical practice.

References

Angst, F., Schwyzer, H., Aeschlimann, A., Simmen, B. R., & Goldhahn, J. (2011). Measures of adult shoulder function : Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) and Its Short Version ( Quick DASH), Shoulder Pain and Disability Index (SPADI), American Shoulder and Elbow Surgeons (ASES) Society Standardized Shoulder Assessment Form, Constant (Murley) Score (CS), Simple Shoulder Test (SST), Oxford Shoulder Score (OSS), Shoulder Disability Questionnaire (SDQ), and Western Ontario Shoulder Instability Index (WOSI). Arthritis Care & Research, 63(S11). https://doi.org/10.1002/acr.20630

Constant, C. R., Gerber, C., Emery, R. J. H., Søjbjerg, J. O., Gohlke, F., & Boileau, P. (2008). A review of the Constant score : Modifications and guidelines for its use. Journal of Shoulder and Elbow Surgery, 17(2), 355‑361. https://doi.org/10.1016/j.jse.2007.06.022

Cordesse, G. (2014). Le questionnaire DASH (Disabilities of the Arm, Shoulder and Hand), un outil pour le bilan de l’épaule ? Kinésithérapie, la Revue, 14(149), 17‑20. https://doi.org/10.1016/j.kine.2014.01.011

Desai, A. S., Dramis, A., & Hearnden, A. J. (2010). Critical appraisal of subjective outcome measures used in the assessment of shoulder disability. The Annals of The Royal College of Surgeons of England, 92(1), 9‑13. https://doi.org/10.1308/003588410X12518836440522

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Roach, K. E., Budiman‐Mak, E., Songsiridej, N., & Lertratanakul, Y. (1991). Development of a Shoulder Pain and Disability Index. Arthritis & Rheumatism, 4(4), 143‑149. https://doi.org/10.1002/art.1790040403

Roy, J., MacDermid, J. C., & Woodhouse, L. J. (2009). Measuring shoulder function : A systematic review of four questionnaires. Arthritis Care & Research, 61(5), 623‑632. https://doi.org/10.1002/art.24396

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Wolfensberger, A., Vuistiner, P., Konzelmann, M., Plomb-Holmes, C., Léger, B., & Luthi, F. (2016). Clinician and Patient-reported Outcomes Are Associated With Psychological Factors in Patients With Chronic Shoulder Pain. Clinical Orthopaedics & Related Research, 474(9), 2030‑2039. https://doi.org/10.1007/s11999-016-4894-0

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Which questionnaire to choose for the assessment of the shoulder in physiotherapy?

DASH, QuickDASH, SPADI or Constant score?