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

DASH, QuickDASH, SPADI or Constant-Murley

Caught up in our daily routines, we rarely take the time to truly choose our assessment tools.

Yet shoulder questionnaires do not measure the same things…
and do not serve the same clinical purposes.

👉 In just a few minutes, here are the key points to help you choose the right tool, at the right time.

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Why use a shoulder questionnaire?

Standardized questionnaires help to assess:

• pain
• function
• impact on daily activities

They provide a measure of the patient’s perception, complementing the clinical examination.

But be careful:
👉 not all questionnaires measure the same dimensions.

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First question: what do you actually want to measure?

This is the key point.

👉 Monitoring pain and shoulder-specific disability
→ SPADI

👉 Assessing overall upper limb function
→ DASH / QuickDASH

👉 Clinical assessment including objective measures
→ Constant-Murley

👉 The goal is not to choose “the best questionnaire”…
but the one that matches your clinical objective.

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Patient or clinician: who is assessing?

Another essential distinction:

🧍 Patient-reported questionnaires (PROMs)

• DASH
• QuickDASH
• SPADI

👉 Measure the patient’s perception
👉 Simple, fast, reproducible

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👨‍⚕️ Composite clinical score

• Constant-Murley

👉 Combines:

• patient-reported outcomes
• objective measures (range of motion, strength)

👉 More comprehensive… but also more demanding

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Clinical context: a key factor

The choice also depends on the situation:

• acute vs chronic phase
• isolated pathology vs global impairment
• clinical follow-up vs research

👉 The same questionnaire may be relevant… or not, depending on the context.

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Practical constraints: the real filter in daily practice

In reality, these are often what determine the choice:

⏱ Time

• DASH → longer
• QuickDASH / SPADI → faster

🧩 Simplicity

• short questionnaires → more likely to be used
• complex tools → often abandoned

🧪 Equipment

• Constant → requires equipment and standardization

👉 An imperfect but usable tool is often more valuable than a perfect tool… that is never used.

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Quick comparison

Questionnaire	Time	Specificity
DASH	~10–15 min	Upper limb
QuickDASH	~5–10 min	Upper limb
SPADI	~3–5 min	Shoulder-specific
Constant	~5–7 min	Clinical score (mixed)

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Interpreting scores: an often overlooked point

Measuring is one thing.
Interpreting is another.

Score changes rely on several concepts:

• measurement error (SEM)
• minimal detectable change (MDC)
• minimal clinically important difference (MCID)

👉 However, these values are derived from highly heterogeneous populations,
making their direct use… challenging.

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A common difficulty in practice

In some cases, particularly with the Constant score:

👉 a patient may feel improvement
👉 without exceeding measurement error thresholds

In other words:
➡️ perceived improvement
➡️ but not yet objectively confirmed

This discrepancy does not question the validity of the tools…
but it does complicate interpretation.

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A more practical approach: thinking in zones

To simplify interpretation, it is helpful to think in three levels:

🟡 perceived improvement
🟠 uncertainty zone
🟢 real change

👉 This approach helps reconcile:

• scientific rigor
• clinical reality

📊 Detailed thresholds and how they are defined are presented in the full article.

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Which questionnaire for which situation?

👉 A few simple guidelines:

• Limited time → QuickDASH or SPADI
• Need for shoulder specificity → SPADI
• Global upper limb assessment → DASH / QuickDASH
• Comprehensive clinical assessment → Constant

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Key takeaways

👉 No questionnaire is universal
👉 The choice depends on context and objectives
👉 Interpretation is as important as measurement

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Go further

This article provides a simplified overview for immediate clinical use.

👉 The full version includes:

• measurement properties (SEM, MDC, MCID)
• interpretation thresholds by questionnaire
• specific limitations of each tool
• a complete decision tree
• full references

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💡 A score is only meaningful if you know how to interpret it.

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