The DASH QuestionnaireThe Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure is a 30-item, self-report questionnaire designed to assess the patient’s health status during the previous week. The items enquire about the degree of difficulty in performing different physical activities because of arm, shoulder and hand problems (21 items), the severity of each of the symptoms of pain, activity-related pain, tingling, weakness and stiffness (five items) and the impact of the problem on social functioning, work, sleep and self-image (four items). Each item has five response options. The scores are then used to calculate a scale score ranging from 0 (no disability) to 100 (most severe disability)—this is called the DASH score. The DASH questionnaire is used as an indicator of the impact of an impairment on the level and type of disability. It assesses the whole person’s ability to function, even if the person is compensating with the other limb.The questionnaire was designed jointly by researchers at the Institute of Work and Health in Canada and the American Academy of Orthopaedic Surgeons.
Scoring the DASH. The DASH Outcome Measure is scored in two components: the disability/symptom section (30 items, scored 1-5) and the optional high. INSTRUCTIONS: This questionnaire asks about your symptoms as well as your ability to perform certain activities.Please answer every question, based on your condition in the last week.If you did not have the opportunity to perform an activity in the past week, please make your best estimate on which response would be the most accurate. It doesn't matter which hand or arm you use to perform the.
Their work was supported by many learned North American associations and societies including the American Association for Hand Surgery, the American Orthopedic Society for Sports Medicine, the American Shoulder and Elbow Surgeons, the American Society for Surgery of the Hand, the Arthroscopy Association of North America and the American Society of Plastic and Reconstructive Surgeons.It was developed both to help describe the disability experienced by people with upper-limb disorders and to monitor changes in symptoms and function over time. Extensive testing has shown that the DASH performs well in both these roles. It gives clinicians and researchers the advantage of having a single, reliable instrument that can be used to assess any or all joints in the upper extremity.In addition to the basic DASH questionnaire, the DASH outcome measure also contains two-optional, four-item modules intended to measure symptoms and function in athletes, performing artists and other workers whose jobs require a high degree of physical performance. Because they may be having difficulties only at high performance levels—which are beyond the scope of the 30-item DASH outcome measure, occupational physicians and other clinicians may find the modules, which are scored separately from the DASH, useful in assessing these professional workers.
Guidance on scoring is available in Scoring the DASH. UsageThe questionnaire is free to use, but there are conditions of use and copyright requirements. It can be downloaded from. The scoring was updated in 2002 to be easier and to allow for analysis in the presence of missing data.
Upper Extremity Musculoskeletal Disorders.Gabel (2009): Excellent test-retest reliability (ICC=0.94).Polson (2010): Excellent test-retest reliability (ICC=0.94).Gummesson (2006; n=105; mean age=52; symptoms more than 2 months): Excellent test-retest reliability (ICC=0.93).Franchignoni (2011; n=283; mean age=52.3(15.9) years): Excellent item separation reliability (ICC=0.99)Shoulder, Elbow & Wrist Arthroplasty Patients.Angst (2009; n=320): Excellent test-retest reliability (ICC=0.93)Common Shoulder Conditions. Fayad (2009; n=153; mean age=57): Excellenttest-retest reliability (ICC=0.94).
Upper Extremity Musculoskeletal DisordersGummesson (2006).For the patients who rated their arm status after surgery as better (“much better” and “somewhat better”) and as “unchanged,” the difference in area under ROC curves for DASH & QuickDASH=0.01, indicating excellent convergent validity with the DASH, as there is no ability to discriminate a difference between the 2 groups. In the ROC analysis comparing the ability to discriminate “much better” from “somewhat better,” the difference in the area under the ROC curves was 0.03, also indicating excellent convergent validity.Gabel (2009).Construct validity was demonstrated by a standard t-test that verified change between the baseline and the repeated measures.Shoulder, Elbow & Wrist Arthroplasty Patients Angst (2009).
The higher the effect size, the more sensitive (responsive) is a scale and a more sensitive scale requires more specific item questions. In this sense, the responsiveness is also a measure of the instrument’s specificity and is considered to be a form of construct validity. ES: QuickDASH/DASH= 1.42/1.65. Neck & Upper Extremity Musculoskeletal Disorders.Fan (2011): High responsiveness (ES=1.3; SRM=1.0)Upper Extremity Musculoskeletal Disorders.Gabel (2009): High responsiveness (ES=1.05).Polson (2010): High responsiveness (ES=1.02; SRM=1.1).Gummesson (2006): Moderate responsiveness (ES=0.5; SRM=0.63)Shoulder, Elbow & Wrist Arthroplasty Patients.Angst (2009): High responsiveness (ES: QuickDASH/DASH=1.42/1.65)Common Shoulder Conditions. Fayad (2009): High responsiveness (ES=1.23; SRM=1.09). BibliographyAngst, F., J.
Goldhahn, et al. 'How sharp is the short QuickDASH? A refined content and validity analysis of the short form of the disabilities of the shoulder, arm and hand questionnaire in the strata of symptoms and function and specific joint conditions.' Quality of Life Research 18(8): 1043-1051.Angst, F., H.
Schwyzer, et al. 'Measures of adult shoulder function: Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) and its short version (QuickDASH), 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): S174-S188.Beaton, D., C.
Bombardier, et al. 'Recommendations for the cross-cultural adaptation of the DASH & QuickDASH outcome measures.' Institute for Work & Health 1(1): 1-45.Beaton, D. Wright, et al. 'Development of the QuickDASH: comparison of three item-reduction approaches.' The Journal of Bone & Joint Surgery 87(5): 1038-1046.Fan, Z. Smith, et al.
'Assessing Validity of the Quick DASH and SF-12 as Surveillance Tools among Workers with Neck or Upper Extremity Musculoskeletal Disorders.' Journal of Hand Therapy 21(4): 354-365.Fan, Z.
Smith, et al. 'Responsiveness of the QuickDASH and SF-12 in workers with neck or upper extremity musculoskeletal disorders: one-year follow-up.' Journal of occupational rehabilitation 21(2): 234-243.Fayad, F., M.-M. Lefevre-Colau, et al. 'Reliability, validity and responsiveness of the French version of the questionnaire Quick Disability of the Arm, Shoulder and Hand in shoulder disorders.' Manual therapy 14(2): 206-212.Franchignoni, F., G.
Ferriero, et al. 'Psychometric properties of QuickDASH–A classical test theory and Rasch analysis study.' Manual therapy 16(2): 177-182.Gabel, C. Yelland, et al. 'A modified QuickDASH-9 provides a valid outcome instrument for upper limb function.' BMC musculoskeletal disorders 10(1): 161.Gummesson, C., M. 'The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): validity and reliability based on responses within the full-length DASH.'
BMC Musculoskeletal Disorders 7(1): 44.Haas, F., M. Hubmer, et al. 'Long-term subjective and functional evaluation after thumb replantation with special attention to the Quick DASH questionnaire and a specially designed trauma score called modified mayo score.' Journal of Trauma-Injury, Infection, and Critical Care 71(2): 460-466.Kennedy, C., D. Beaton, et al.
'The DASH and Quick DASH Outcome Measure's Manual.' Kennedy, C., D. Beaton, et al. 'The DASH and Quick DASH Outcome Measure's Manual Institute for Work & Health.'
Toronto, Ontario.London, D. Stepan, et al. 'Performance characteristics of the verbal QuickDASH.' J Hand Surg Am 39(1): 100-107.Mardani-Kivi, M., M. Karimi-Mobarakeh, et al.
“The effects of corticosteroid injection versus local anesthetic injection in the treatment of lateral epicondylitis: a randomized single-blinded clinical trial.” Archives of Orthopaedic and Trauma Surgery 133(6): 757-763.Matheson, L. Melhorn, et al. 'Reliability of a visual analog version of the QuickDASH.' The Journal of Bone & Joint Surgery 88(8): 1782-1787.Mehta, S., J. MacDermid, et al.
'Concurrent validation of the DASH and the QuickDASH in comparison to neck-specific scales in patients with neck pain.' Spine 35(24): 2150-2156.Mintken, P.
Glynn, et al. 'Psychometric properties of the shortened disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) and Numeric Pain Rating Scale in patients with shoulder pain.'
Journal of Shoulder and Elbow Surgery 18(6): 920-926.Nakamoto, H., Y. Oshima, et al. 'Usefulness of QuickDASH in patients with cervical laminoplasty.' J Orthop Sci 19(2): 218-222.Niekel, M. Lindenhovius, et al. 'Correlation of DASH and QuickDASH with measures of psychological distress.' The Journal of hand surgery 34(8): 1499-1505.Polson, K., D.
'Responsiveness, minimal importance difference and minimal detectable change scores of the shortened disability arm shoulder hand (QuickDASH) questionnaire.' Manual therapy 15(4): 404-407.Quatman-Yates, C.
Gupta, et al. 'Internal consistency and validity of the QuickDASH instrument for upper extremity injuries in older children.' J Pediatr Orthop 33(8): 838-842.Stepan, J. London, et al. 'Accuracy of patient recall of hand and elbow disability on the QuickDASH questionnaire over a two-year period.' J Bone Joint Surg Am 95(22): e176. Information Provided by Shirley Ryan AbilityLabThe Rehabilitation Measures Database (RMD) is a service provided by the Shirley Ryan AbilityLab, the and leader in translational medicine.
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