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DASH Outcome Measure

From Physiopedia

Original Editor - Nicole Wente as part of the Temple University EBP Project


Top Contributors -

Nicole Wente, Rachael Lowe, Scott A Burns and Laura Ritchie  

Contents

Summary

The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire is a 30-item questionnaire that looks at the ability of a patient to perform certain upper extremity activities.[1][2][3] This questionnaire is a self-report questionnaire that patients can rate difficulty and interference with daily life on a 5 point Likert scale.[1][2].  

The QuickDASH is an abbreviated version of the original DASH outcome measure[4] In comparison to the original 30 item DASH outcome measure, the QuickDASH only contains 11 items[4] It is a questionnaire that measures an individual’s ability to complete tasks, absorb forces, and severity of symptoms[4] The QuickDASH tool uses a 5-point Likert scale from which the patient can select an appropriate number corresponding to his/her severity level/ function level[5]

Intended Population

  • The intended population for the DASH is any person with one or more upper extremity musculoskeletal disorders.[1][2][3] 
  • The QuickDASH outcome measure is designed to be used on patients presenting with one or more disabilities of the arm, shoulder, and hand[4][5]

Scoring 

DASH and QuickDASH Scoring Formula = ([(sum of n responses)/n] -1)(25) where n represents the number of completed items[1].

  • DASH cannot be computed if greater than three items are missing.[1]
  • QuickDASH cannot be computed if greater than 1 item is missing.[1]

Level of Disability

In both the DASH and QuickDASH a higher scores indicate a greater level of disability and severity, whereas, lower scores indicate a lower level of disability.[1][3] The score on both test ranges from 0 (no disability) to 100 (most severe disability)[4]

Additonal Optional Modules

The DASH and QuickDASH have two optional 4-item additional modules that can be used. The two optional additional modules are:[1]

  • Work Module - Used for workman compensation patients or those whose disability is affecting their ability to work
  • Sports/Performing Arts Module - Used for Athletes and Musicians

The optional modules cannot be scored if an answer is missing.[1]

Evidence

Table

Psychometric Property DASH QuickDASH
Reliability ICC(2,1) = 0.96[2] ICC(2,1) = 0.90[6]
Validity Pearson r > 0.70[2] Pearson r > 0.70[7]
Minimal Detectable Change (MDC) 12.75% - 17.23%[3] 11.2%[6]
Minimal Clinical Important Difference (MCID)     -------- 8%[6]

(MDC)– the smallest amount of change that has to occur before the change can be considered a true change and not error[3]
(MCID) – the amount of change in the score that has to occur before it signifies an important or beneficial difference in the patient’s condition.
[6]

Responsiveness

  • DASH

               - good responsiveness to self-rated changes before and after most arm, shoulder, and hand diagnoses and surgeries[3] 
               - comparable responsiveness compared to other joint and disease-specific measures[2]

  • QuickDASH

                - slightly more responsive to the original DASH outcome measure and, clinically, may be preferable due to shorter length[4][7]

Miscellaneous

  • The DASH is available in 27 different languages.[1] Also many of these versions have had or are in the process of being tested for their psychometric properties.[1]
  • The QuickDASH measure has more relative efficiency compared with the DASH[7] Recent studies have also analyzed the reliability of a modified QuickDASH outcome measure, from a questionnaire into a visual analog version[5]

Recent Related Research (from Pubmed)

References

  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 The DASH outcome measure. Available at http://www.dash.iwh.on.ca, Accessed March 12, 2011.
  2. 2.0 2.1 2.2 2.3 2.4 2.5 Beaton D.E., Katz J.N., Fossel A. H., Wright J.G., Tarasuk V., Bombardier C. Measuring the whole or the parts? Validity, reliability, and responsiveness of the Disabilities of the Arm, Shoulder and Hand outcome measure in different regions of the upper extremity. J Hand Ther. 2001; 14(2): 128-146.
  3. 3.0 3.1 3.2 3.3 3.4 3.5 Beaton D.E., Davis A.M., Hudak P., McConnell S. The DASH (Disabilities of the Arm, Shoulder and Hand) outcome measure: What do we know about it now? British Journal of Hand Therapy. 2001; 6(4): 109-118.
  4. 4.0 4.1 4.2 4.3 4.4 4.5 Gummesson C., Ward M.M., Atroshi I. The shortened disabilities of the arm, shoulder and hand questionnaire (Quick DASH): validity and reliability based on responses within the full-length DASH. BMC Musculoskeletal Disorders. 2006; 7(44): 1-7.
  5. 5.0 5.1 5.2 Matheson L.N., Melhorn M., mayer T.G., Theodore B.R., Gatchel R.J. Reliability of a visual analog version of the Quick DASH. J Bone Joint Surg Am. 2006; 88: 1782-1787.
  6. 6.0 6.1 6.2 6.3 Mintken P.E., Glynn P., Cleland J.A. Psychometric properties of the shortened disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) and Numeric Pain Rating Scale in patients with shoulder pain. J Shoulder Elbow Surg. 2009; 18(6): 920-926.
  7. 7.0 7.1 7.2 Beaton D.E., Wright J., Katz J.N. Development of the Quick DASH: comparison of the three item-reduction approaches. J Bone Joint Surg Am. 2005; 87: 1038-1046.

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