DASH Outcome Measure

Introduction[edit | edit source]

Arm.jpg

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 DASH has been translated in many different languages and has demonstrated to be a valid and reliable questionnaire for a variety of upper extremity disorders. [4]

The QuickDASH is an abbreviated version of the original DASH outcome measure. In comparison to the original 30 item DASH outcome measure, the QuickDASH only contains 11 items[5] It is a questionnaire that measures an individual’s ability to complete tasks, absorb forces, and severity of symptoms[5] The QuickDASH tool uses a 5-point Likert scale from which the patient can select an appropriate number corresponding to his/her severity/function level.[6]

Intended Population[edit | edit source]

  • 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.[5][6]

Some examples of the DASH questions[edit | edit source]

How would you rate your ability to do the following tasks 1-5 (1 being no difficulty, 5 being unable):

" Place an object on a shelf above your head"

"Use a knife to cut food"

"Wash your back"

The latter part of the questionnaire rates your symptoms and impact on work and sport using a similar scale.

The full DASH is available here

The QuickDASH is available here

Scoring [edit | edit source]

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 one 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)[5]

Additional Optional Modules[edit | edit source]

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

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

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

Evidence[edit | edit source]

Psychometric Property DASH QuickDASH
Reliability ICC(2,1) = 0.96[2] ICC(2,1) = 0.90[7]
Validity Pearson r > 0.70[2] Pearson r > 0.70[8]
Minimal Detectable Change (MDC) 12.75% - 17.23%[3] 11.2%[7]
Minimal Clinical Important Difference (MCID) 10.83-15[9] 15.91-20[9]
Responsiveness
  • 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]
Slightly more responsive to the original DASH outcome measure and, clinically, may be preferable due to shorter length[5][8]
Miscellaneous Available in 27 different languages.

Many of these versions have had or are in the process of being tested for their psychometric properties.[1]

QuickDASH measure has more relative efficiency compared with the DASH[8] Recent studies have also analyzed the reliability of a modified QuickDASH outcome measure, from a questionnaire into a visual analog version[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.
[7]

Resources[edit | edit source]

Online version of DASH

Online version of QuickDASH

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 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 DE, Katz JN, Fossel AH, Wright JG, 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. Journal of Hand Therapy. 2001 Apr 1;14(2):128-42.
  3. 3.0 3.1 3.2 3.3 3.4 3.5 Beaton DE, Davis AM, Hudak P, McConnell S. The DASH (Disabilities of the Arm, Shoulder and Hand) outcome measure: what do we know about it now?. The British Journal of Hand Therapy. 2001 Dec;6(4):109-18..
  4. Sigirtmac IC, Oksuz C. Systematic review of the quality of the cross-cultural adaptations of Disabilities of the Arm, Shoulder and Hand (DASH). La Medicina del Lavoro. 2021;112(4):279.
  5. 5.0 5.1 5.2 5.3 5.4 Gummesson C, Ward MM, 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 Dec 1;7(1):44.
  6. 6.0 6.1 6.2 Matheson LN, Melhorn JM, Mayer TG, Theodore BR, Gatchel RJ. Reliability of a visual analog version of the QuickDASH. JBJS. 2006 Aug 1;88(8):1782-7.
  7. 7.0 7.1 7.2 Mintken PE, Glynn P, Cleland JA. 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. 2009 Nov 1;18(6):920-6.
  8. 8.0 8.1 8.2 Beaton DE, Wright JG, Katz JN, Upper Extremity Collaborative Group. Development of the QuickDASH: comparison of three item-reduction approaches. JBJS. 2005 May 1;87(5):1038-46.
  9. 9.0 9.1 Franchignoni F, Vercelli S, Giordano A, Sartorio F, Bravini E, Ferriero G. Minimal clinically important difference of the disabilities of the arm, shoulder and hand outcome measure (DASH) and its shortened version (QuickDASH). journal of orthopaedic & sports physical therapy. 2014 Jan;44(1):30-9.