Elsevier

Journal of Hand Therapy

Volume 14, Issue 2, April–June 2001, Pages 128-142
Journal of Hand Therapy

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 extremity1

https://doi.org/10.1016/S0894-1130(01)80043-0Get rights and content

Abstract

The Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure was developed to evaluate disability and symptoms in single or multiple disorders of the upper limb at one point or at many points in time. Purpose: The purpose of this study was to evaluate the reliability, validity, and responsiveness of the DASH in a group of diverse patients and to compare the results with those obtained with joint-specific measures. Methods: Two hundred patients with either wrist/hand or shoulder problems were evaluated by use of questionnaires before treatment, and 172 (86%) were re-evaluated 12 weeks after treatment. Eighty-six patients also completed a test-retest questionnaire three to five days after the initial (baseline) evaluation. The questionnaire package included the DASH, the Brigham (carpal tunnel) questionnaire, the SPADI (Shoulder Pain and Disability Index), and other markers of pain and function. Correlations or t-tests between the DASH and the other measures were used to assess construct validity. Test-retest reliability was assessed using the intraclass correlation coefficient and other summary statistics. Responsiveness was described using standardized response means, receiver operating characteristics curves, and correlations between change in DASH score and change in scores of other measures. Standard response means were used to compare DASH responsiveness with that of the Brigham questionnaire and the SPADI in each region. Results: The DASH was found to correlate with other measures (r > 0.69) and to discriminate well, for example, between patients who were working and those who were not (p< 0.0001). Test-retest reliability (ICC = 0.96) exceeded guidelines. The responsiveness of the DASH (to self-rated or expected change) was comparable with or better than that of the joint-specific measures in the whole group and in each region. Conclusions: Evidence was provided of the validity, test-retest reliability, and responsiveness of the DASH. This study also demonstrated that the DASH had validity and responsiveness in both proximal and distal disorders, confirming its usefulness across the whole extremity.

References (84)

  • JN Katz et al.

    Symptoms, functional status, and neuromuscular impairment following carpal tunnel release

    J Hand Surg.

    (1995)
  • L Christensen et al.

    A method of assessing change in a single subject: an alteration of the RC index

    Behav Ther.

    (1986)
  • NS Jacobson et al.

    Psychotherapy outcome research: methods for reporting variability and evaluating clinical significance

    Behav Ther.

    (1984)
  • P Ravaud et al.

    Assessing smallest detectable change over time in continuous structural outcome measures: application to radiological change in knee osteoarthritis

    J Clin Epidemiol.

    (1999)
  • KW Wyrwich et al.

    Further evidence supporting standard error of measurement based criterion for identifying meaningful intra-individual change in health-related quality of life

    J Clin Epidemiol.

    (1999)
  • AF De Bruin et al.

    Assessing the responsiveness of a functional status measure: the Sickness Impact Profile versus the SIP68

    J Clin Epidemiol.

    (1997)
  • JG Wright

    The minimal important difference: Who's to say what is important?

    J Clin Epidemiol.

    (1996)
  • RA Deyo et al.

    Assessing the responsiveness of functional scales to clinical change: an analogy to diagnostic test performance

    J Chronic Dis.

    (1986)
  • DA Redelmeier et al.

    Assessing the minimal important difference in symptoms: a comparison of two techniques

    J Clin Epidemiol.

    (1996)
  • FX Gibbons

    Social comparison as a mediator of response shift

    Soc Sci Med.

    (1999)
  • PJ Allison et al.

    Quality of life: a dynamic construct

    Soc Sci Med.

    (1997)
  • MAG Sprangers et al.

    Integrating response shift into health-related quality of life research: a theoretical model

    Soc Sci Med.

    (1999)
  • J Reid et al.

    Pilgrimage of pain: the illness experiences of women with repetition strain injury and the search for credibility

    Soc Sci Med.

    (1991)
  • DA Redelmeier et al.

    Patients' memories of painful medical treatments: real-time and retrospective evaluations of two minimally invasive procedures

    Pain

    (1996)
  • AM Jette

    Physical disablement concepts for physical therapy research and practice

    Phys Ther.

    (1994)
  • B Cole et al.
  • PW Brand et al.
  • KE Roach et al.

    Development of a shoulder pain and disability index

    Arthritis Care Res.

    (1991)
  • SR Stock et al.

    Review of applicability of existing functional status measures to the study of workers with musculoskeletal disorders of the neck and upper limb

    Am J Ind Med.

    (1996)
  • JC MacDermid et al.

    Patient-rating of wrist pain and disability: a reliable and valid measurement tool

    J Orthop Trauma.

    (1998)
  • DW Levine et al.

    A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome

    J Bone Joint Surg.

    (1993)
  • AM Davis et al.

    Development of a measure of physical function for patients with bone and soft tissue sarcoma

    Qual Life Res.

    (1996)
  • A Kirkley et al.

    The development and evaluation of a disease-specific quality of life measurement tool for shoulder instability: The Western Ontario Shoulder Instability Index (WOSI)

    Am J Sports Med.

    (1998)
  • S McConnell et al.
  • PL Hudak et al.

    Development of an upper extremity outcome measure: The DASH (Disabilities of the Arm, Shoulder and Head)

    Am J Ind Med.

    (1996)
  • LM Verbrugge et al.

    Exploring the iceberg: common symptoms and how people care for them

    Med Care

    (1987)
  • DC Turchin et al.

    Validity of observer-based aggregate scoring systems as descriptors of elbow pain, function, and disability

    J Bone Joint Surg.

    (1998)
  • RD Hays et al.

    Psychometric consideration in evaluating health-related quality of life measures

    Qual Life Res.

    (1993)
  • RF DeVellis

    A consumer's guide to finding, evaluating, and reporting on measurement instruments

    Arthritis Care Res.

    (1996)
  • GH Guyatt et al.

    Users' guides to the medical literature: XII. How to use articles about health-related quality of life

    JAMA

    (1997)
  • GR Norman et al.
  • Cited by (1080)

    View all citing articles on Scopus
    1

    This work was supported by research grants from the American Society for Surgery of the Hand, Rosemont, Illinois, and the Institute for Work and Health, Toronto, Ontario, Canada; by a PhD fellowship in health research from the Medical Research Council of Canada (Dr. Beaton); by a scientist award from the Medical Research Council of Canada (Dr. Wright); and by grant AR36308 from the U.S. National Institutes of Health and the U.S. National Arthritis Foundation (Dr. Katz).

    View full text