Disabilities of the Arm, Shoulder and Hand (DASH) Score
Introduced in 1996, The Disabilities of the Arm, Shoulder and Hand (DASH) score was designed to measure shoulder, elbow, wrist and hand function in one combined metric. It was developed via a collaborative effort by the Council of Musculoskeletal Specialty Societies, the American Academy of Orthopaedic Surgeons (AAOS) and the Institute for Work and Health.
The DASH score is unique in its instructions to patients because it does not focus solely on the arm (or shoulder) that underwent treatment. Instead, it asks patients to rate their ability to carry out an activity based on which arm (or shoulder) they generally use to perform it. For some questions this may represent the limb that received treatment and for others it may not. Because of this lack of distinction, the questionnaire produces a score of patient function that represents the composite abilities of both upper limbs. This feature is both an advantage and limitation of the instrument.
DASH is a patient-reported outcome measure (PROM) that attempts to determine the amount of difficulty a patient has when doing an activity. It consists of thirty (30) core questions and eight (8) optional questions that assess work, sports and activities of daily living. Each item is scored on a 5-point Likert scale and a cumulative DASH score is scaled from 0 to 100, with higher scores indicating a greater level of disability.
In 2005, a shorter version of the DASH score was created – the QuickDASH. It was developed to minimize the time required for survey completion. The QuickDASH consists of eleven (11) questions also scored on a 5-point scale. Similar to DASH, a higher score indicates more disability. A high correlation has been shown between the DASH and QuickDASH.
DASH has been widely studied and offers several advantages. It has been validated in over fifteen (15) languages and normative data has been established for American and Norwegian populations. It has also been shown to be valid and responsive compared to other joint-specific measures of the upper extremity, and correlates well to general health measures such as the Short Form-36 (SF-36).
By design, DASH doesn’t discriminate between the affected and non-affected limb. This makes the scale more generalizable but functional items may not reflect an accurate response to treatment. For example, if a patient carries out an activity that mostly involves use of their dominant limb but it was the non-dominant one that received the treatment, the questionnaire may not accurately reflect this.
Overall, DASH together with its short form (QuickDASH), is the most widespread, best-tested and characterized instrument for shoulder assessment. The form is relatively quick to fill out and easy to understand.
Although the DASH and QuickDASH are both valid, reliable and responsive, the authors of the instrument suggest that because the full DASH provides greater precision it should be used by clinicians who wish to monitor arm pain and function in individual patients.
Licensing and Cost
The DASH and QuickDASH measures require a license and may require a fee. To learn more about the DASH and QuickDASH, visit their website: https://dash.iwh.on.ca/.
Upper Extremity-Specific Measures of Disability and Outcomes in Orthopaedic Surgery | Functional outcomes assessment in shoulder surgery | 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) | DASH website