With the goal of measuring shoulder, elbow, wrist, and hand function in one combined metric, The Disabilities of the Arm, Shoulder and Hand (DASH) score was born in 1996 as part of a collaborative effort by the Council of musculoskeletal specialty societies, the American Academy of Orthopedic Surgeons (AAOS) and the Institute for Work and Health.

The DASH score is unique in its instructions to patients because it doesn’t 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. [1]

DASH is a patient-reported outcome (PRO) tool that attempts to determine the amount of difficulty a patient has when doing an activity. It consists of 30 questions and eight 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. Developed to minimize the time required for survey completion, QuickDASH consists of 11 questions also scored on a 5-point scale, and similar to DASH, a higher score indicates more disability. A high correlation has been shown between the DASH and QuickDASH [1].

What PRO Tools are available for Shoulder patients?

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Strengths

DASH has been validated in more than 15 languages, and normative data has been established for American and Norwegian populations [2]. It ‘s shown to be valid and responsive compared to other joint-specific measures of the upper extremity [1]. It also correlates well to general health measures such as the Short Form-36 (SF-36) [1].

 

Weaknesses

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 [2].

Overall, DASH together QuickDASH is the most widespread, best-tested and characterized instrument for shoulder assessment [3]. 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 [4].

 

License

A license is required to use the DASH and QuickDASH tools.
Details can be found at: http://www.dash.iwh.on.ca/

 

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References

  1. Smith, M. V., Calfee, R. P., Baumgarten, K. M., Brophy, R. H., & Wright, R. W. (2012). Upper Extremity-Specific Measures of Disability and Outcomes in Orthopaedic Surgery. The Journal of Bone and Joint Surgery. American Volume., 94(3), 277–285. http://doi.org/10.2106/JBJS.J.01744 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3262183/
  2. Wylie JD, Beckmann JT, Granger E, Tashjian RZ. Functional outcomes assessment in shoulder surgery. World J Orthop 2014; 5(5): 623-633 http://www.wjgnet.com/2218-5836/full/v5/i5/623.htm
  3. Angst, F., Schwyzer, H. K., Aeschlimann, A., Simmen, B. R., & Goldhahn, J. (2011). 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. http://onlinelibrary.wiley.com/doi/10.1002/acr.20630/full
  4. www.dash.iwh.on.ca/faq