Evaluation of the construct validity of the DASH questionnaire by correlation to the SF-36

doi:10.1053/jhsu.2002.32964

The Journal of Hand Surgery

Volume 27, Issue 3, May 2002, Pages 537-541

https://doi.org/10.1053/jhsu.2002.32964 Get rights and content

Abstract

The construct validity of the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire was evaluated by examining its correlation to the Medical Outcomes Study Short Form–36 (SF-36). The study sample was 90 patients seen at the upper-extremity clinic of a university-based orthopedic practice. Patients were asked to complete a packet that included the DASH and SF-36 questionnaires. Pearson correlation coefficients of the DASH questionnaire to the SF-36 subscales ranged from −0.36 to −0.62. The DASH questionnaire had fewer ceiling and floor scores than most of the SF-36 subscales. These results support the DASH questionnaire as a valid measure of health status useful in patients with a wide variety of upper-extremity complaints. (J Hand Surg 2002;27A:537–541. Copyright © 2002 by the American Society for Surgery of the Hand.)

Section snippets

Study design

The study sample consisted of patients presenting to the upper-extremity clinic at a tertiary referral center over a period of 4 months. All patients were given a study packet and asked to complete an informed consent form on initial and follow-up visits. All patients were included if they were able to read English and complete the packet. The informed consent form and protocol were approved by the institutional review board before enrollment of patients. Participating patients completed the

Results

A total of 872 patients were scheduled to be seen in the upper-extremity clinic from October 30, 1997, through February 27, 1998. Review of charts identified 105 patients with diagnoses not related to the upper extremity. Of the remaining 767 scheduled visits, 167 packets were returned with completed informed consent and at least partial completion of questionnaires; this represents 22% of scheduled visits.

Of the patients returning packets, 77 did not respond to sufficient numbers of items to

Discussion

Several outcomes instruments have been proposed for use in patients with musculoskeletal complaints. The SF-36 has been validated in this population and is used widely for measuring health outcomes.2, 4, 11 The SF-36 is a generic questionnaire, however, and has the potential disadvantage of being less sensitive to clinical change in patients with complaints specific to an anatomic region or disease process. The DASH and a variety of region-specific and disease-specific questionnaires have been

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No clinically important difference in patient-reported shoulder disability (DASH) was found between both groups, despite a larger range of motion in the 135° NSA group. This study is the first to show the impact of NSA on patient-reported shoulder disability using the DASH.
The upper extremity postthrombotic syndrome score: an international Delphi consensus study to determine the score's functional disability component
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In upper extremity thrombosis research, the occurrence of upper extremity postthrombotic syndrome (UE-PTS) is commonly used as the main outcome parameter. However, there is currently no reporting standard or a validated method to assess UE-PTS presence and severity. In a recent Delphi study, consensus was reached on a preliminary UE-PTS score, combining 5 symptoms, 3 signs, and the inclusion of a functional disability score. However, no consensus was reached on which functional disability score to be included.
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This Delphi project was designed as a three-round study using open text questions, statements with 7-point Likert scales, and multiple-choice questions. The CREDES recommendations for Delphi studies were applied. In this context, a systematic review was conducted before the start of the Delphi rounds to identify the available functional disability scores as available in the literature and present these to the expert panel.
Thirty-five of 47 initially invited international experts from multiple disciplines completed all the Delphi rounds. In the second round, consensus was reached on the incorporation of the quick disabilities of the arm, shoulder, and hand (QuickDASH) in the UE-PTS score, rendering the third round obsolete.
Consensus was reached that the QuickDASH should be incorporated in the UE-PTS score. The UE-PTS score will need to be validated in a large cohort of patients with upper extremity thrombosis before it can be used in clinical practice and future research.
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In contrast to region-specific patient-reported outcome measures (PROMs), generic PROMs can be argued to have an added benefit of enabling cost-utility analyses and allowing for comparisons to be made across different conditions. The aim of this study was to assess the responsiveness and strength of the association between region-specific and generic PROMs in patients treated operatively for a displaced intra-articular distal radius fracture.
Over a 4-year period, 166 patients aged 18–70 years with a displaced intra-articular fracture of the distal radius were treated with either a volar locking plate or external fixation augmented by K-wires and followed-up prospectively for 2 years. The main outcome measure was the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, but EuroQol-5D (EQ-5D) and 36-Item Short Form Survey (SF-36) were also employed. The associations between the QuickDASH score and EQ-5D and between the QuickDASH score and SF-36 were assessed using a linear mixed model.
There was a significant positive association between the QuickDASH score and EQ-5D and between the QuickDASH score and SF-36 throughout the follow-up period, although wide dispersion existed for the outcome measures at an individual level. However, the association between the QuickDASH score and SF-36 was significantly weaker at 6 weeks and 3 months than that at baseline, indicating that EQ-5D more closely mirrors changes in the QuickDASH score in the early postoperative period.
The study demonstrates that the QuickDASH score and EQ-5D correlate well on a group level, but large individual variations exist. The SF-36 had decreased sensitivity for the changes in the QuickDASH score at 6 weeks and 3 months.
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Atraumatic shoulder instability of the shoulder is well described, and numerous extrinsic factors have been identified as having a negative influence on long-term shoulder function, including age, sex, smoking, and workers' compensation status. Furthermore, physical factors such as acute or chronic pain, as well as psychological comorbidities such as depression and suicidal thoughts, are common in shoulder-related conditions.
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Normative values of the DASH questionnaire in healthy individuals over 50 years of age
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Citation Excerpt :
Additional parameters are available for more specific evaluation of musicians and sportsmen. The DASH questionnaire has proven to be a simple, quick to answer, sensitive and reliable instrument [2,3]. It allows comparison between patients as well as longitudinal evaluation of the same patient over time, monitoring improvement or deterioration of his/her clinical condition, as this is reflected at his/her DASH score.
This study aimed to define the normative values of the DASH score in healthy individuals over 50 years of age. One hundred and twenty subjects equally representing both genders and six age categories (50−54, 55−59, 60−64, 65−69, 70−74 and 75−80 years), with no past medical history affecting the upper limb, were asked to complete the DASH questionnaire. A visual analogue scale for pain and an HAQ-DI questionnaire were also completed to confirm the absence of symptomatic untreated upper limb pathologies. In this series of a priori normal subjects, most had a DASH score greater than 0. Moreover, the DASH score was found to rise with age, with a statistically significant difference between women and men. The DASH questionnaire is widely accepted in the everyday medical practice as a tool to evaluate upper limb function. However, age adjustment of the DASH questionnaire is necessary to correctly evaluate the clinical status and progression of individuals over the age of 50.
Cette étude visait à définir les valeurs normatives du score DASH des individus sains de plus de 50 ans. Cent-vingt sujets représentant équitablement les deux sexes et six catégories d'âge (50−54, 55−59, 60−64, 65−69, 70−74 et 75−80 ans), sans antécédents médicaux affectant le membre supérieur, ont été invités à remplir le questionnaire DASH. Une échelle visuelle analogique de la douleur, ainsi qu'un questionnaire HAQ-DI ont également été répondus dans l'objectif de s'assurer de l'absence de pathologies symptomatiques du membre supérieur non traitées. Dans cette série de sujets a priori normaux, la plupart avaient un score DASH supérieur à zéro. De plus, le score DASH augmentait avec l'âge, présentant une différence statistiquement significative entre les femmes et les hommes. Le questionnaire DASH a prouvé son efficacité et est largement accepté dans la pratique médicale quotidienne. Cependant, une pondération de l'âge du questionnaire DASH selon l' est nécessaire, afin d'évaluer correctement l'état clinique et l'évolution des individus de plus de 50 ans.
II
Complications and functional outcomes after transolecranon distal humerus fracture
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Transolecranon distal humerus fractures are uncommon injuries. This is the first multipatient case series to describe outcomes and complications following transolecranon distal humerus fractures in the adult population.
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A total of 16 patients with open (n = 12) or closed (n = 4) transolecranon distal humerus fractures were identified. Nine female and 7 male patients with a mean age of 47 years were included. Mechanisms of injury included motor vehicle collisions (n = 3), motorcycle crashes (n = 4), ground-level falls (n = 3), falls from height (n = 4), train collision (n = 1), and an industrial accident (n = 1). Seven patients (44%) presented with nerve injury. Patients underwent open reduction with internal fixation (n = 15), external fixation (n = 6), or both (n = 5). Additional surgeries were ultimately required in 11 patients (69%), with a mean of 3 surgeries to manage each patient's elbow injuries. All patients returned for at least 3 clinical follow-up visits; mean clinical follow-up was 15.8 months and mean radiographic follow-up was 12.3 months. Complications were observed in 15 patients (94%). Eleven patients (69%) had limited range of motion with a flexion arc of less than 100° at their last clinic visit. Seven patients (44%) developed deep wound infections requiring repeat débridement and intravenous antibiotics. Implant removal was performed in 10 patients (62.5%) because of infection (n = 5), symptomatic hardware (n = 4), or device failure (n = 1). Heterotopic ossification was seen in 8 patients (50%) and post-traumatic arthrosis in 4 (25%). Two patients (12.5%) required flap reconstruction for soft tissue defects. Nonunion occurred in 7 patients (44%). DASH scores were obtained for 10 patients (62.5%) at a mean of 3.8 years after injury. The mean DASH score was 40.2, ranging from 4.2 to 76.5. Among respondents, 7 (70%) were able to resume working, with an average DASH work module score of 25.
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^☆☆: Reprint requests: Nelson Fong SooHoo, MD, Balance Orthopaedic Foot and Ankle Center, 2651 Elm Ave, Ste 205, Long Beach, CA 90806.

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Original CommunicationsEvaluation of the construct validity of the DASH questionnaire by correlation to the SF-36☆,☆☆

Abstract

Section snippets

Study design

Results

Discussion

Clin Plast Surg

J Hand Surg

Comparisons of five health status instruments for orthopedic evaluation

Med Care

Musculoskeletal function assessment instrument: criterion and construct validity

J Orthop Res

Comparison of the Musculoskeletal Function Assessment questionnaire with the Short Form-36, the Western Ontario and McMaster Universities Osteoarthritis Index, and the Sickness Impact Profile health-status measures

J Bone Joint Surg

The POSNA Pediatric Musculoskeletal Functional Health Questionnaire: report on the reliability, validity, and sensitivity to change

J Pediatr Orthop

Measuring function of the shoulder: a cross-sectional comparison of five questionnaires

J Bone Joint Surg

Responsiveness of self-reported and objective measures of disease severity in carpal tunnel syndrome

Med Care

Original Communications
Evaluation of the construct validity of the DASH questionnaire by correlation to the SF-36☆,☆☆