Disabilities of the Arm, Shoulder, & Hand

Overview

Author(s): Kennedy, C.A., Beaton, D.E., Solway, S., McConnell, S.G., & Bombardier, C.

Year of Publication: 2011- 3rd Edition

Publisher: Toronto, Ontario: Institute for Work & Health

Type of Assessment: 

• Self-report Questionnaire

• Norm-referenced

• Standardized 

Cost: Free

How to Access: https://www.myoptumhealthphysicalhealth.com/Documents/Forms/DASH.pdf

Age: Adults (18-65+)

Diagnosis/Condition: joint conditions (eg. arthritis), multiple sclerosis, musculoskeletal conditions, chronic pain, upper extremity injuries

Setting: Unspecified health-related settings

Administration

Time: 5-30 mins

Group/Individual: Individual

Subtests: 30 items describing abilities, limitations, & symptoms related to upper-extremity function. 

• Four additional optional elements including

  • Work Module - assess working abilities

  • Sports/Performing Arts Module to assess the impact of the upper extremity on playing an instrument or sport.

Instructions: 

• Clients will answer every question based on the condition in the last week by circling the appropriate number. 

• Ratings are based on a 5-point Likert scale 

  • "1" = lowest level of difficulty or severity 

  • "5" = highest level of difficulty or severity. 

• If the activity was not performed in the past week, make the best estimate on which would be most accurate. 

• Answers should be based on the client's ability regardless of how they perform the task.

Materials: Questionnaire & pencil

User Qualifications: No training

Scoring Procedures

How to Score: Add values of each response, then divide by 4, subtract 1 and multiply by 25: [(sum of n responses/n) -1] x25, where n is the number of completed responses

• *Cannot be completed if more than 3 items are missing

Score Indications: Scores range from 0 to indicate no disability to 100 indicating a most severe disability

Psychometrics

Reliability: Excellent - ICC (2,1) = 0.96

Validity: Strong - Pearson r > 0.70

Pros & Cons

Strengths:

• Quick & easy to administer

• Sensitive to change to detect functional improvements or declines over time to tract rehabilitation progress 

• Translated to many languages including Spanish, Chinese, French, Japanese, & Swedish

• Standardized - Highly reliable & valid 

• Abbreviated version (Quick DASH-11 items) is available to measure the individual's ability to complete tasks, absorb forces, and severity of symptoms

Weaknesses:

• Self-report can introduce client bias and inaccurate results

• Limited performance-based measurement & relies solely on subjective reporting

• Can lack specificity for certain conditions

*ICC: intraclass correlation coefficient - measures the reliability of ratings in studies with 2+ raters ranging from 0 (no reliability among raters) to 1 (perfect reliability among raters) (Bobbitt, 2021)

References

• Asher, I. E. (2014). Asher’s occupational therapy assessment tools: An annotated index (4th ed.). AOTA Press.

• Bobbitt, Z. (2021, March 19). Intraclass correlation coefficient: Definition+example. Statology. https://www.statology.org/intraclass-correlation-coefficient/ 

• Institute for Work & Health. (1996). DASH outcome measure. https://www.iwh.on.ca/tools-and-guides/dash-outcome-measure 

• Shirley Ryan Ability Lab. (2021, October 17). Disabilities of the arm, shoulder, and hand questionnaire. https://www.sralab.org/rehabilitation-measures/disabilities-arm-shoulder-and-hand-questionnaire 

• Wente, N. (n.d.). Dash outcome measure. Physiopedia. https://www.physio-pedia.com/DASH_Outcome_Measure