Journal of Occupational Rehabilitation

, Volume 21, Issue 2, pp 234–243 | Cite as

Responsiveness of the QuickDASH and SF-12 in Workers with Neck or Upper Extremity Musculoskeletal Disorders: One-Year Follow-Up

  • Z. Joyce FanEmail author
  • Caroline K. Smith
  • Barbara A. Silverstein


Introduction Questionnaires that measure functional status such as the Disability of the Arm, Shoulder and Hand (QuickDASH) and the Medical Outcomes Study 12-item Short-Form Health Survey (SF-12) can quantify the impact of health on performance. Little is known about whether these questionnaires can be used as a tool for measuring disabilities among workers. We compare the responsiveness of these two functional status questionnaires to changes in clinical outcomes of neck or upper extremity musculoskeletal disorders (UEMSD) among active workers in a longitudinal study. Methods We evaluated the effect size (ES) and standardized response means (SRM) of the QuickDASH and the SF-12 for 148 workers who were divided into four subgroups based on the diagnosis status change between baseline and 1-year visit. Results The ES and SRM for QuickDASH scores were 0.6/0.6 for the 50 subjects who became incident symptomatic neck or UEMSD cases, 1.3/1.0 for the 18 subjects who became incident clinical cases of neck or UEMSD, −1.0/−1.1 for the 46 subjects who recovered from having neck or UEMSD symptoms, and −1.1/−1.1 for the 34 subjects who recovered from being neck or UEMSD clinical cases. The correspondent ES/SRM for the QuickDASH work module were 0.4/0.3, 0.7/0.5, −0.6/−0.4, and −1.0/−0.8, respectively. The correspondent ES/SRM for the physical component scores of SF-12 (PCS12) for the four subgroups were 0.2/0.2, −0.9/−0.6, 0.3/0.2, and 0.3/0.3, respectively. Conclusions The QuickDASH scores were responsive to changes among active workers who were neck or UEMSD symptomatic or clinical case. PCS12 scores were sufficient only for use in clinical case status change.


Responsiveness Neck or upper extremity musculoskeletal disorders QuickDASH SF-12 


  1. 1.
    Bongers PM, Kremer AM, ter Laak J. Are psychosocial factors, risk factors for symptoms and signs of the shoulder, elbow, or hand/wrist? A review of the epidemiological literature. Am J Ind Med. 2002;41:315–42.PubMedCrossRefGoogle Scholar
  2. 2.
    Aptel M, Aublet-Cuvelier A, Cnockaert JC. Work-related musculoskeletal disorders of the upper limb. Joint Bone Spine. 2002;69:546–55.PubMedCrossRefGoogle Scholar
  3. 3.
    Silverstein BA, Welp E, Nelson NA, Kalat J. Claims incidence of work related musculoskeletal disorders of the upper extremities: Washington State, 1987 through 1995. Am J Public Health. 1998;88:1827–33.PubMedCrossRefGoogle Scholar
  4. 4.
    Ashbury FD. Occupational repetitive strain injuries and gender in Ontario, 1986 to 1991. J Occup Environ Med. 1995;37:479–85.PubMedCrossRefGoogle Scholar
  5. 5.
    Silverstein B, Adams D. Work-related musculoskeletal disorders of the neck, back and upper extremity in Washington State. Technical Report 40-11-2007. Washington State Department of Labor and Industries, Olympia Washington. 2007.Google Scholar
  6. 6.
    Katz JN, Stock SR, Rempel D, Franzblau A, Gray RH. Classification criteria and severity assessment in work-associated upper extremity disorders: methods matter. Am J Ind Med. 2000;38:369–72.PubMedCrossRefGoogle Scholar
  7. 7.
    Kuorinka I, Jonsson B, Kilbom A, Vinterberg H, Biering-Sørensen F, Andersson G, Jørgensen K. Standardized Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon. 1987;18:233–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Franzblau A, Salerno DF, Armstrong TJ, Werner RA. Test-retest reliability of an upper-extremity discomfort questionnaire in an industrial population. Scand J Work Environ Health. 1997;23:299–307.PubMedGoogle Scholar
  9. 9.
    Stock S, Streiner D, Tugwell P, Loisel P, Reardon R, Durand, MJ. 1996. Validation of the neck and upper limb index (NULI), a functional status instrument for work related musculoskeletal disorders. In 25ème Congrès annuel de la Commission internationale de santé au travail/CIST.Google Scholar
  10. 10.
    Beaton DE, Davis AM, Hudak P, McConnell S. The DASH (disabilities of the arm, shoulder and hand) outcome measure: what do we know about it now. Br J Hand Ther. 2001;6:109–18.Google Scholar
  11. 11.
    Atroshi I, Gummesson C, Andersson B, Dahlgren E, Johansson A. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire. Reliability and validity of the Swedish version evaluated in 176 patients. Acta Orthop Scand. 2000;71:613–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Offenbaecher M, Ewert T, Sangha O, Stucki G. Validation of a German version of the disabilities of arm, shoulder, and hand questionnaire (DASH-G). J Rheumatol. 2002;29:401–2.PubMedGoogle Scholar
  13. 13.
    Padua R, Padua L, Ceccarelli E, Romanini E, Zanoli G, Amadio PC, Campi A. Italian version of the disability of the arm, shoulder and hand (DASH) questionnaire. Cross-cultural adaptation and validation. J Hand Surg [Br]. 2003;28:179–86.Google Scholar
  14. 14.
    Rosales RS, Delgado EB, De La Lastra-Bosch ID. Evaluation of the Spanish version of the DASH and carpal tunnel syndrome health-related quality-of-life instruments: cross-cultural adaptation process and reliability. J Hand Surg [Am]. 2002;27:334–43.Google Scholar
  15. 15.
    Bot SD, Terwee CB, van der Windt DA, Bouter LM, Dekker J, de Vet HC. Clinimetric evaluation of shoulder disability questionnaires: a systematic review of the literature. Ann Rheum Dis. 2004;63:335–41.PubMedCrossRefGoogle Scholar
  16. 16.
    Turchin DC, Beaton DE, Richards RR. Validity of observer-based aggregate scoring systems as descriptors of elbow pain, function, and disability. J Bone Joint Surg. 1998;80:154–62.PubMedGoogle Scholar
  17. 17.
    Beaton DE, Wright JG, Katz JN. Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am. 2005;87:1038–46.Google Scholar
  18. 18.
    McHorney CA, Ware JE Jr. Construction and validation of an alternate form general mental health scale for the Medical Outcomes Study Short-Form 36-Item Health Survey. Med Care. 1995;33:15–28.PubMedCrossRefGoogle Scholar
  19. 19.
    Ware JE, Wright JG, Katz JN. A 12-item short-form health survey. Construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34:220–33.PubMedCrossRefGoogle Scholar
  20. 20.
    Fan ZJ, Smith C, Silverstein BA. Assessing validity of the QuickDASH and SF-12 as surveillance tools among workers with neck or upper extremity musculoskeletal disorders. J Hand Ther. 2008;21:354–65.Google Scholar
  21. 21.
    Kirkley A, Griffin S, McLintock H, Ng L. 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;26:764–72.PubMedGoogle Scholar
  22. 22.
    MacDermid JC, Richards RS, Donner A, Bellamy N, Roth JH. Responsiveness of SF-36, DASH and PRWE and physical impairments in evaluating recovery after distal radius fracture. J Hand Surg [Am]. 2000;25:330–340.Google Scholar
  23. 23.
    Silverstein BA, Viikari-Juntura E, Fan ZJ, Bonauto DK, Bao S, Smith C. Natural course of nontraumatic rotator cuff tendinitis and shoulder symptoms in a working population. Scand J Work Environ Health. 2006;32:99–108.PubMedGoogle Scholar
  24. 24.
    ACGIH. Threshold limit values for chemical substances and physical agents and biological exposure indices. 2000.Google Scholar
  25. 25.
    Sluiter JK, Rest KM, Frings-Dresen MHW. Criteria document for evaluating the work-relatedness of upper-extremity musculoskeletal disorders. Scand J Work Environ Health. 2001;27:1–102.PubMedGoogle Scholar
  26. 26.
    Washington State Department of Labor and Industries. Diagnosis and treatment of work-related carpal tunnel syndrome. Med Treat Guidel. 2005;32–36.Google Scholar
  27. 27.
    The Institute for Work & Health and American Academy of Orthopaedic Surgeon. The QuickDASH outcome measure. 2006.Google Scholar
  28. 28.
    De Bruin AF, Diederiks PM, De Witte LP, Stevens FC, Philipsen H. Assessing the responsiveness of a functional status measure: the Sickness Impact Profile versus the SIP68. J Clin Epidemiol. 1997;50:529–540.Google Scholar
  29. 29.
    Terwee CB, Diederiks JP, Wiersinga WM, Prummel MF, Bossuyt PM. On assessing responsiveness of health-related quality of life instruments: guidelines for instrument evaluation. Qual Life Res. 2003;12:349–362.Google Scholar
  30. 30.
    Kazis LE, Anderson JJ, Meenan RF. Effect sizes for interpreting changes in health status. Med Care. 1989;27:S178–89.PubMedCrossRefGoogle Scholar
  31. 31.
    Olejnik S, Algina J. Measures of effect size for comparative studies: applications, interpretations and limitations. Contemp Educ Psychol. 2000;25:241–86.PubMedCrossRefGoogle Scholar
  32. 32.
    Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Lawrence Erlbaum Associates; 1988.Google Scholar
  33. 33.
    Liang MH, Fossel AH, Larson MG. Comparisons of five health status instruments for orthopedic evaluation. Med Care. 1990;28:632–42.Google Scholar
  34. 34.
    Hedges LV, Olkin I. Statistical methods for meta-analysis. Orlando: Academic Press; 1985.Google Scholar
  35. 35.
    Gummesson C, Atroshi I, Ekdahl C. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskelet Disord. 2003;12:349–62.Google Scholar
  36. 36.
    Navsarikar A, Gladman DD, Husted JA, Cook RJ. Validity assessment of the disabilities of the arm, shoulder and hand questionnaire (DASH) for patients with psoriatic arthritis. J Rheumatol. 1999;26:2191–4.PubMedGoogle Scholar
  37. 37.
    Kudielka BM, Hanebuth D, von Kanel R, Gander ML, Grande G, Fischer JE. Health-related quality of life measured by the SF12 in working populations: associations with psychosocial work characteristics. J Occup Health Psychol. 2005;10:429–40.PubMedCrossRefGoogle Scholar
  38. 38.
    Dahlberg R, Karlqvist L, Bildt C, Nykvist K. Do work technique and musculoskeletal symptoms differ between men and women performing the same type of work tasks? Appl Ergon. 2004;35:521–9.PubMedCrossRefGoogle Scholar
  39. 39.
    Silverstein B, Fan ZJ, Smith CK, Bao S, Howard N, Spielholz P, Bonauto D, Viikari-Juntura E. Gender adjustment or stratification in discerning upper extremity musculoskeletal disorder risk? Scand J Work Environ Health. 2009;35:113–26.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Z. Joyce Fan
    • 1
    Email author
  • Caroline K. Smith
    • 1
  • Barbara A. Silverstein
    • 1
  1. 1.Safety & Health Assessment and Research for Prevention (SHARP)Washington State Department of Labor & IndustriesOlympiaUSA

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