Examination of the Applicability of the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire to Patients with Hand Injuries and Diseases Using Rasch Analysis

  • Kathrin Braitmayer
  • Caroline Dereskewitz
  • Cornelia Oberhauser
  • Klaus-Dieter Rudolf
  • Michaela CoenenEmail author
Original Research Article



The Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire is the most commonly applied patient-reported outcome measure used to assess disability and functioning in clinical research and practice for patients with injuries and diseases of the upper extremities. The objective of this study was to assess whether the DASH is a valid and reliable questionnaire to measure disability and functioning in patients with hand injuries and diseases using Rasch analysis.


We performed a psychometric study using data derived from two multicentre studies carried out to develop the International Classification of Functioning, Disability and Health (ICF) Core Sets for Hand Conditions. We analysed the data of 417 patients recruited in a clinical setting and suffering from hand injuries (e.g. finger fracture, flexor tendon injury) or diseases (e.g. carpal tunnel syndrome, rhizarthrosis). We examined whether the DASH fulfilled the assumptions for its use as a measure by applying a partial credit model and testing for differential item functioning for sex and age.


Bifactor analysis revealed problems with the underlying latent trait of functioning and disability. Rasch analysis raised further issues, including disordered thresholds for eight items and misfit in nine items. One item showed Differential Item Functioning for sex.


The study reveals that some DASH items do not fit the underlying trait that the DASH aims to measure. Further studies using Rasch analysis are needed to compare our findings with results of studies involving other target groups (e.g. patients with injuries of the upper arm and shoulder).


Differential Item Functioning Carpal Tunnel Syndrome Latent Trait Partial Credit Model Hand Injury 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We would like to thank all persons involved in the data collection at (1) the Department of Hand Surgery, Plastic and Microsurgery at the BG Klinikum Hamburg, (2) the Department of Plastic and Hand Surgery, Burns Unit at the BG Klinikum Bergmannstrost Halle, (3) the Department of Hand Surgery, Plastic and Microsurgery at the Unfallkrankenhaus Berlin and (4) the Department of Hand, Plastic, Reconstructive and Burns Surgery at the BG Klinik Tübingen.

Author contributions

Michaela Coenen initiated and supervised the study, contributed to the design of the study and revised the draft version of the manuscript. Kathrin Braitmayer performed the data analysis, interpreted the results and drafted the manuscript. Cornelia Oberhauser supervised the data analysis and contributed to the writing and revising of the manuscript. Caroline Dereskewitz and Klaus-Dieter Rudolf contributed to the design of the study, managed and supervised the data collection of the two former studies and contributed to the writing of the manuscript.

Compliance with Ethical Standards


The two former studies that provided the data used in this study were funded by the German Social Accident Insurance, DGUV. The authors of this publication are responsible for its content.

Disclosure of potential conflicts of interest

K Braitmayer, C. Dereskewitz, C. Oberhauser, K.-D. Rudolf and M. Coenen declare that they have no competing interests.

Statement on human rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Statement on the welfare of animals

This article does not include any animal studies performed by any of the authors.

Informed consent

For this psychometric study, we used data from two former studies. Both studies were approved by the Ethics Committee of the Medical Association, Hamburg, and the Ethics Committee of the Ludwig-Maximilians-Universität (LMU), Munich. Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Chair for Public Health and Health Services Research, Department of Medical Informatics, Biometry and Epidemiology-IBE, Research Unit for Biopsychosocial HealthLudwig-Maximilians-Universität (LMU) MunichMunichGermany
  2. 2.Department of Hand Surgery, Plastic- and MicrosurgeryBG Hospital HamburgHamburgGermany

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