Abstract
Purpose
To assess and compare content, validity, and specificity of the QuickDASH (Disability of the arm, shoulder and hand questionnaire) as compared to the full-length DASH and other instruments to give a recommendation for its use depending on a specific clinical situation.
Methods
Data of three large cohorts of patients with shoulder (n = 138), elbow (n = 79), and carpo-metacarpal I (n = 103) arthroplasties were analyzed. The item content of both instruments was compared within the subdomains function and symptoms. Scores and correlations to other instruments were compared in all strata to assess construct convergence. Specificity was quantified and compared using receiver operating characteristics curves (ROC) and effect sizes (in shoulder only).
Results
The QuickDASH underestimates symptoms (e.g., 71.1 vs. DASH 66.1 in elbow, 100 = no symptoms, P < 0.001) but overestimates disability (e.g., 72.8 vs. DASH 78.5 in wrist, 100 = full function, P < 0.001). It does not measure the same content as the DASH although the total score levels of both instruments are similar. Furthermore, the QuickDASH is less specific than the DASH in the subdomains, especially in symptoms: for example, area under ROC 0.65 vs. DASH 0.68 in elbow (P = 0.015); effect size in shoulder 1.42 vs. DASH 1.65 (P < 0.001).
Conclusion
The short QuickDASH can be recommended for a summary assessment of arm symptoms and function based on the total score in the daily clinical rush. For differentiated assessment of symptoms and function, e.g. for clinical studies, the full-length DASH provides more specific and sophisticated results.
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References
McConnell, S., Beaton, D. E., & Bombardier, C. (1999). The DASH outcome measure: A user’s manual. Toronto, Ontario: Institute for Work & Health.
Offenbaecher, M., Ewert, T., Sangha, O., & Stucki, G. (2002). Validation of a German version of the disabilities of arm, shoulder, and hand questionnaire (DASH-G). Journal of Rheumatology, 29, 401–402.
Hudack, P., Amadio, P. C., Bombardier, C., & The Upper Extremity Collaborative Group. (1996). Development of an upper extremity outcome measure: The DASH (disabilities of the arm shoulder and hand). American Journal of Industrial Medicine, 29, 602–608.
Dowrick, A. S., Gabbe, B. J., Williamson, O. D., & Cameron, P. A. (2005). Outcome instruments for the assessment of the upper extremity following trauma: A review. Injury, 36(4), 468–476.
Beaton, D. E., Katz, J. N., Fossel, A. H., Wright, J. G., & Tarasuk, V. (2001). Measuring the whole or parts? Validity, reliability, and responsiveness of the disabilities of the arm shoulder and hand outcome measure in different regions of the upper extremity. Journal of Hand Therapy, 14, 128–146.
Beaton, D. E., & Richards, R. R. (1996). Measuring function of the shoulder. A cross-sectional comparison of five questionnaires. Journal of Bone & Joint Surgery (America), 78A, 882–890.
Beaton, D. E., & Richards, R. R. (1998). Assessing the reliability and responsiveness of 5 shoulder questionnaires. Journal of Shoulder and Elbow Surgery, 7, 565–572.
Bot, S. D. M., Terwee, C. B., van der Windt, D. A. W. M., Bouter, L. M., & de Vet, H. C. W. (2004). Clinimetric evaluation of shoulder disability questionnaires: A review of the literature. Annals of the Rheumatic Diseases, 63, 335–341.
Angst, F., Pap, G., Mannion, A. F., Herren, D. B., Aeschlimann, A., Schwyzer, H. K., et al. (2004). Comprehensive assessment of clinical outcome and quality of life after total shoulder arthroplasty. Usefulness and validity of subjective outcome measurement. Arthritis and Rheumatism, 51(5), 819–828.
Doornberg, J. N., Ring, D., Fabian, L. M., Malhotra, L., Zurakowski, D., & Jupiter, J. B. (2005). Pain dominates measurement of elbow function and health status. Journal of Bone & Joint Surgery, 87A(8), 1725–1731.
Angst, F., John, M., Mannion, A. F., Herren, D. B., Aeschlimann, A., Schwyzer, H. K., et al. (2005). Comprehensive assessment of clinical outcome and quality of life after total elbow arthroplasty. Arthritis and Rheumatism, 53(1), 73–82.
MacDermid, J. C., Richards, R. S., Donner, A., Bellamy, N., & Roth, J. H. (2000). Responsiveness of the short form 36, disability of the arm, shoulder and hand questionnaire, patient rated wrist evaluation, and physical impairment measures evaluating recovery after distal radius fracture. Journal of Hand Surgery, 25A, 330–340.
Angst, F., John, M., Goldhahn, J., Herren, D. B., Pap, G., Aeschlimann, A., et al. (2005). Comprehensive assessment of clinical outcome and quality of life after resection interposition arthroplasty of the thumb saddle joint. Arthritis and Rheumatism, 53(2), 205–213.
Angst, F., Goldhahn, J., Drerup, S., Aeschlimann, A., Schwyzer, H. K., & Simmen, B. R. (2008). Responsiveness of six outcome assessment instruments in total shoulder arthroplasty. Arthritis and Rheumatism, 59(3), 391–398.
Beaton, D. E., Wright, J. G., Katz, J. N., & the Upper Extremity Collaborative Group. (2005). Development of QuickDASH: Comparison of three item-reduction approaches. Journal of Bone & Joint Surgery, 87-A(5), 1038–1046.
Gummesson, C., Ward, M. M., & Atroshi, I. (2006). The shortened disability of the arm, shoulder and hand questionnaire (QuickDASH): Validity and reliability based on responses within the full-length DASH. BMC Muculoskel Dis, 7, 44. URL: www.biomedcentral.com/1471-2474/7/44.
Ware, J. E., Snow, K. K., Kosinski, M., & Gandek, B. (2000). SF-36 health survey: Manual and interpretation guide (2nd ed.). Lincoln, Rhode Island: QualityMetric Incorporated.
Ware, J. E., & Kosinski, M. (2004). SF-36 physical and mental summary scales: A manual for users of version 1 (2nd ed.). Lincoln, Rhode Island: QualityMetric Incorporated. (5th printing).
Bullinger, M., & Kirchberger, I. (1998). SF-36 Fragebogen zum Gesundheitszustand. Handanweisung. Göttingen: Hogrefe.
Roach, K. E., Budiman-Mak, E., Songsiridej, N., & Lertrantanakul, Y. (1991). Development of a shoulder and pain disability index. Arthritis Care & Research, 4, 143–149.
Angst, F., Goldhahn, J., Pap, G., Mannion, A. F., Roach, K. E., Siebertz, D., et al. (2007). Cross-cultural adaptation, reliability, and validity of the German shoulder pain and disability index (SPADI). Rheumatology (Oxford), 46(1), 87–92.
MacDermid, J. C. (2001). Outcome evaluation in patients with elbow pathology: Issues in instrument development and evaluation. Journal of Hand Therapy, 14(2), 105–114.
John, M., Angst, F., Pap, G., Junge, A., & Mannion, A. F. (2007). Cross-cultural adaptation, reliability and validity of the patient related elbow evaluation (PREE) for German speaking patients. Clinical and Experimental Rheumatology, 25(2), 195–205.
MacDermid, J. C., Turgeon, T., Richards, R. S., Beadle, M., & Roth, J. H. (1998). Patient rating of wrist pain and disability: A reliable an valid measurement tool. Journal of Orthopaedic Trauma, 12(8), 577–586.
Hemelaers, L., Angst, F., Goldhahn, J., Drerup, S., MacDermid, J. C., & Wood-Dauphinée, S. (2008). Reliability and validity of the German version of the patient related wrist evaluation form (PRWE) in patients with acute distal radius fracture. Journal of Elbow Hand Therapy, 21(4), 366–376.
Rosner, B. (2000). Different significant tests. In B. Rosner (Ed.), Fundamentals of biostatistics (5th ed.). California: Duxbury (Thomson learning). pages 275,343,459.
Wyrwich, K. W., & Wolinsky, F. D. (2000). Identifying meaningful intra-individual change standards for health-related quality of life measures. Journal of Evaluation in Clinical Practice, 6(1), 39–49.
Streiner, D. L., & Norman, G. R. (2003). Homogeneity of the items. In D. L. Streiner & G. R. Norman (Eds.), Health measurement scales. A practical guide to their development and use (3rd ed., pp. 68–73). Oxford: Oxford University Press.
Sachs, L. (1999). Significance tests of two correlation coefficients. In L. Sachs (Ed.), Angewandte Statistik. Anwendung statistischer Methoden. (Applied statistics. Application of statistical methods.) (9th ed., pp. 543–544). Berlin: Springer.
Streiner, D. L., & Norman, G. R. (2003). Receiver operating characteristic curves, responsiveness. In D. L. Streiner & G. R. Norman (Eds.), Health measurement scales. A practical guide to their development and use (3rd ed., pp. 119–123). Oxford: Oxford University Press. 198–199,209.
Hanley, J. A., & McNeil, B. J. (1982). The meaning and the use of the area under the receiver operating characteristic (ROC) curve. Radiology, 143, 29–36.
Bessette, L., Sangha, O., Kuntz, K. M., Keller, R. B., Lwe, R. A., Fossle, A. H., et al. (1998). Comparative responsiveness of generic versus disease-specific and weighted versus unweighted health status measures in carpal tunnel syndrome. Medical Care, 36, 491–502.
Kazis, L. E., Anderson, J. J., & Meenan, R. F. (1989). Effect sizes for interpreting changes in health status. Medical Care, 27(Suppl. 3), 178–189.
Angst, F., Aeschlimann, A., Michel, B. A., & Stucki, G. (2002). Minimal clinically important rehabilitation effects in patients with osteoarthritis of the lower extremities. Journal of Rheumatology, 29(1), 131–138.
Abrahamson, J. H., & Abrahamson, Z. H. (2001). Measures of strength. In J. H. Abrahamson & Z. H. Abrahamson (Eds.), Making sense of data. A self-instruction manual on the interpretation of epidemiologic data (3rd ed., pp. 200–201). Oxford: Oxford University Press.
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Angst, F., Goldhahn, J., Drerup, S. et al. How sharp is the short QuickDASH? A refined content and validity analysis of the short form of the disabilities of the shoulder, arm and hand questionnaire in the strata of symptoms and function and specific joint conditions. Qual Life Res 18, 1043–1051 (2009). https://doi.org/10.1007/s11136-009-9529-4
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DOI: https://doi.org/10.1007/s11136-009-9529-4