Scientific/Clinical Article| Volume 30, ISSUE 1, P30-40.e2, January 2017

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A user's survey of the clinical application and content validity of the DASH (Disabilities of the Arm, Shoulder and Hand) outcome measure

  • Carol A. Kennedy
    Corresponding author. Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, Ontario M5G 2E9, Canada. Tel.: +1 416 927 2027; fax: +1 416 927 4167.
    Institute for Work & Health, Toronto, Ontario, Canada

    Mobility Program, Musculoskeletal Health & Outcomes Research, St. Michael's Hospital, Toronto, Ontario, Canada
    Search for articles by this author
  • Dorcas E. Beaton
    Institute for Work & Health, Toronto, Ontario, Canada

    Mobility Program, Musculoskeletal Health & Outcomes Research, St. Michael's Hospital, Toronto, Ontario, Canada
    Search for articles by this author


      Study Design


      Purpose of the Study

      To elicit feedback on the clinical use and content validity of the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure from frontline users of the instrument.


      A cross-sectional survey was administered to registered DASH users and inquired about how the DASH was being used and to identify the informational value of items of the DASH (content validity).


      About 172 completed the survey. One or both of the DASH and/or QuickDASH were consistently (89.5%) being used. About 90% were using it in adults (21-65 years), and at least 70% were using it across the entire extremity, and to a lesser extent, 10% reported using it in isolated neck injuries. Most respondents (66.9%-75.8%) were using the DASH in musculoskeletal (MSK) disorders, with some applying it for other more unique or non-MSK conditions (2.5%-16.6%). All but 1 of the 30 DASH items had at least 10% endorsement as being informative, and 4 items were identified as being problematic by greater than 20%.


      The DASH is being used as intended (whole extremity and MSK conditions), and in addition, it is being used in different body regions and diverse conditions.

      Level of Evidence

      Not applicable (descriptive survey).


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        • Liss G.
        • Switzer-McIntyre S.
        • Lander L.
        • Jiang D.
        DASH work module in workers with hand-arm vibration syndrome.
        Occup Med (Lond). 2012; 62: 448-450
        • House R.
        • Wills M.
        • Liss G.
        • Switzer-McIntyre S.
        • Manno M.
        • Lander L.
        Upper extremity disability in workers with hand-arm vibration syndrome.
        Occup Med (Lond). 2009; 59: 167-173
        • Mason H.J.
        • Poole K.
        • Elms J.
        Upper limb disability in HAVS cases—how does it relate to the neurosensory or vascular elements of HAVS?.
        Occup Med (Lond). 2005; 55: 389-392
        • Poole K.
        • Mason H.
        Disability in the upper extremity and quality of life in hand-arm vibration syndrome.
        Disabil Rehabil. 2005; 27: 1373-1380
        • Poole K.
        • Mason H.
        Relationship between self-reported upper limb disability and quantitative tests in hand-arm vibration syndrome.
        Disabil Rehabil. 2007; 29: 359-366
        • Sinclair C.F.
        • Gleysteen J.P.
        • Zimmermann T.M.
        • et al.
        Assessment of donor site morbidity for free radial forearm osteocutaneous flaps.
        Microsurgery. 2012; 32: 255-260
        • Sieg P.
        • Dericioglu M.
        • Hansmann C.
        • Jacobsen H.C.
        • Trenkle T.
        • Hakim S.G.
        Long-term functional donor site morbidity after ulnar forearm flap harvest.
        Head Neck. 2012; 34: 1312-1316
        • Miles B.A.
        • Gilbert R.W.
        Maxillary reconstruction with the scapular angle osteomyogenous free flap.
        Arch Otolaryngol Head Neck Surg. 2011; 137: 1130-1135
        • Ashford S.
        • Turner-Stokes L.
        • Siegert R.
        • Slade M.
        Initial psychometric evaluation of the Arm Activity Measure (ArmA): a measure of activity in the hemiparetic arm.
        Clin Rehabil. 2013; 27: 728-740
        • Cano S.
        • Barrett L.
        • Zajicek J.
        • Hobart J.
        Beyond the reach of traditional analyses: using Rasch to evaluate the DASH in people with multiple sclerosis.
        Mult Scler. 2011; 17: 214-222
        • Chapman T.T.
        • Richard R.L.
        • Hedman T.L.
        • Renz E.M.
        • Wolf S.E.
        • Holcomb J.B.
        Combat casualty hand burns: evaluating impairment and disability during recovery.
        J Hand Ther. 2008; 21: 150-158
        • Wu A.
        • Edgar D.W.
        • Wood F.M.
        The QuickDASH is an appropriate tool for measuring the quality of recovery after upper limb burn injury.
        Burns. 2007; 33: 843-849
        • Dale L.M.
        • Bolin E.
        • Howearth H.
        • et al.
        The upper limb functional index and QuickDASH are responsive tools for measuring clinical change after an upper extremity burn.
        J Hand Ther. 2011; 24: 385-386
        • Davies C.
        • Brockopp D.
        Internal consistency of the Disability of the Arm, Shoulder, and Hand (DASH) outcome measure in assessing functional status among breast cancer survivors.
        Rehabil Oncol. 2014; 31: 6-12
        • Yang E.J.
        • Kim B.R.
        • Shin H.I.
        • Lim J.Y.
        Use of the international classification of functioning, disability and health as a functional assessment tool for breast cancer survivors.
        J Breast Cancer. 2012; 15: 43-50
        • Nulty D.D.
        The adequacy of response rates to online and paper surveys: what can be done?.
        Assess Eval High Educ. 2008; 33: 301-314

      JHT Read for Credit

      Quiz: #460

      Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to There is only one best answer for each question.
      • #1.
        The authors implied that DASH users were
        • a.
        • b.
          all CHTs
        • c.
        • d.
          patients who had completed the DASH
      • #2.
        A primary purpose of the investigation was to determine
        • a.
          how the DASH was being utilized in day-to-day practice
        • b.
          how long it took to administer the DASH
        • c.
          how well patients were able to complete the DASH
        • d.
          if the DASH was cost effective
      • #3.
        The authors found that
        • a.
          the DASH was being used as intended
        • b.
          the DASH was being used across a wide variety of upper extremity diagnoses
        • c.
          the response rate was low
        • d.
          all of the above
      • #4.
        The user sample was
        • a.
          primarily non English speaking users
        • b.
          50% European
        • c.
          weighted heavily to US users, some 50+%
        • d.
          entirely North American
      • #5.
        Only 4 items were identified as being problematic, and those by only 20% of the users
        • a.
        • b.
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.