Highlights
- •We analyzed the preoperative QuickDASH scores of 1916 patients who had undergone carpal tunnel decompression (CTD).
- •Exploratory Factor Analysis and Structural Equation Modelling was undertaken using established methodology.
- •Based on the results, we conclude that the QuickDASH Patient Reported Outcome Measure (PROM) measures 2 separate factors in patients undergoing CTD: function, and symptoms.
- •Dividing and analyzing the QuickDASH PROM as 2 independent sub-scales with distinct scores could optimize its structural validity in this condition.
ABSTRACT
Study design
Retrospective cohort.
Background
The QuickDASH is a commonly used questionnaire for the assessment of carpal tunnel
patients, although it is unclear whether the questionnaire has suitable structural
validity
Purpose
This study aimed to evaluate the structural validity of the QuickDASH patient-reported
outcome measure (PROM), when used in CTS, through exploratory factor analysis (EFA)
and structural equation modelling (SEM).
Methods
Between 2013 and 2019, we recorded preoperative QuickDASH scores of 1916 patients
undergoing carpal tunnel decompressions at a single unit. One hundred and eighteen
patients with incomplete datasets were excluded leaving a final study group of 1798
patients with complete data. EFA was undertaken using the R statistical computing
environment. We then conducted SEM in a random sample of 200 patients. Model fit was
assessed using the chi-square (χ2) test, comparative fit index (CFI), Tucker-Lewis index (TLI), root mean square error
of approximation (RMSEA) and standardized root mean square residuals (SRMR). A second
“validation” SEM analysis was undertaken by repeating the analysis with a separate
sample of 200 randomly-selected patients.
Results
EFA revealed a 2-factor model: items 1-6 represented the first factor (“function”)
and items 9-11 measured a different factor (“symptoms”). SEM demonstrated excellent
fit (χ2 p value 0.167, CFI 0.999, TLI 0.999, RMSEA 0.032, SRMR 0.046) and this was supported
in our “validation” sample.
Conclusions
This study demonstrates that the QuickDASH PROM measures 2 distinct factors in CTS.
This is comparable with the findings of a previous EFA that assessed the full-length
Disabilities of the Arm, Shoulder and Hand PROM in patients with Dupuytren's disease.
Keywords
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References
- Carpal tunnel syndrome.BMJ. 2014; : 349https://doi.org/10.1136/bmj.g6437
- Impact of occupations and job tasks on the prevalence of carpal tunnel syndrome.Scand J Work Environ Heal. 1992; 18: 337-345https://doi.org/10.5271/sjweh.1564
- Occupation classification predicts return to work after carpal tunnel decompression.Occup Med (Lond). 2020; 70: 415-420https://doi.org/10.1093/occmed/kqaa061
- Validity of the Disabilities of the Arm, Shoulder and Hand patient-reported outcome measure (DASH) and the Quickdash when used in Dupuytren's disease.J Hand Surg Eur. 2016; 41: 589-599https://doi.org/10.1177/1753193415601350
- Development of the QuickDASH: comparison of three item-reduction approaches.J Bone Jt Surg. 2005; 87: 1038-1046https://doi.org/10.2106/JBJS.D.02060
- Outcome metrics in the treatment of carpal tunnel syndrome: a systematic review.Hand (N Y). 2020; (October)1558944720949951https://doi.org/10.1177/1558944720949951
- Psychometric properties of QuickDASH - a classical test theory and Rasch analysis study.Man Ther. 2011; 16: 177-182https://doi.org/10.1016/j.math.2010.10.004
- Development of the QuickDASH: COmparison of three item-reduction approaches.J Bone Jt Surg - Ser A. 2005; 87: 1038-1046https://doi.org/10.2106/JBJS.D.02060
Team RC. R: A language and environment for statistical computing. 2013.
- Exploratory factor analysis: a five-step guide for novices.J Emerg Prim Heal Care. 2010; 8: 1-13https://doi.org/10.33151/ajp.8.3.93
D'agostino R, Russell H. Scree test. In: Encyclopedia of Biostatistics. 2005. doi:10.1002/0470011815.b2a10082.
- Repairing Tom Swift's electric factor analysis machine.Underst Stat. 2003; 2: 13-43https://doi.org/10.1207/s15328031us0201_02
Buchanan E. Advanced statistics. Advanced Statistics. doi:10.17605/OSF.IO/DNUYV.
James D. Choosing the right number of components or factors in PCA and EFA. JALT Test Eval SIG.
Kenny D. Measuring model fit. Available at: http://www.davidakenny.net/cm/fit.htm. Published 2015. Accessed February 6, 2021.
- Confirmatory factor analysis with ordinal data: comparing robust maximum likelihood and diagonally weighted least squares.Behav Res Methods. 2016; 48: 936-949https://doi.org/10.3758/s13428-015-0619-7
- Robust statistical methods: a primer for clinical psychology and experimental psychopathology researchers.Behav Res Ther. 2017; 98: 19-38https://doi.org/10.1016/j.brat.2017.05.013
- Reporting structural equation modeling and confirmatory factor analysis results: a review.J Educ Res. 2006; 99: 323-338https://doi.org/10.3200/JOER.99.6.323-338
- The scree test for the number of factors.Multivariate Behav Res. 1966; 1: 245-276https://doi.org/10.1207/s15327906mbr0102_10
Patil VH, Singh SN, Mishra S, Donavan DT. Parallel analysis engine to aid in determining number of factors to retain using R [Computer software]. 2017.
- QuickDASH questionnaire items behave as 2 distinct subscales rather than one scale in Dupuytren's disease.J Hand Ther. 2021; (December)https://doi.org/10.1016/J.JHT.2021.11.001
- Occupation classification predicts return to work after carpal tunnel decompression.Occup Med (Chic Ill). 2020; 70: 415-420https://doi.org/10.1093/occmed/kqaa061
- Reliability, validity and responsiveness of the French version of the questionnaire Quick Disability of the Arm, Shoulder and Hand in shoulder disorders.Man Ther. 2009; 14: 206-212https://doi.org/10.1016/j.math.2008.01.013
- Validation of the Japanese Society for Surgery of the Hand version of the Quick Disability of the Arm, Shoulder, and Hand (QuickDASH-JSSH) questionnaire.J Orthop Sci. 2006; 11: 248-253https://doi.org/10.1007/s00776-006-1013-1
- Exploratory factor analysis: a guide to best practice.J Black Psychol. 2018; 44: 219-246https://doi.org/10.1177/0095798418771807
Article info
Publication history
Published online: March 11, 2023
Accepted:
September 13,
2022
Received in revised form:
September 8,
2022
Received:
November 4,
2021
Publication stage
In Press Corrected ProofFootnotes
Funding: None.
No relevant conflicts of interest or financial disclosures.
Level of evidence: Not applicable.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
