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DASH Score Reporting for Hand and Wrist Conditions: A Scoping Review
Heather Baltzer, MD, PhD; Christine B. Novak, PT, PhD; Steven J. McCabe, MD
University of Toronto, Toronto, ON, Canada

Introduction: Upper extremity disability is frequently assessed using self report questionnaires such as the Disability of the Arm, Shoulder and Hand (DASH). These outcomes have been reported for a variety of hand and wrist conditions. The purpose of this study was to perform a scoping review of the literature regarding studies which have used to DASH to report outcomes in hand and wrist conditions.
Material & Methods: A literature review was performed using three electronic databases: MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (from the earliest available date to January 1, 2013). The initial review included search terms "DASH AND Hand" and subsequent searches included combinations of "DASH" and each condition identified in the initial search. Studies which reported a DASH score for hand or wrist pathology were reviewed. Inclusion criteria: DASH score for a patient sample with a single pathology. Chronic inflammatory, degenerative, chronic post-traumatic conditions were included to assess "baseline" DASH values for a variety of conditions. Exclusion criteria: Studies that did not report baseline DASH score for each condition. Patient and measurement factors related the DASH score (pre- and post-operative timing, repeated measures, other reported outcomes and study design) were recorded.
Results: There were 791 citations identified. Following review of abstracts, 118 full text articles were identified and 80 were selected for full review: 38 prospective cohort studies, 23 retrospective cohort studies, 14 cross-sectional studies, 4 randomized trials and one systematic review. DASH scores were recorded for 23 hand or wrist pathologies. There was substantial variation in assessment time points (range two weeks to two years). There was a substantial range of DASH scores for different pathologies and the trend in increasing scores did not correspond to more complex injuries; digit and upper limb replant (range 2-28) had lower scores than DeQuervain's tenosynovitis (range 26-93) and CMC osteoarthritis (range 26-61). DASH scores were the only outcome reported 20% of the time, while grip and key pinch were reported with the DASH 58% and other hand/wrist measures 20% of the time.
Conclusions: In this scoping review, we found: 1) substantial range in disability assessed by the DASH; 2) varied methods and time points of DASH assessment; 3) increased DASH scores did not correspond to the condition severity. These themes highlight the need for further study into for contextualizing DASH score according to other patient related factors and standardization of DASH measurement methodology.


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