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Validity of the DASH Questionnaire in Upper Extremity Nerve Injury
Christine B. Novak, PT, PhD
University of Toronto, Toronto, ON, Canada

Introduction: Self-report questionnaires such as the Disabilities of the Arm, Shoulder and Hand (DASH) are used to assess upper extremity disability as a single construct score. The purpose of this study was to evaluate the validity of the factor structure and individual item completion of the DASH questionnaire in patients with upper extremity nerve injury.

Materials & Methods: Data from a previous cross-sectional study which evaluated patients with an upper extremity nerve injury were used. Institutional Research Ethics Board approval was obtained for secondary analyses of these data. Descriptive and factor analyses were performed.

Results: Patients (n = 242; 170 men, 72 women) with upper extremity nerve injury who completed the DASH were included in this study; diagnoses included distal nerve injury (n = 131) and brachial plexus or single proximal nerve injury (n = 111). Most patients (n = 227, 94%) completed all questionnaire items with a mean DASH score 47.3 22 and mean QuickDASH score 50.4 22. Using mean item scores for replacement of missing items, the mean DASH score was 46.9 22. The highest scored item (indicating increased difficulty) was related to recreational activities and the lowest scored item was related to transportation needs. The internal consistency was high for the DASH (? = 0.96) and QuickDASH (? = 0.90). For the DASH, a 3-factor structure had the highest variance (60.7%) and no overlap between factors. The 3-factor structure revealed domains related to: 1) light effort tasks; 2) greater effort tasks and; 3) limitations in social/work activities and pain. For the QuickDASH, a 2-factor structure had the highest variance (62%) and the item regarding limitation in activity was the only item with overlap between factors.

Conclusions: The DASH completion rate and internal consistency of all questionnaire items was high. In this sample of patients with nerve injury, the confirmatory factor analysis of the DASH and QuickDASH indicated a multi-factor construct. These multi-factor domains should be considered when utilizing the DASH as a single construct score of upper extremity disability.


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