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Validity and Responsiveness of Patients' DASH Scores as an Outcome Measure Following Ulnar Nerve Transposition for Cubital Tunnel Syndrome
Gregory C. Ebersole, MS, MS; Kristen Davidge, MD; Marci Bailey, RN, MSN; Susan E. Mackinnon, MD; Washington University School of Medicine in St Louis
Washington University School of Medicine in St Louis, Saint Louis, MO, USA


The purpose of this study was to determine the validity and responsiveness of the Disability of the Arm, Shoulder, and Hand questionnaire (DASH) as an outcome measure in cubital tunnel syndrome. The DASH was compared to other questionnaires and physical measurements of hand function. The clinical success of ulnar nerve transpositions (UNT) should correlate with significant decreases in post-operative DASH scores.


Subjects comprised of 69 patients diagnosed with cubital tunnel syndrome undergoing a UNT (n=41), a UNT/Guyon's canal release (n=21), or a UNT/Guyon's canal release/supercharge end-to-side transfer (n=7) from 9/09 to 12/11. The DASH was compared retrospectively to patient pain evaluations and SF-8 health survey scores, as well as key pinch and grip values. Patient evaluations were completed before surgery and from 0.5-12 months post-operatively. Data was analyzed using Wilcoxon Rank-Sum tests and Spearman correlation coefficients. Responsiveness was measured by evaluating effect size (ES) and standardized response mean. Analysis was performed for each surgical intervention and all interventions compiled at four time-points (0-1.5, 1.5-3, 3-6, and 6-12 months).


The responsiveness of the DASH increased over the post-operative period (ES = 0.0019 to -0.5663). Effect sizes were considered low for UNT/G interventions and low to moderate for UNT, UNT/G/SETS, and compiled interventions over time. However, DASH values did not decrease by a significant amount for any time-point for any surgery type. Pain evaluations showed significant (p<0.05) changes in a patient's perception of quality of life and pain in the surgery hand at up to 3 months for all intervention types except UNT/G/SETS. The responsiveness of patient quality of life scores was considered strong (ES>0.8) for all surgeries at almost every time-point. Physical symptomatic recovery appeared greatest from 3-6 months post-operatively. Spearman's coefficients showed the greatest correlation between changes in DASH scores and changes in pain evaluation quality of life, pain in the surgery hand, and grip strength.


DASH scores were found to be moderately responsive at 3 and >6 months post-operatively. Grip strength correlated moderately to strongly with DASH scores. Pain evaluation and quality of life scores were most responsive at early time-points, while physical measures and DASH scores showed greatest improvement from 3-6 months post-operatively. DASH scores are a valid quality of life outcome measure following UNT for cubital tunnel syndrome.

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