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Disabilities of the Arm, Shoulder and Hand (DASH) Users Viewpoint Clarifies Interpretability of Scores
1Dorcas E. Beaton, PhD; 2Carol A. Kennedy, BScPT, MSc
1University of Toronto, Toronto, ON; 2Institute for Work & Health, Toronto, ON, Canada

Introduction: The DASH Outcome Measure is a well-recognized instrument for measuring upper-limb function and symptoms. One of the most difficult challenges is the ability to interpret an individual's numeric score. Some benchmarks and means of interpretation are available. The viewpoint of the stakeholder is an important perspective. The aim of this study was to help us understand how DASH users are interpreting individual scores.

Materials & Methods: A cross-sectional survey was administered to registered DASH Outcome Measure. The survey included user's work setting, interpretation of DASH scores based on clinical experiences, highest and lowest scores typically seen, satisfaction and agreement with information on interpretability, and how they think about their patients' progress. Descriptive statistics were used. Differences were assessed between work settings (clinical vs. research) with the chi-square (?) test.

Results: 172 DASH users completed the survey. Most respondents were treating clinicians (77%), and the remaining being researchers/educators (23%).

Interpretation of DASH scores: Most respondents thought DASH scores ranged from 10 to 29 in patients who were: a) "at a threshold for returning to work" (39%), b) "ready for discharge from treatment/therapy" (47%) and c) "aware of their upper limb limitations but it is not a problem" (55%). Most (55%) thought that DASH scores ranged from 40 to 69 in patients who were "having a lot of difficulty." Most (61%) thought DASH scores ranged from 0 to 29 in patients who were "no longer considering their upper limb disorder a problem." Over 75% indicated that the highest DASH scores they typically saw were in the range of 50 to 100 (80-90 range was most endorsed 18%). Greater than 70% indicated that the lowest scores they typically saw were in the range of 0 to 29. (? p>0.5)

Minimal Clinically Important Difference (MCID): Survey respondents were given information about the MCID and day-to-day variability, as well as thresholds for interpreting true change. Almost 90% of respondents were satisfied with this recommendation. Most thought the MCID was likely about right (59.8%). (? p>0.6)

Interpreting Progress in Patients: Almost 70% reported that they considered a combination that the patient had changed AND their final scores. 26% only thought about how much the patient had changed. Fewer reported thinking only about the final score (3.4%). (? p=0.29)

Conclusions: DASH users viewpoint clarifies interpretability of DASH Outcome Measure scores despite not pointing respondents to published cut-points. Users can manage the idea of multiple MCIDs and there is consensus.

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