Skip to main content
Top
Published in: The Patient - Patient-Centered Outcomes Research 3/2017

01-06-2017 | Original Research Article

Examination of the Applicability of the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire to Patients with Hand Injuries and Diseases Using Rasch Analysis

Authors: Kathrin Braitmayer, Caroline Dereskewitz, Cornelia Oberhauser, Klaus-Dieter Rudolf, Michaela Coenen

Published in: The Patient - Patient-Centered Outcomes Research | Issue 3/2017

Login to get access

Abstract

Background

The Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire is the most commonly applied patient-reported outcome measure used to assess disability and functioning in clinical research and practice for patients with injuries and diseases of the upper extremities. The objective of this study was to assess whether the DASH is a valid and reliable questionnaire to measure disability and functioning in patients with hand injuries and diseases using Rasch analysis.

Methods

We performed a psychometric study using data derived from two multicentre studies carried out to develop the International Classification of Functioning, Disability and Health (ICF) Core Sets for Hand Conditions. We analysed the data of 417 patients recruited in a clinical setting and suffering from hand injuries (e.g. finger fracture, flexor tendon injury) or diseases (e.g. carpal tunnel syndrome, rhizarthrosis). We examined whether the DASH fulfilled the assumptions for its use as a measure by applying a partial credit model and testing for differential item functioning for sex and age.

Results

Bifactor analysis revealed problems with the underlying latent trait of functioning and disability. Rasch analysis raised further issues, including disordered thresholds for eight items and misfit in nine items. One item showed Differential Item Functioning for sex.

Conclusion

The study reveals that some DASH items do not fit the underlying trait that the DASH aims to measure. Further studies using Rasch analysis are needed to compare our findings with results of studies involving other target groups (e.g. patients with injuries of the upper arm and shoulder).
Literature
1.
go back to reference Hobart JC, Cano SJ, Zajicek JP, Thompson AJ. Rating scales as outcome measures for clinical trials in neurology: problems, solutions, and recommendations. Lancet Neurol. 2007;6(12):1094–105.CrossRefPubMed Hobart JC, Cano SJ, Zajicek JP, Thompson AJ. Rating scales as outcome measures for clinical trials in neurology: problems, solutions, and recommendations. Lancet Neurol. 2007;6(12):1094–105.CrossRefPubMed
2.
go back to reference Smith MV, Calfee RP, Baumgarten KM, Brophy RH, Wright RW. Upper extremity-specific measures of disability and outcomes in orthopaedic surgery. J Bone Joint Surg Am. 2012;94(3):277–85.CrossRefPubMedPubMedCentral Smith MV, Calfee RP, Baumgarten KM, Brophy RH, Wright RW. Upper extremity-specific measures of disability and outcomes in orthopaedic surgery. J Bone Joint Surg Am. 2012;94(3):277–85.CrossRefPubMedPubMedCentral
3.
go back to reference Chung KC, Pillsbury MS, Walters MR, Hayward RA. Reliability and validity testing of the Michigan Hand Outcomes Questionnaire. J Hand Surg Am. 1998;23(4):575–87.CrossRefPubMed Chung KC, Pillsbury MS, Walters MR, Hayward RA. Reliability and validity testing of the Michigan Hand Outcomes Questionnaire. J Hand Surg Am. 1998;23(4):575–87.CrossRefPubMed
4.
go back to reference Kirkley A, Alvarez C, Griffin S. The development and evaluation of a disease-specific quality-of-life questionnaire for disorders of the rotator cuff: the Western Ontario Rotator Cuff Index. Clin J Sport Med. 2003;13(2):84–92.CrossRefPubMed Kirkley A, Alvarez C, Griffin S. The development and evaluation of a disease-specific quality-of-life questionnaire for disorders of the rotator cuff: the Western Ontario Rotator Cuff Index. Clin J Sport Med. 2003;13(2):84–92.CrossRefPubMed
5.
go back to reference Levine DW, Simmons BP, Koris MJ, Daltroy LH, Hohl GG, Fossel AH, et al. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am. 1993;75(11):1585–92.CrossRefPubMed Levine DW, Simmons BP, Koris MJ, Daltroy LH, Hohl GG, Fossel AH, et al. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am. 1993;75(11):1585–92.CrossRefPubMed
6.
go back to reference Davis AM, Beaton DE, Hudak P, Amadio P, Bombardier C, Cole D, et al. Measuring disability of the upper extremity: a rationale supporting the use of a regional outcome measure. J Hand Ther. 1999;12(4):269–74.CrossRefPubMed Davis AM, Beaton DE, Hudak P, Amadio P, Bombardier C, Cole D, et al. Measuring disability of the upper extremity: a rationale supporting the use of a regional outcome measure. J Hand Ther. 1999;12(4):269–74.CrossRefPubMed
7.
go back to reference Bialocerkowski AE. Difficulties associated with wrist disorders–a qualitative study. Clin Rehabil. 2002;16(4):429–40.CrossRefPubMed Bialocerkowski AE. Difficulties associated with wrist disorders–a qualitative study. Clin Rehabil. 2002;16(4):429–40.CrossRefPubMed
9.
go back to reference Hill S, Dziedzic KS, Ong BN. The functional and psychological impact of hand osteoarthritis. Chronic Illn. 2010;6(2):101–10.CrossRefPubMed Hill S, Dziedzic KS, Ong BN. The functional and psychological impact of hand osteoarthritis. Chronic Illn. 2010;6(2):101–10.CrossRefPubMed
10.
go back to reference World Health Organization. International Classification Of Functioning, Disability and Health. Geneva: World Health Organization; 2001. World Health Organization. International Classification Of Functioning, Disability and Health. Geneva: World Health Organization; 2001.
11.
go back to reference Coenen M, Kus S, Rudolf KD, Muller G, Berno S, Dereskewitz C, et al. Do patient-reported outcome measures capture functioning aspects and environmental factors important to individuals with injuries or disorders of the hand? J Hand Ther. 2013;26(4):332–42 (quiz 42).CrossRefPubMed Coenen M, Kus S, Rudolf KD, Muller G, Berno S, Dereskewitz C, et al. Do patient-reported outcome measures capture functioning aspects and environmental factors important to individuals with injuries or disorders of the hand? J Hand Ther. 2013;26(4):332–42 (quiz 42).CrossRefPubMed
12.
go back to reference Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (Disabilities Of The Arm, Shoulder and Hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996;29(6):602–8.CrossRefPubMed Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (Disabilities Of The Arm, Shoulder and Hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996;29(6):602–8.CrossRefPubMed
13.
go back to reference Kus S, van de Ven-Stevens LA, Coenen M, Berno S, Kollerits B, Cieza A. What is our knowledge of functioning and disability in hand conditions based on? Arch Phys Med Rehabil. 2011;92(8):1326–32.CrossRefPubMed Kus S, van de Ven-Stevens LA, Coenen M, Berno S, Kollerits B, Cieza A. What is our knowledge of functioning and disability in hand conditions based on? Arch Phys Med Rehabil. 2011;92(8):1326–32.CrossRefPubMed
14.
go back to reference Beaton DE, Davis AM, Hudak PL, McConnell S. The DASH (Disabilities of the Arm, Shoulder and Hand) outcome measure: what do we know about it now? Br J Hand Ther. 2001;6(4):109–18. Beaton DE, Davis AM, Hudak PL, McConnell S. The DASH (Disabilities of the Arm, Shoulder and Hand) outcome measure: what do we know about it now? Br J Hand Ther. 2001;6(4):109–18.
15.
go back to reference Beaton DE, Katz JN, Fossel AH, Wright JG, Tarasuk V, Bombardier C. Measuring the whole or the parts? Validity, reliability, and responsiveness of the Disabilities of the Arm, Shoulder and Hand outcome measure in different regions of the upper extremity. J Hand Ther. 2001;14(2):128–46.CrossRefPubMed Beaton DE, Katz JN, Fossel AH, Wright JG, Tarasuk V, Bombardier C. Measuring the whole or the parts? Validity, reliability, and responsiveness of the Disabilities of the Arm, Shoulder and Hand outcome measure in different regions of the upper extremity. J Hand Ther. 2001;14(2):128–46.CrossRefPubMed
16.
go back to reference Gummesson C, Atroshi I, Ekdahl C. The Disabilities of the Arm, Shoulder and Hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskelet Disord. 2003;4:11–6.CrossRefPubMedPubMedCentral Gummesson C, Atroshi I, Ekdahl C. The Disabilities of the Arm, Shoulder and Hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskelet Disord. 2003;4:11–6.CrossRefPubMedPubMedCentral
17.
go back to reference Offenbaecher M, Ewert T, Sangha O, Stucki G. Validation of a German version of the Disabilities of Arm, Shoulder, and Hand Questionnaire (DASH-G). J Rheumatol. 2002;29(2):401–2.PubMed Offenbaecher M, Ewert T, Sangha O, Stucki G. Validation of a German version of the Disabilities of Arm, Shoulder, and Hand Questionnaire (DASH-G). J Rheumatol. 2002;29(2):401–2.PubMed
18.
go back to reference SooHoo NF, McDonald AP, Seiler JG 3rd, McGillivary GR. Evaluation of the construct validity of the DASH questionnaire by correlation to the SF-36. J Hand Surg Am. 2002;27(3):537–41.CrossRefPubMed SooHoo NF, McDonald AP, Seiler JG 3rd, McGillivary GR. Evaluation of the construct validity of the DASH questionnaire by correlation to the SF-36. J Hand Surg Am. 2002;27(3):537–41.CrossRefPubMed
19.
go back to reference Germann G, Harth A, Wind G, Demir E. Standardisation and validation of the German version 2.0 of the Disability of Arm, Shoulder, Hand (DASH) Questionnaire. Unfallchirurg. 2003;106(1):13–9.CrossRefPubMed Germann G, Harth A, Wind G, Demir E. Standardisation and validation of the German version 2.0 of the Disability of Arm, Shoulder, Hand (DASH) Questionnaire. Unfallchirurg. 2003;106(1):13–9.CrossRefPubMed
20.
go back to reference Lehman LA, Woodbury M, Velozo CA. Examination of the factor structure of the Disabilities of the Arm, Shoulder, and Hand Questionnaire. Am J Occup Ther. 2011;65(2):169–78.CrossRefPubMed Lehman LA, Woodbury M, Velozo CA. Examination of the factor structure of the Disabilities of the Arm, Shoulder, and Hand Questionnaire. Am J Occup Ther. 2011;65(2):169–78.CrossRefPubMed
21.
go back to reference Franchignoni F, Giordano A, Sartorio F, Vercelli S, Pascariello B, Ferriero G. Suggestions for refinement of the Disabilities of the Arm, Shoulder and Hand outcome measure (DASH): a factor analysis and Rasch validation study. Arch Phys Med Rehabil. 2010;91(9):1370–7.CrossRefPubMed Franchignoni F, Giordano A, Sartorio F, Vercelli S, Pascariello B, Ferriero G. Suggestions for refinement of the Disabilities of the Arm, Shoulder and Hand outcome measure (DASH): a factor analysis and Rasch validation study. Arch Phys Med Rehabil. 2010;91(9):1370–7.CrossRefPubMed
22.
go back to reference Cheng HM, Sampaio RF, Mancini MC, Fonseca ST, Cotta RM. Disabilities of the Arm, Shoulder and Hand (DASH): factor analysis of the version adapted to Portuguese/Brazil. Disabil Rehabil. 2008;30(25):1901–9.CrossRefPubMed Cheng HM, Sampaio RF, Mancini MC, Fonseca ST, Cotta RM. Disabilities of the Arm, Shoulder and Hand (DASH): factor analysis of the version adapted to Portuguese/Brazil. Disabil Rehabil. 2008;30(25):1901–9.CrossRefPubMed
23.
go back to reference Mousavi SJ, Parnianpour M, Abedi M, Askary-Ashtiani A, Karimi A, Khorsandi A, et al. Cultural adaptation and validation of the Persian version of the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure. Clin Rehabil. 2008;22(8):749–57.CrossRefPubMed Mousavi SJ, Parnianpour M, Abedi M, Askary-Ashtiani A, Karimi A, Khorsandi A, et al. Cultural adaptation and validation of the Persian version of the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure. Clin Rehabil. 2008;22(8):749–57.CrossRefPubMed
24.
go back to reference Beaton DE, Wright JG, Katz JN, Upper ExtremityCollaborative G. Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am. 2005;87(5):1038–46.PubMed Beaton DE, Wright JG, Katz JN, Upper ExtremityCollaborative G. Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am. 2005;87(5):1038–46.PubMed
25.
go back to reference Cano SJ, Barrett LE, Zajicek JP, Hobart JC. Beyond the reach of traditional analyses: using Rasch to evaluate the DASH in people with multiple sclerosis. Mult Scler. 2011;17(2):214–22.CrossRefPubMed Cano SJ, Barrett LE, Zajicek JP, Hobart JC. Beyond the reach of traditional analyses: using Rasch to evaluate the DASH in people with multiple sclerosis. Mult Scler. 2011;17(2):214–22.CrossRefPubMed
26.
go back to reference Rudolf KD, Kus S, Chung KC, Johnston M, LeBlanc M, Cieza A. Development of the international classification of functioning, disability and health core sets for hand conditions—results of the World Health Organization International Consensus process. Disabil Rehabil. 2012;34(8):681–93.CrossRefPubMed Rudolf KD, Kus S, Chung KC, Johnston M, LeBlanc M, Cieza A. Development of the international classification of functioning, disability and health core sets for hand conditions—results of the World Health Organization International Consensus process. Disabil Rehabil. 2012;34(8):681–93.CrossRefPubMed
27.
go back to reference Kus S, Oberhauser C, Cieza A. Validation of the brief international classification of functioning, disability, and health (ICF) core set for hand conditions. J Hand Ther. 2012;25(3):274–86 (quiz 87).CrossRefPubMed Kus S, Oberhauser C, Cieza A. Validation of the brief international classification of functioning, disability, and health (ICF) core set for hand conditions. J Hand Ther. 2012;25(3):274–86 (quiz 87).CrossRefPubMed
28.
go back to reference Kus S, Dereskewitz C, Wickert M, Schwab M, Eisenschenk A, Steen M, et al. Validation of the comprehensive international classification of functioning, disability and health (ICF) core set for hand conditions. Hand Therapy. 2011;16(3):58–66.CrossRef Kus S, Dereskewitz C, Wickert M, Schwab M, Eisenschenk A, Steen M, et al. Validation of the comprehensive international classification of functioning, disability and health (ICF) core set for hand conditions. Hand Therapy. 2011;16(3):58–66.CrossRef
29.
go back to reference Cronbach L. Coefficient alpha and the internal structure of tests. Psychometrika. 1951;16(3):297–334.CrossRef Cronbach L. Coefficient alpha and the internal structure of tests. Psychometrika. 1951;16(3):297–334.CrossRef
30.
go back to reference Revelle W, Zinbarg R. Coefficients alpha, beta, omega, and the glb: comments on Sijtsma. Psychometrika. 2009;74(1):145–54.CrossRef Revelle W, Zinbarg R. Coefficients alpha, beta, omega, and the glb: comments on Sijtsma. Psychometrika. 2009;74(1):145–54.CrossRef
31.
go back to reference Roscino A, Pollice A. A generalization of the polychoric correlation coefficient. In: Zani S, Cerioli A, Riani M, Vichi M, editors. Data analysis, classification and the forward search. Berlin, Heidelberg: Springer; 2006. p. 135–42.CrossRef Roscino A, Pollice A. A generalization of the polychoric correlation coefficient. In: Zani S, Cerioli A, Riani M, Vichi M, editors. Data analysis, classification and the forward search. Berlin, Heidelberg: Springer; 2006. p. 135–42.CrossRef
34.
go back to reference Reise SP. The rediscovery of bifactor measurement models. Multivar Behav Res. 2012;47(5):667–96.CrossRef Reise SP. The rediscovery of bifactor measurement models. Multivar Behav Res. 2012;47(5):667–96.CrossRef
35.
go back to reference Buja A, Eyuboglu N. Remarks on parallel analysis. Multivar Behav Res. 1992;27(4):509–40.CrossRef Buja A, Eyuboglu N. Remarks on parallel analysis. Multivar Behav Res. 1992;27(4):509–40.CrossRef
36.
go back to reference Reeve BB, Fayers P. Applying item response theory modeling for evaluating questionnaire item and scale properties. In: Fayers P, Hays RD, editors. Assessing quality of life in clinical trials: methods of practice. 2nd ed. Oxford: Oxford University Press; 2005. p. 55–73. Reeve BB, Fayers P. Applying item response theory modeling for evaluating questionnaire item and scale properties. In: Fayers P, Hays RD, editors. Assessing quality of life in clinical trials: methods of practice. 2nd ed. Oxford: Oxford University Press; 2005. p. 55–73.
37.
go back to reference Elhan AH, Küçükdeveci AA, Tennant A. The Rasch measurement model. In: Franchignoni F, editor. Research issues in physical and rehabilitation medicine. Pavia: Maugeri Foundation Books; 2010. p. 89–102. Elhan AH, Küçükdeveci AA, Tennant A. The Rasch measurement model. In: Franchignoni F, editor. Research issues in physical and rehabilitation medicine. Pavia: Maugeri Foundation Books; 2010. p. 89–102.
38.
go back to reference Tesio L. Measuring behaviours and perceptions: Rasch analysis as a tool for rehabilitation research. J Rehabil Med. 2003;35(3):105–15.CrossRefPubMed Tesio L. Measuring behaviours and perceptions: Rasch analysis as a tool for rehabilitation research. J Rehabil Med. 2003;35(3):105–15.CrossRefPubMed
39.
go back to reference Tennant A, Conaghan PG. The Rasch measurement model in rheumatology: what is it and why use it? When should it be applied, and what should one look for in a Rasch paper? Arthritis Rheum. 2007;57(8):1358–62.CrossRefPubMed Tennant A, Conaghan PG. The Rasch measurement model in rheumatology: what is it and why use it? When should it be applied, and what should one look for in a Rasch paper? Arthritis Rheum. 2007;57(8):1358–62.CrossRefPubMed
40.
go back to reference Pallant JF, Tennant A. An introduction to the Rasch measurement model: an example using the Hospital Anxiety and Depression Scale (HADS). Br J Clin Psychol. 2007;46(Pt 1):1–18.CrossRefPubMed Pallant JF, Tennant A. An introduction to the Rasch measurement model: an example using the Hospital Anxiety and Depression Scale (HADS). Br J Clin Psychol. 2007;46(Pt 1):1–18.CrossRefPubMed
41.
go back to reference Smith AB, Rush R, Fallowfield LJ, Velikova G, Sharpe M. Rasch fit statistics and sample size considerations for polytomous data. BMC Med Res Methodol. 2008;8(1):33.CrossRefPubMedPubMedCentral Smith AB, Rush R, Fallowfield LJ, Velikova G, Sharpe M. Rasch fit statistics and sample size considerations for polytomous data. BMC Med Res Methodol. 2008;8(1):33.CrossRefPubMedPubMedCentral
42.
go back to reference Bond TG, Fox CM. Applying the Rasch model: fundamental measurement in the human sciences. 2nd ed. Mahwah: Lawrence Erlbaum Associates, Inc.; 2007. Bond TG, Fox CM. Applying the Rasch model: fundamental measurement in the human sciences. 2nd ed. Mahwah: Lawrence Erlbaum Associates, Inc.; 2007.
43.
go back to reference R Core Team. R: a language and environment for statistical computing. Vienna: R Foundation for Statisctical Computing; 2013. R Core Team. R: a language and environment for statistical computing. Vienna: R Foundation for Statisctical Computing; 2013.
45.
go back to reference Choi SW, Gibbons LE, Crane PK. lordif: an R package for detecting differential item functioning using iterative hybrid ordinal logistic regression/item response theory and Monte Carlo simulations. J Stat Softw. 2011;39(8):1–30.CrossRefPubMedPubMedCentral Choi SW, Gibbons LE, Crane PK. lordif: an R package for detecting differential item functioning using iterative hybrid ordinal logistic regression/item response theory and Monte Carlo simulations. J Stat Softw. 2011;39(8):1–30.CrossRefPubMedPubMedCentral
Metadata
Title
Examination of the Applicability of the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire to Patients with Hand Injuries and Diseases Using Rasch Analysis
Authors
Kathrin Braitmayer
Caroline Dereskewitz
Cornelia Oberhauser
Klaus-Dieter Rudolf
Michaela Coenen
Publication date
01-06-2017
Publisher
Springer International Publishing
Published in
The Patient - Patient-Centered Outcomes Research / Issue 3/2017
Print ISSN: 1178-1653
Electronic ISSN: 1178-1661
DOI
https://doi.org/10.1007/s40271-016-0212-x

Other articles of this Issue 3/2017

The Patient - Patient-Centered Outcomes Research 3/2017 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.