The ‘M² DASH’—Manchester-Modified Disabilities of Arm Shoulder and Hand Score

The Disability of the Arm, Shoulder, and Hand (DASH) questionnaire was originally designed as a measure of disability in patients with disorders of the upper limb, but the DASH score is also affected by disability because of lower limb disorders. The aim of this study was to investigate the construct validity of the DASH questionnaire and to create a revised DASH questionnaire, the Manchester-modified or M² DASH, with fewer questions that is more specific to the upper limb. Patients were asked to fill in the DASH questionnaire in a fracture clinic after ethical approval. This included 79 patients with upper limb injuries, 61 patients with lower limb injuries, and 52 control subjects. The mean DASH scores for the three groups varied significantly, and the lower limb group had a mean score of 16. The M² DASH questionnaire was developed using questions more specific to the upper limb and included questions 1–4, 6, 13–17, 21–23, and 26–30 from the original questionnaire. The mean M² DASH score for the lower limb group was 9 and, unlike the original DASH score, was not statistically different from the control group. The M² DASH scores were then calculated for the upper limb group and a correlation study showed highly significant correlation between the original DASH scores and the M² DASH scores. Our study shows that the original DASH questionnaire is not specific for the upper limb. The M² DASH questionnaire has the advantage of being more specific for the upper limb than the DASH questionnaire, and it correlates well with the original DASH questionnaire when looking at isolated upper limb injuries.