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

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

doi:10.1007/s40271-016-0212-x

Cited by 22 publications

(19 citation statements)

References 39 publications

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“…Consistent with our findings, DASH has been reported to violate the requirement of local item independence. A pattern of high residual correlation similar to ours where activity-related item group together while impairment-related items group together has been reported in patients with various upper extremity musculoskeletal disorders [ 15 , 16 , 18 , 34 , 36 , 37 ]. Similar to the approach used in the current study, Prodinger et al reported the use of two testlets (activity limitation and impairment testlets) to accommodate the issue of local dependency within the scale and this method yielded satisfactory fit to the Rasch model in line with the findings of the current study [ 34 ].…”

Section: Discussionsupporting

confidence: 86%

Structural validity of the Arabic version of the disabilities of the Arm, Shoulder and Hand (DASH) using Rasch measurement model

Alnahdi

2021

J Patient Rep Outcomes

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Background The disabilities of the arm, shoulder and hand (DASH) is a commonly used region-specific patient-reported outcome measure (PROM) that quantify upper extremity function (activity limitation) and symptoms. Current evidence suggests that measurement properties of the adapted versions of the DASH are not sufficiently examined. The Arabic DASH has evidence supporting its internal consistency, test–retest reliability, construct validity and responsiveness. On the other hand, the validity of the assumed unidimensionality of the Arabic DASH has not been examined previously. The aim of this study was to examine the structural validity of the Arabic DASH in patients with upper extremity musculoskeletal disorders using Rasch measurement model. Methods Patients with upper extremity musculoskeletal disorders were recruited and were asked to complete the Arabic DASH at their initial visit to physical therapy departments. The overall fit of the Arabic DASH to the requirement of the Rasch measurement model was examined using chi-square statistics for item-trait interaction, mean item and person fit residuals. The fit of individual items, thresholds ordering, local dependency, differential item functioning (DIF), and unidimensionality using the t-test approach were also examined. Results The Arabic DASH did not fit the Rasch measurement model initially (χ2 = 179.04, p < 0.001) with major breach of local item independence and a pattern of high residual correlations among the activity-related items and among the impairment-related items. Combining items into activity-limitation and impairment testlets accommodated the local dependency and led to satisfactory fit of the Arabic DASH to the requirement of the Rasch measurement model (χ2 = 3.99, p = 0.41). Conclusions Rasch measurement model supports the structural validity of the Arabic DASH as a unidimensional measure after the accommodation of local dependency.

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Section: Discussionsupporting

confidence: 86%

Structural validity of the Arabic version of the disabilities of the Arm, Shoulder and Hand (DASH) using Rasch measurement model

Alnahdi

2021

J Patient Rep Outcomes

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“…Braitmayer et al reported poor discrimination for patients with low disability when analysing the DASH with a similar study population. 12 Forget et al also found that the DASH had better coverage and targeting in patients with high disability in a sample made up of Dupuytren's contracture patients. 7 The present patient sample represented a mixture of typical patients encountered at the hand surgery clinic (see Table 1).…”

Section: Discussionmentioning

confidence: 97%

“…Studies that have used Rasch analysis on the DASH have shown several problems including multidimensionality of the data, disordered thresholds, differential item functioning (DIF) and high residual correlation between items. [12][13][14] Previously, to correct the problems of multidimensionality and local dependence, studies have removed items that do not fit the Rasch model 7,15 or split the DASH into subscales. 13,16,17 More recently, the creation of testlets has been proposed to solve these issues.…”

Section: Introductionmentioning

confidence: 99%

The structural validity of the Finnish version of the Disabilities of the Arm, Shoulder and Hand: A Rasch model analysis

et al. 2020

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Introduction The construct validity of the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) has previously been questioned. The purpose of this study was to evaluate the measurement properties of the Finnish version of the DASH for assessing disability in patients with hand complaints using Rasch Measurement Theory. Methods A cohort of 193 patients with typical hand and wrist complaints were recruited at a surgery outpatient clinic. The DASH scores were analysed using the Rasch model for differential item functioning, unidimensionality, fit statistics, item residual correlation, coverage/targeting and reliability. Results In the original DASH questionnaire, the item response thresholds were disordered for 2 of 30 of the items. The item fit was poor for 9 of 30 of the items. Unidimensionality was not supported. There was substantial residual correlation between 87 pairs of items. Item reduction (chi square 95, degrees of freedom 50, p < 0.001) and constructing two testlets led to unidimensionality (chi square 0.64, degrees of freedom 4, p = 0.96). Person separation index was 0.95. The testlets had good fit with no differential item functioning towards age or gender. Conclusion Unidimensionality of the original Finnish version of the DASH was not supported, meaning the questionnaire seems to gauge traits other than disability alone. Hence, the clinician must be careful when trying to measure change in patients’ scores. Item reduction or the creation of testlets did not lead to good alternatives for the original Finnish DASH. Differential item functioning showed that the original Finnish scale exhibits minor response bias by age in one item. The original Finnish DASH covers different levels of ability well among typical hand surgery patients.

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“…Measurement invariance assesses the equivalence of items across specified groups, with only one study reporting no significant differences between group factors (sex, hand dominance, and side injured) and PEM score. 45 Braitmayer et al 15 conducted multifactor analysis for the DASH and reported DIF for sex. The Rasch-refined UEFI showed DIF for sex on 2 items “using tools/appliances” and “cleaning”.…”

Section: Discussionmentioning

confidence: 99%

“…The Rasch-refined UEFI showed DIF for sex on 2 items “using tools/appliances” and “cleaning”. 46 The PEM comprises symptom items (pain, stiffness, etc), whereas the DASH items with pronounced DIF were task based, specifically item 11 (carrying a heavy object) demonstrated important differences between sex, 15 which was mirrored by the task-based items with DIF in the UEFI. 46 The site-specific PROMs appraised here comprise some with mainly task-based items, some with symptom-based items, and some that are a mix of the 2.…”

Section: Discussionmentioning

confidence: 99%

Site-specific Patient-reported Outcome Measures for Hand Conditions: Systematic Review of Development and Psychometric Properties

Wormald

Geoghegan

Sierakowski

et al. 2019

Plastic and Reconstructive Surgery - Global Open

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Background: There are a number of site-specific patient-reported outcome measures (PROMs) for hand conditions used in clinical practice and research for assessing the efficacy of surgical and nonsurgical interventions. The most commonly used hand-relevant PROMs are as follows: Disabilities of the Arm, Shoulder and Hand (DASH), QuickDASH (qDASH), Michigan Hand Questionnaire (MHQ), Patient Evaluation Measure (PEM), Upper Extremity Functional Index (UEFI), and Duruoz Hand Index (DHI). There has been no systematic evaluation of the published psychometric properties of these PROMs. Methods: A PRISMA-compliant systematic review of the development and validation studies of these hand PROMs was prospectively registered in PROSPERO and conducted to assess their psychometric properties. A search strategy was applied to Medline, Embase, PsycINFO, and CINAHL. Abstract screening was performed in duplicate. Assessment of psychometric properties was performed. Results: The search retrieved 943 articles, of which 54 articles met predefined inclusion criteria. There were 19 studies evaluating DASH, 8 studies evaluating qDASH, 13 studies evaluating MHQ, 5 studies evaluating UEFI, 4 studies evaluating PEM, and 5 studies evaluating DHI. Assessment of content validity, internal consistency, construct validity, reproducibility, responsiveness, floor/ceiling effect, and interpretability for each PROM is described. Conclusions: The psychometric properties of the most commonly used PROMs in hand research are not adequately described in the published literature. DASH, qDASH, and MHQ have the best-published psychometric properties, though they have either some poor psychometric performance or incompletely studied psychometric properties. There are more limited published data describing the psychometric properties of the UEFI, PEM, and DHI.

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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

Abstract: 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).

Cited by 22 publications

References 39 publications

Structural validity of the Arabic version of the disabilities of the Arm, Shoulder and Hand (DASH) using Rasch measurement model

Structural validity of the Arabic version of the disabilities of the Arm, Shoulder and Hand (DASH) using Rasch measurement model

The structural validity of the Finnish version of the Disabilities of the Arm, Shoulder and Hand: A Rasch model analysis

Site-specific Patient-reported Outcome Measures for Hand Conditions: Systematic Review of Development and Psychometric Properties

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