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. 2019 Jan 25;20(1):41.
doi: 10.1186/s12891-019-2414-6.

Revisiting the disabilities of the arm, shoulder and hand (DASH) and QuickDASH in rheumatoid arthritis

B Prodinger  1   2   3   4 , A Hammond  5 , A Tennant  6   7   8 , Y Prior  5   9 , S Tyson  10
Affiliations

Revisiting the disabilities of the arm, shoulder and hand (DASH) and QuickDASH in rheumatoid arthritis

B Prodinger et al. BMC Musculoskelet Disord. .

Abstract

Background: Limitations in upper limb functioning are common in Musculoskeletal disorders and the Disabilities of the Arm, Shoulder and Hand scale (DASH) has gained widespread use in this context. However, various concerns have been raised about its construct validity and so this study seeks to examine this and other psychometric aspects of both the DASH and QuickDASH from a modern test theory perspective.

Methods: Participants in the study were eligible if they had a confirmed diagnosis of Rheumatoid Arthritis (RA). They were mailed a questionnaire booklet which included the DASH. Construct validity was examined by fit to the Rasch measurement model. The degree of precision of both the DASH and QuickDASH were considered through their Standard Error of Measurement (SEM).

Results: Three hundred and thirty-seven subjects with confirmed RA took part, with a mean age of 62.0 years (SD12.1); 73.6% (n = 252) were female. The median standardized score on the DASH was 33 (IQR 17.5-55.0). Significant misfit of the DASH and QuickDASH was observed but, after accommodating local dependency among items in a two-testlet solution, satisfactory fit was obtained, supporting the unidimensionality of the total sets and the sufficiency of the raw (ordinal or standardized) scores.

Conclusion: Having accommodated local response dependency in the DASH and QuickDASH item sets, their total scores are shown to be valid, given they satisfy the Rasch model assumptions. The Rasch transformation should be used whenever all items are used to calculate a change score, or to apply parametric statistics within an RA population.

Significance and innovations: Most previous modern psychometric analyses of both the DASH and QuickDASH have failed to fully address the effect of a breach of the local independence assumption upon construct validity. Accommodating this problem by creating 'super items' or testlets, removes this effect and shows that both versions of the scale are valid and unidimensional, as applied with a bi-factor equivalent solution to an RA population. The Standard Error of Measurement of a scale can be biased by failing to take into account the local dependency in the data which inflates reliability and thus making the SEM appear better (i.e. smaller) than the true value without bias.

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Conflict of interest statement

Ethics approval and consent to participate

Ethical approval was obtained from the NRES Committee North West (Greater Manchester North) [12/NW/0841] and the University of Salford Health Sciences Research Ethics Panel prior to the start of the study. Approvals from the Research and Development departments were obtained at each site. All participants provided informed, written consent.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Differential item functioning by gender for PF testlet
See this image and copyright information in PMC

References

    1. Zeng SY, Gong Y, Zhang YP, Chen SB, Chen JY, Lin CQ, Peng JH, Hou ZD, Zhong JQ, Liang HJ, Huang GH, Wang DM, Lai HY, Li LP, Zeng QY. Changes in the Prevalence of Rheumatic Diseases in Shantou, China, in the Past Three Decades: A COPCORD Study. PLoS One. 2015;10(9):e0138492. doi: 10.1371/journal.pone.0138492. - DOI - PMC - PubMed
    1. Wright AR, Shi XA, Busby-Whitehead J, Jordan JM, Nelson AE. The Prevalence of Neck and Shoulder Symptoms and Associations with Comorbidities and Disability: The Johnston County Osteoarthritis Project. Myopain. 2015;23(1–2):34–44. doi: 10.3109/10582452.2015.1132026. - DOI - PMC - PubMed
    1. Badley EM, Tennant A. The changing profile of joint troubles with age: findings from a postal survey of the population. Ann Rheum Dis. 1992;51:366–371. doi: 10.1136/ard.51.3.366. - DOI - PMC - PubMed
    1. Penta M, Tesio L, Arnould C, Zancan A, Thonnard JL. The ABILHAND questionnaire as a measure of manual ability in chronic stroke patients: Rasch-based validation and relationship to upper limb impairment. Stroke. 2001;32(7):1627–1634. doi: 10.1161/01.STR.32.7.1627. - DOI - PubMed
    1. Preston N, Horton M, Levesley M, Mon-Williams M, O'Connor RJ. Development of a parent-reported questionnaire evaluating upper limb activity limitation in children with cerebral palsy. Physiother Res Int. 2017. 10.1002/pri.1684 [Epub ahead of print]. - PMC - PubMed

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