GENERAL
Disabilities of the Arm, Shoulder & Hand (DASH)
DASH is a self-administered outcome instrument, measuring disability and dysfunction of the upper extremity. It consists of 30 items of disability/symptom scale, each scored from 1 to 5. The final score is converted to a scale of 0 to 100 (higher scores represent higher disability). Two optional modules are available - the Work module and the Sports/ Performing Arts module.
The minimal clinically important difference [MCID] for the DASH is 10 points [95% confidence interval 5 - 15].
References:
- 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. doi:10.1186/1471- 2474-4-11.
- Sorensen AA, Howard D, Tan WH, Ketchersid J, Calfee RP. Minimal clinically important differences of 3 patient-rated outcomes instruments. J Hand Surg Am. 2013 Apr;38(4):641-9. doi: 10.1016/j.jhsa.2012.12.032. Epub 2013 Mar 6. PMID: 23481405; PMCID: PMC3640345.
Quick DASH
The Quick DASH score is an abbreviated version of the original DASH score. Instead of 30, it consists of 11 questions to measure upper extremity dysfunction of symptoms. The same optional modules as the full DASH questionnaire are also available.
The minimal clinically important difference [MCID] for the qDASH is 14 points [95% confidence interval 9 - 20].
References:
- Gummesson C, Ward MM, Atroshi I. The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): validity and reliability based on responses within the full-length DASH. BMC Musculoskelet Disord. 2006;7:44. Published 2006 May 18. doi:10.1186/1471-2474-7-44
- Sorensen AA, Howard D, Tan WH, Ketchersid J, Calfee RP. Minimal clinically important differences of 3 patient-rated outcomes instruments. J Hand Surg Am. 2013 Apr;38(4):641-9. doi: 10.1016/j.jhsa.2012.12.032. Epub 2013 Mar 6. PMID: 23481405; PMCID: PMC3640345.s
Michigan Hand Questionnaire (MHQ)
The MHQ was developed in 1998 to determine the various health states in patients suffering from a hand pathology. It is a patient rated score consisting of 37 items in six domains - Pain, Work, Function, Aesthetics, Daily Living, Satisfaction.
The scoring consists of converting each domain into a scale of 0 to 100. This is performed as given below:
| SCALE | RECODE * | RAW SCORE RANGE | NORMALISATION |
|---|---|---|---|
| Function | None | 5 to 25 per hand | L or R =[-(raw score-25)/20]*100 |
| Activities of Daily Living | None | 5 to 25 per hand, 7 to 35 both hands | L or R =[-(raw score-25)/20]*100, Both = [-(raw score-35)/28]*100 Overall ADL - if only L or R affected = (L or R + Both)/2, Overall ADL - if both L and R affected = (L + R + Both)/3 |
| Work | None | 5 to 25 per hand | =[(raw score-5)/20]*100 |
| Pain | Question 2 (iva2, ivb2) change: 1=5, 2=4, 4=2, 5=1 | 5 to 25 per hand | If Question 1 (iva1, ivb1) =5, then pain score =0 for that hand. If Question 1 (iva1, ivb1) does not =5, then pain score for L or R =[-(raw score25)/20]*100 |
| Aesthetics | Question 1 (va1, vb1) change: 1=5, 2=4, 4=2, 5=1 | 4 to 20 per hand | L or R = [(raw score-4)/16]*100 |
| Satisfaction | None | 6 to 30 per hand | L or R = [-(raw score-30)/24]*100 |
* the response for some questions need to be reversed and recoded.
For the Pain scale, higher scores mean more pain. For the other scales, higher scores represent better performance.
The overall MHQ score is the average of the six subscales, after reversing the Pain score.
Overall MHQ Score per hand = [Function + Activities of Daily Living + Work + (100-Pain) + Aesthetics + Satisfaction]/6
References:
Shauver MJ, Chung KC. The Michigan hand outcomes questionnaire after 15 years of field trial. Plast Reconstr Surg. 2013 May;131(5):779e787e
Brief MHQ
The brief MHQ is an abbreviated version of the Michigan Hand Questionnaire. It is a 12-item questionnaire with each item scored from 1 to 5. Similar to the full MHQ, the raw scores are totaled up and normalized to a scale of 0 to 100. Also, eight of the responses need to be reversed and recoded for the score calculation (details in the bMHQ PDF).
References:
Waljee JF, Kim HM, Burns PB, Chung KC. Development of a brief, 12-item version of the Michigan Hand Questionnaire. Plast Reconstr Surg. 2011;128(1):208-220.
Patient Reported Outcomes Measurement Information System (PROMIS)
The Patient Reported Outcomes Measurement Information System (PROMIS) is a comprehensive collection of resources for patient reported data collection. The PROMIS collection allows selfreporting of a wide variety of domains, including the Upper Extremity. PROMIS questionnaires can also be administered online via the Computer Adaptive Test option. The scores can also be converted to standardised T-scores that can be compared to the general population.
Intro to PROMISPatient Specific Functional Scale (PSFS)
The PSFS is a self-reported valid, reliable, and responsive outcome measure for patients with back, neck, knee and upper extremity problems. It has also been shown to have a high test-retest reliability in both generic lower back pain and knee dysfunction issues. It is also clinically responsive to changes over time with chronic pain patients. It is quick to complete and relatively easy for the patients.
References:
Hefford C, Abbott JH, Arnold R, Baxter GD. The patient-specific functional scale: validity, reliability, and responsiveness in patients with upper extremity musculoskeletal problems. J Orthop Sports Phys Ther. 2012 Feb;42(2):56-65