Occupational Medicine 2014;64:67–68
 doi:10.1093/occmed/kqt130
Questionnaire Review
DASH
The DASH Questionnaire
The Disabilities of the Arm, Shoulder and Hand
(DASH) outcome measure is a 30-item, self-report
questionnaire designed to assess the patient’s health
status during the previous week. The items enquire
about the degree of difficulty in performing different
physical activities because of arm, shoulder and hand
problems (21 items), the severity of each of the symp-
toms of pain, activity-related pain, tingling, weakness
and stiffness (five items) and the impact of the problem
on social functioning, work, sleep and self-image (four
items). Each item has five response options. The scores
are then used to calculate a scale score ranging from
0 (no disability) to 100 (most severe disability)—this
is called the DASH score. The DASH questionnaire is
used as an indicator of the impact of an impairment
on the level and type of disability. It assesses the whole
person’s ability to function, even if the person is com-
pensating with the other limb.
The questionnaire was designed jointly by research-
ers at the Institute of Work and Health in Canada and
the American Academy of Orthopaedic Surgeons. Their
work was supported by many learned North American asso-
ciations and societies including the American Association
for Hand Surgery, the American Orthopedic Society for
Sports Medicine, the American Shoulder and Elbow
Surgeons, the American Society for Surgery of the Hand,
the Arthroscopy Association of North America and the
American Society of Plastic and Reconstructive Surgeons.
It was developed both to help describe the disability
experienced by people with upper-limb disorders and to
monitor changes in symptoms and function over time.
Extensive testing has shown that the DASH performs
well in both these roles. It gives clinicians and research-
ers the advantage of having a single, reliable instrument
that can be used to assess any or all joints in the upper
extremity.
In addition to the basic DASH questionnaire, the
DASH outcome measure also contains two-optional,
four-item modules intended to measure symptoms and
function in athletes, performing artists and other work-
ers whose jobs require a high degree of physical perfor-
mance. Because they may be having difficulties only at
high performance levels—which are beyond the scope of
the 30-item DASH outcome measure, occupational phy-
sicians and other clinicians may find the modules, which
are scored separately from the DASH, useful in assess-
ing these professional workers. Guidance on scoring is
© The Author 2014. Published by Oxford University Press on behalf of the Society of Occupational Medicine.
All rights reserved. For Permissions, please email: journals.permissions@oup.com
available in Scoring the DASH (http://www.dash.iwh.
on.ca/system/files/dash_scoring_2010.pdf).
Usage
The questionnaire is free to use, but there are conditions
of use and copyright requirements. It can be downloaded
Downloaded from https://academic.oup.com/occmed/article/64/1/67/1413534 by guest on 14 March 2024
from http://www.dash.iwh.on.ca/conditions-use. The scor-
ing was updated in 2002 to be easier and to allow for analy-
sis in the presence of missing data.
Interpretation
The DASH questionnaire is not able to say that a partic-
ular score represents a specific level of disability such as
mild, moderate or severe disability or objectively deter-
mine whether an individual patient is or is not able to
work, but a recent study of users of the DASH outcome
measure found that a DASH score ranging from 0 to 29
was thought by most respondents to be the point where
patients/clients were ‘no longer considering their upper-
limb disorder a problem’.
One of the most difficult challenges is the ability to
interpret an individual’s numeric score, because a lot
of confidence and experience with an instrument is
required. There is no established benchmark for inter-
preting the scores.
Variations on DASH
The questionnaire has been translated into 27 languages
and also exists in a shortened form—The QuickDASH—
which is a two-part questionnaire, the first consisting of a
disability/symptom section (consisting of 11 items, each
scored 1–5) and the optional high performance sport/
music or work modules (consisting of four items, each
scored 1–5).
Both tools are valid, reliable and responsive and can
be used for clinical and/or research purposes.
There is also an app for iPad users, which has been
designed to help clinicians track DASH scores (including
DASH, QuickDASH, and Optional DASH Modules) in
their clinical practice. The app allows clinicians to have
their patients directly enter responses using an iPad touch
screen. DASH scores are immediately calculated and
summarized in a summary report that includes the cal-
culated score, item-level responses, as well as information
about interpretability of the score (e.g. comparison to
normative data from the general population, score needed
68 Occupational Medicine
to reach minimal detectable change [95%]). The applica-
tion allows for multiple assessments to be conducted over
time, linked by a unique patient identification number,
and the generation of a cumulative report (including a
graphical representation of the patient’s progress over
time with interpretability benchmarks and an item-level
comparison of the six highest [greatest disability] items
at initial evaluation versus the most current evaluation).
The summary and cumulative reports are available
immediately for view directly on the iPad and also saved
(password protected) on the iPad as exportable files that
can be either printed or emailed to the clinician for their
electronic or paper records, or directly to the patient. The
raw data are also saved (password protected) on the iPad
and can be transferred by email as a downloadable data-
base (CSV format) to the clinician for further analysis
and/or storage. The DASH outcome measure app allows
for real time administration, scoring and longitudinal
tracking of DASH outcomes. Reports have the poten-
tial to help clinicians identify problem areas and monitor
progress over time in a time saving manner.
Validation
Studies of reliability and validity have been published for
the original version [1], as well as for German [2], Italian
[3] and Swedish [4] versions. Studies have also found
that the DASH can detect and differentiate small and
large changes of disability over time after surgery [5].
Gummesson et al. [5] suggest that a 10-point ­difference in
DASH score may be considered as a minimal i­mportant
change in functioning.
QuickDASH has been assessed separately and has
been found to be accurate in identifying individuals or
jobs at high risk of musculoskeletal disorders [6]. It has
also been suggested as a useful screening and tool for
surveillance in working populations [7].
Nerys Williams
Independent Consultant
Occupational Physician,
Solihull, UK
e-mail: neryswilliams1443@gmail.com
References
1. 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;14:128–146.
2. Offenbaecher M, Ewert T, Sangha O, Stucki G. Validation
Downloaded from https://academic.oup.com/occmed/article/64/1/67/1413534 by guest on 14 March 2024
of a German version of the disabilities of arm, ­shoulder,
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