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FOTO Rehab Outcomes Blog

Quick-DASH Requires Caution with Use

The first reference I can find about the Quick-DASH is in 2001. This patient reported outcome measure is favored by many because the DASH is familiar and the Quick-DASH is shorter. Like the DASH it was was originally created as a paper and pencil tool. 

The Quick-DASH has problems.  Even though it is faster to complete, it does not meet Rasch model analysis. Of the 11 items to respond, 2 of the items have a floor effect. Most of the items have a response bias. You can trust the Quick-DASH score.

FOTO has research supporting its shoulder functional status items and computer adaptive testing.  In 2006, the number of items originally tested was 60.  Factor analysis only supported 42 of the items.  The item pool was decreased to 37 items to fit the item response theory model.  

Below you will find a quick view of the abstract about the Quick-DASH.


Rasch Model Analysis Gives New Insights Into the Structural Validity of the Quick-DASH in Patients With Musculoskeletal Shoulder Pain.



Study Design:

Cross-sectional secondary analysis of a prospective cohort study.

Background: The Quick-DASH is a widely used outcome measure which has been extensively evaluated using classical test theory (CTT). Rasch model analysis can identify strengths and weaknesses of rating scales which goes beyond CTT approaches. It uses a mathematical model to test the fit between the observed data and expected responses and converts ordinal-level scores into interval-level measurement.

Objective: To test the structural validity of the Quick-DASH using Rasch analysis.

Methods: A prospective cohort study of 1030 patients with shoulder pain provided baseline data. Rasch analysis was conducted to i) assess how the Quick-DASH fits the Rasch model, ii) identify sources of misfit and iii) explore potential solutions to these. Results There was evidence of multidimensionality and significant misfit to the Rasch model (χ2= 331.04, p<0.001). Two items had disordered threshold responses with strong flooring effects. Response bias was detected in most items for age and gender. Rescoring resulted in ordered thresholds, however the 11-item scale still did not meet the expectations of the Rasch model.

Conclusion: Rasch model analysis on the Quick-DASH has identified a number of problems which cannot be easily detected using traditional analyses. Whilst revisions to the Quick-DASH resulted in better fit, a 'shoulder-specific' version is not advocated at present. Caution needs to be exercised when interpreting results of the Quick-DASH outcome measure as it does not meet the criteria for interval level measurement and shows significant response bias by age and gender. J Orthop Sports Phys Ther, Epub 13 Jul 2017. doi:10.2519/jospt.2017.7288.

 2017 Jul 13:1-20. doi: 10.2519/jospt.2017.7288. [Epub ahead of print]

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