The DASH is designed to evaluate disorders and measure disability of the upper extremities, and monitor change or function over time.
Developed jointly by the Institute for Work & Health and the American Academy of Orthopaedic Surgeons (AAOS).
The DASH was first published in 1996. It has 2 shortened versions, the QuickDASH and the QuickDASH-9. The DASH has been formally translated into 41 versions. There are 18 translations in progress.
The DASH is a 30-item self-report questionnaire designed to assess musculoskeletal disorders of the upper limbs. It has two, 4-item, optional modules used to measure symptoms and function in athletes, artists, and workers who require a high level of function.
Scoring the DASH:
- The 30-item disability/symptom section (item responses range from 1 (e.g. no difficulty, not at all, not limited, none, strongly disagree) to 5 (e.g. unable, extremely, unable, strongly agree))
- Scoring: [(sum of n / n) - 1] x 25; n = number of completed responses (see test sheet for more information)
- The DASH should not be scored if more than three items are missing
- Optional 4-item high performance section
- Add values of each response, then divide by 4, subtract 1 and multiply by 25: [((sum of values/4) - 1)*25]
- Optional modules should not be scored if items are missing
- More information, including a PDF of the DASH, can be found on the DASH website
- Adults with wrist, hand, elbow and should disorders
- Rheumatoid Arthritis
- Psoriatic Arthritis and Inflammatory Disease
- Athletes
- Carpal Tunnel Syndrome
- Elbow Arthroplasty
- Neck Pain
- Proximal Humeral Fractures
- Trauma Disorders
- Post-Operative Upper Extremity Surgery
- Multiple Sclerosis
- Adhesive Capsulitis
- Non-traumatic neck complaints with Upper Extremity symptoms
- Shoulder Impingement
Intercollegiate Athletes:
(Hsu et al, 2010; n = 321; mean age 19.4 (17.6-22.6) years; Pre-competition physical, Intercollegiate Athletes)
- 3.61 (Calculated from MDC = 1.96 x SEM x square root of 2; 10 = 1.96 x SEM x square root of 2)
| Mean | SD | SEM | Lower | Upper | |
| DASH 0 to DASH 3 | -14.93 | 9.63 | 2.27 | -10.14 | -19.72 |
| DASH 0 to DASH 6 | -20.54 | 14.58 | 3.26 | -13.71 | -27.36 |
| DASH 0 to DASH 12 | -20.83 | 20.09 | 4.49 | -11.42 | -30.23 |
Proximal Humeral Fractures:
(Slobogean et al, 2010; n = 61, mean age = 69, Proximal Humeral Fractures)
- Calculated using SEM = Standard Deviation of first outcome * square root (1-ICC)
- SEM = 21.7 * square root (1 - 0.928) = 5.82
- SEM = 5.22
(Beaton D.E., Katz J.N., Fossel A.H., Wright J.G., Tarasuk V., Bombardier C., 2001)
- SEM = 4.6
Intercollegiate Athletes:
(Hsu et al, 2010; n = 321; mean age 19.4 (17.6-22.6) years; Pre-competition physical, Intercollegiate Athletes)
- MDC = 10
Proximal Humeral Fractures:
(Slobogean et al., 2010; n = 61, mean age = 69, Proximal Humeral Fractures)
- Calculated from MDC = 1.96 * SEM * (square root of 2)
- MDC = 1.96 * 5.82 * (square root of 2) = 16.1
- MDC90 = 12.2
(Beaton D.E., Katz J.N., Fossel A.H., Wright J.G., Tarasuk V., Bombardier C., 2001)
- MDC90 = 10.7
- MDC95 = 12.75
Intercollegiate Athletes:
(Hsu et al, 2010; n = 321; mean age 19.4 (17.6-22.6) years; Pre-competition physical, Intercollegiate Athletes)
- MCID = 10
Pre-operative and Post-operative change in UE Function:
(Gummesson, Atroshi and Ekdah; 2003; n = 109; patients had surgery for a variety of upper extermity conditions; assessed prior to surgery then again 6 to 21 months later; Swiss sample)
- Patients (n = 53) reporting "much better" or "much worse"
- Mean Change = 19 (15 to 23) points
- Patients (n = 21) reporting "somewhat better" or "somewhat worse"
- Mean Change = 10 (7 to 14) points
- Patients (n = 9) reporting "no change"
- Mean change = -3 (-3 to 3.0) points
Total Elbow Arthroplasty:
(Angst et al, 2012; n = 65; 61.9 (13.0), Total Elbow Arthroplasty)
- Standard Response Mean = 0.55, Effect Size = 0.20)
- MCID = 10.2
Adults with musculoskeletal upper extremity problems:
(Schmitt J.S., Di Fabio R.P., 2004)
- MCID = 10.2
| Instrument | Mean (SD) | n |
| DASH | 55.3 (23.2) | 77 |
| DASH function | 51.1 (25.2) | 77 |
| DASH symptoms | 66.1 (22.8) | 79 |
| SF-36 physical functioning | 48.7 (28.4) | 79 |
| SF-36 role physical | 45.1 (44.7) | 76 |
| SF-36 bodily pain | 59.1 (27.5) | 79 |
| SF-36 general health | 56.0 (25.7) | 78 |
| SF-36 vitality | 48.4 (22.4) | 78 |
| SF-36 social functioning | 80.7 (22.8) | 79 |
| SF-36 role emotional | 74.8 (41.9) | 72 |
| SF-36 mental health | 71.4 (20.6) | 78 |
| SF-36 physical component summary | 37.2 (12.0) | 75 |
| SF-36 mental component summary | 52.3 (11.5) | 69 |
| SF-36: Short Form 36 DASH: Disabilities of the Arm, Shoulder, and Hand Questionnaire | ||
| Arthroplasty of the carpometacarpal joint for osteoarthritis | ||||
| Minimum | Maximum | Mean | SD | |
| DASH | 0 | 90.8 | 36.7 | 24.03 |
| PRWHE | 0 | 92 | 41.5 | 28.33 |
| SF-36 Mental Component Summary | 21.9 | 66.7 | 47.9 | 11.67 |
| SF-36 Physical Component Summary | 12.0 | 61.5 | 34.6 | 11.38 |
| PRWHE: Patient-Rated Wrist Hand Evaluation DASH: Disabilities of Arm, Shoulder, and Hand Questionnaire SF-36: Short Form 36 | ||||
| Instrument | Mean (SD) | Median | Min | Max |
| DASH (German version) score | 44.52 (19.14) | 44.2 | 5 | 82.5 |
| HAQ score | 1.12 (0.76) | 1.06 | 0 | 2.88 |
| DASH: Disabilities of Arm, Shoulder, and Hand Questionnaire HAQ: Health Assessment Questionnaire | ||||
| Score for PRWE, DASH-JSSH, and VAS: | ||||||
| Instrumental Scale | No. | Mean | SD | Median | Minimum | Maximum |
| DASH-JSSH | 116 | 44.2 | 28.2 | 39.5 | 0(a) | 100(b) |
| PRWE | 112 | 58.7 | 24.3 | 61.5 | 5 | 99 |
| VAS | 111 | 59.3 | 24.3 | 60 | 6 | 100(b) |
| PRWE: Patient-Related Wrist Evaluation DASH-JSSH: Disability/Symptom scale of the Japanese version of the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnatire VAS: Visual Analogue Scale for Pain (0-10 Scale) Maximum Health Status Scores (Ceiling) | ||||||
Overhead Athletes:
(Alberta et al, 2010; n = 252 mean age = 23.7, Overhead Athletes)
- Adequate test-retest reliability (ICC = 0.536)
Proximal Humeral Fractures:
(Slobogean et al, 2010; n = 61, mean age = 69, Proximal Humeral Fractures)
- Excellent test-retest reliability (ICC 2,1 = 0.928)
| Instrument | ICC (95% CI) | Mean Difference | Limits of Agreement |
| EQ-5D | 0.773 (0.604 to 0.875) | 0.03 (0.00 to 0.06) | -0.18 to 0.24 |
| HUI3 | 0.471 (0.184 to 0.686) | 0.04 (-0.03 to 0.11) | -0.37 to 0.45 |
| SF-6D | 0.794 (0.634 to 0.889) | 0.01 (-0.02 to 0.04) | -0.17 to 0.19 |
| DASH | 0.928 (0.860 to 0.963) | 0.4 (-2.3 to 3.1) | -15.2 to 15.9 |
Total Elbow Arthroplasty:
(Angst et al, 2012; n = 65; 61.9 (13.0), Total Elbow Arthroplasty)
- Excellent test-retest reliability (ICC = 0.96)
- ICC = 0.97
Swedish Patients with Rheumatoid Arthritis:
(Bilberg A., Bremell T., Mannerkorpi K., 2012; n = 67)
- ICC = 0.99 (95% CI, 0.98-0.99)
Adults with musculoskeletal upper extremity problems:
(Schmitt J.S., Di Fabio R.P., 2004)
- ICC = 0.91
(Beaton D.E., Katz J.N., Fossel A.H., Wright J.G., Tarasuk V., Bombardier C., 2001)
- ICC = 0.96 (95% CI, 0.93-0.98)
Proximal Humeral Fractures:
(Slobogean et al, 2010; n = 61, mean age = 69, Proximal Humeral Fractures)
- See Test-retest reliability in Proximal Humeral Fractures for format
- Cronbach's alpha = 0.97
Adults with upper extremity musculoskeletal complaints undergoing surgery:
(Gummesson C., Atroshi I., Ekdahl C., 2003)
- Cronbach's alpha = 0.92-0.97
Adults with Multiple Sclerosis:
(Cano S., Barrett L., Zajicek J., Hobart J., 2011)
- Cronbach's alpha = 0.98
General Population:
(Hunsaker F.G., Cioffi D.A., Amadio P.C., Wright J.G., Caughlin B., 2002)
- Cronbach's alpha = 0.94-0.98
Neck Pain:
(Mehta et al., 2010; n = 66, mean age= 40.6 (14.2), Neck Pain)
- Both versions of the DASH showed high correlation (0.82-0.84) with the NDI and moderate correlation with the CSOQ and VAS.
Correlation Between Self-Report Measures
| CSOQ Neck Pain | CSOQ Shoulder and Arm Pain | CSOQ Physical Symptom | CSOQ Functional Disability | CSOQ Psychological Distress | VAS | ||
| DASH | 0.61* | 0.55* | 0.67* | 0.58* | 0.56* | 0.55* | |
| *Correlation is significant at the 0.01 level (2-tailed); | |||||||
Neck Pain:
(Huisstede et al., 2009; n = 679; 41.0 (23.0), Neck Pain)
| SF-12 Physical Component | SF-12 Mental Component | Severity | |
| Correlation | Correlation | Correlation | |
| S-A-H | 0.62 | 0.15 | 0.55 |
| N-S-A-H | 0.61 | 0.16 | 0.52 |
| N-S-A-H | 0.63 | 0.19 | 0.5 |
| N | 0.62 | 0.27 | 0.44 |
| S-A-H- only | 0.61 | 0.1 | 0.56 |
| N-only | 0.57 | 0.33 | 0.44 |
| Correlations of the SF-36 component summary scores with PRWHE and DASH Scores | ||
| SF-36 Subscale | PRWHE | DASH |
| Physical Component Summary | -0.35 | -0.49 |
| Mental Component Summary | -0.45 | -0.49 |
| All correlations significant at the 0.01 level (2-tailed) SF-36: Short Form 36 PRWHE: Patient-Rated Wrist Hand Evaluation | ||
| Correlation between self-report function scores and measured impairments* | ||
| PRWHE total | DASH | |
| Strength | ||
| Grip | -0.45** | -0.43** |
| Tripod pinch | -0.45** | -0.44** |
| Key pinch | -0.36** | -0.40** |
| Wrist flexion | -0.39** | -0.44** |
| Wrist extension | -0.39** | -0.37** |
| Dexterity | ||
| NK small objects | 0.32** | 0.30** |
| NK medium objects | 0.39** | 0.48** |
| NK large objects | 0.44** | 0.48** |
| Range of Motion | ||
| Wrist flexion | -0.26** | -0.23* |
| Wrist extension | -0.05 | -0.07 |
| Radial deviation | -0.15 | -0.12 |
| Ulnar deviation | -0.23* | -0.12 |
| Pronation | -0.05 | -0.03 |
| Supination | 0.00 | -0.01 |
| Thumb IP flexion | 0.03 | -0.08 |
| Thumb MCP flexion | 0.03 | 0.05 |
| Thumb IP extension | 0.12 | 0.06 |
| Thumb MCP extension | -0.10 | -0.02 |
| Thumb CMC extension | -0.12 | -0.11 |
| Thumb abduction | 0.01 | 0.03 |
| Thumb opposition | 0.11 | 0.10 |
| Hand Span | -0.34** | -0.25** |
| *Impairments measured using the NK Hand Assessment System ** Correlation significant at 0.01 (2-tailed). *Correlation significant at 0.05 (2-tailed) PRWHE: Patient-Rated Wrist Hand Evaluation DASH: Disabilities of Arm, Shoulder, Hand | ||
Proximal Humeral Fractures:
(Slobogean et al, 2010; n = 61, mean age = 69, Proximal Humeral Fractures)
| Spearman Correlations between Study Instruments | ||||||
| Self Function | 1 | |||||
| SF-12 PCS | 0.49 | 1 | ||||
| DASH | -0.76 | 1 | ||||
| EQ-5D | 0.53 | 0.73 | -0.75 | 1 | ||
| HUI3 | 0.38* | 0.63 | -0.58 | 0.63 | 1 | |
| SF-6D | 0.45 | 0.83 | -0.73 | 0.74 | 0.59 | 1 |
| All correlations are significant to P < 0.01, except Self Function, HUI3 where P < 0.02. | ||||||
| SF-36 Subscale | Mean (SD) | Correlation to DASH (German version) |
| Physical functioning | 47.16 (24.17) | -0.73 (P < 0.01) |
| Role-physical | 32.43 (44.04) | -0.53 (P < 0.01) |
| Bodily pain | 43.92 (22.37) | -0.53 (P < 0.01) |
| General health | 51.41 (18.62) | -0.43 (P < 0.01) |
| Vitality | 46.08 (22.36) | -0.51 (P < 0.001) |
| Social functioning | 81.42 (21.77) | -0.35 (P < 0.03) |
| Role-emotional | 72.97 (41.45) | -0.31 (P < 0.05) |
| Mental health | 71.24 (18.66) | -0.57 (P < 0.001) |
(Raven E.E.J., Haverkamp D., Siervelt I.N., et al., 2008)
- Correlation of DASH and other outcome measures: (Pearson correlation)
- Health Assessment Questionnaire – r = 0.88
- SF-36 – r = 0.70
- Arthritis Impact Measurement Scale – r = 0.85
- Disease Activity Score – r = 0.42
- Grip Strength – r = 0.41-0.48
- Visual Analog Scale – r = 0.60-0.65
Swedish Patients with Rheumatoid Arthritis:
(Bilberg A., Bremell T., Mannerkorpi K., 2012; n = 67)
- Correlation of DASH and other outcome measures: (Spearman correlation)
- Health Assessment Questionnaire – r = 0.80
- Active shoulder-arm motion – r = -0.38 to -0.50
- Handgrip force – r = -0.46 to -0.59
- Activity-Induced pain – r = 0.66
- Disease Activity Score in 28 joints – r = 0.63
Adults with musculoskeletal upper extremity problems:
(Schmitt J.S., Di Fabio R.P., 2004)
- Global Disability Rating – Spearman r = 0.67-0.71
(Beaton D.E., Katz J.N., Fossel A.H., Wright J.G., Tarasuk V., Bombardier C., 2001)
- SPADI pain – Pearson r = 0.79, Spearman r = 0.76
- SPADI function – Pearson r = 0.85, Spearman r = 0.83
Adhesive Capsulitis:
(Staples M.P., Forbes A., Green S., Buchbinder R., 2010)
- SPADI – r = 0.55
- Croft Index – r = 0.65
- Visual Analog Scale – r = 0.31
- Health Assessment Questionnaire – r = 0.54
Shoulder Arthroplasty (Switzerland, German-language):
(Angst F., Pap G., Mannion A.F., et al., 2004; n = 43)
- SF-36 (PCS) – r = 0.67
- SF-36 (MCS) – r = 0.06
- SPADI – r = 0.93
- pASES – r = 0.79
- cASES – r = 0.59
- Constant Shoulder – r = 0.82
Discriminative Validity:
Adults with musculoskeletal upper extremity problems:
(Beaton D.E., Katz J.N., Fossel A.H., Wright J.G., Tarasuk V., Bombardier C., 2001)
- Participants who were working with their upper limb condition and were able to continue to work had a significantly lower disability than those unable to work (26.8 vs. 50.7, t=-7.51, p<0.0001).
- Similarly, the DASH was able to discriminate between those who could do everything they wanted to vs. those who could not (23.6 vs. 47.1, t=-5.81, p<0.0001).
| DASH Floor and Ceiling Effects: | |||||
| n | Minimum | Maximum | Floor, % | Ceiling, % | |
| DASH symptoms | 79 | 12.5 | 100.0 | 0 | 6 |
| DASH function | 77 | 4.3 | 100.0 | 0 | 3 |
| DASH | 77 | 15.0 | 100.0 | 0 | 1 |
Intercollegiate Athletes:
(Hsu et al, 2010, Intercollegiate Athletes)
| N | Minimum | Maximum | Floor % | Ceiling % | |
| DASH | 321 | 0 | 100 | 0 | 65.11 |
Proximal Humeral Fractures:
(Slobogean et al, 2010; n = 61, mean age = 69, Proximal Humeral Fractures)
- No Floor effect established
- Moderate: 7% ceiling effect
- Floor effect: none
- Ceiling effect: none
Adults with musculoskeletal upper extremity problems:
(Beaton D.E., Katz J.N., Fossel A.H., Wright J.G., Tarasuk V., Bombardier C., 2001)
- Floor effect: none
- Ceiling effect: only 1 of 200 in the sample scored 0 points
Neck Pain:
(Huisstede et al., 2009; n = 679; 41.0 (23.0), Neck Pain)
- DASH was considered acceptable for each (sub)group
- The responsiveness ratio was higher in the S-A-H–only group (1.92) than in the N–only group (1.38)
| | Responsiveness Ratio |
| S-A-H Improved | 2.01 |
| S-A-H Stable | |
| N-S-A-H Improved | 1.91 |
| N-S-A-H Stable | |
| N-S Improved | 2.04 |
| N-S Stable | |
| N Improved | 1.85 |
| N Stable | |
| S-A-H Only Improved | 1.92 |
| S-A-H Only Stable | |
| N-Only Improved | 1.38 |
| N-Only Stable |
Total Elbow Arthroplasty:
(Angst et al, 2012; n = 65; 61.9 (13.0), Total elbow Arthroplasty)
· Effect Size = 0.56, Sensitivity = 0.59, Specificity = 0.71
Wrist Disorders:
| Total | Radius Fracture | |||||
| Instrument Scale | No. | SRM | Effect Size | No. | SRM | Effect Size |
| DASH | 50*** | 1.30 | 1.20 | 24*** | 2.13 | 2.05 |
| PRWE | 50*** | 1.55 | 1.92 | 24*** | 1.90 | 3.32 |
| VAS | 49*** | 1.75 | 2.23 | 24*** | 2.00 | 2.96 |
| SRM, Standardized Response Means PRWE, Patient-Related Wrist Evaluation VAS, Visual Analogue Scale ***Significant difference between the preoperative and postoperative median values (p < 0.001) | ||||||
- A shortform is also available (QuickDASH)
- The DASH has been translated in 27 languages
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