DASH Score

The DASH score was designed to be a standardized assessment of the impact on function of a variety of musculoskeletal disease and injuries in the upper extremity.1

The DASH score consists of 30 questions and is used to assess functional disorders of the upper extremity.

A special feature of the questionnaire is that no differentiation is made between the respective upper extremities. 21 questions test the extent to which the patient has had problems performing certain activities within the last week. The patient is asked to answer the questions regardless of which arm or hand they used for the activity. Thus, the DASH score is not a joint-specific questionnaire but measures the function of both extremities as a whole.2,3

In addition, 6 questions assess specific symptoms (e.g. pain, paraesthesia, sleep disorders) and 3 questions assess social or occupational limitations.

Two optional additional parts also provide the opportunity to describe limitations in playing musical instruments, sports and occupation.

The DASH score was further developed and shortened to the QuickDASH score with 11 questions. The QuickDASH has been assessed separately and has been found to be accurate in identifying individuals or jobs at high risk of musculoskeletal disorders.⁴ Despite its smaller size, several studies have demonstrated that the QuickDASH Score is a meaningful instrument that can achieve results similar to those of the DASH Score.^{5 – 8}

The DASH score can only be calculated if no more than 3 answers are missing. For the QuickDASH Score, a maximum of 1 answer may be missing. The calculation is done for both types of scores according to the following formula:

DASH score for disability/symptoms = ([(sum of n responses]-1) / n)x(25) where n represents the number of completed items.

The possible score ranges from 0 to 100 points. 0 points represent a complete, unrestricted function of the upper extremities, while 100 points represent the greatest possible functional impairment.

The DASH score is one of the most established questionnaires for disorders of the upper limb. With over 20 years of use, numerous studies have demonstrated its validity for upper limb joint disorders associated with dysfunction.⁹ In addition, it has been found to correlate with other commonly used scores, such as the Shoulder Pain and Disability Index (SPADI), Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons score (ASES) and the Short Form-36 (SF-36).^{10, 11}

Furthermore, the collection and analysis of the results are easy to use and interpret with the score being available in over 15 languages.¹²

The unique nature of the DASH score also represents a weakness in its validity as it does not distinguish between the individual possible functional disorders of the joints themselves but only between disorders of the upper extremities as a whole. For example, if the left arm of a right-handed person is functionally impaired, whilst the patient is able to perform the activities tested in the score with their dominant right arm, the information about the impaired left arm is distorted.¹²

Wylie et al., noted that dysfunctions of the lower extremities can also impair the activities tested by the DASH score. ² However, it should be noted that additional studies need to be conducted to adequately assess the validity of this.¹²

The Institute for Work & Health (Toronto, Canada) holds the copyright for both the DASH and QuickDASH scores. Therefore, licensing is required for the use and evaluation of both scores with an annual subscription is required for commercial use. This is free of charge for non-commercial use.¹³ Our PRO consultants happily provide more in-detail information.

The DASH and QuickDASH scores are both established, valid instruments that can be reliably used for patients with upper limb dysfunction. 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.

Testing has proven that the DASH and QuickDASH have performed well in both roles, providing physicians and researchers with a single, reliable instrument that can be used to assess any or all joints in the upper extremity.