lecture 6: the DASH Flashcards
what are the two main purposes of the DASH?
- describe different groups of people and discriminate between individuals/groups to compare impact of UE disorders
> discriminative measure - evaluate and assess changes over time related to natural history of disorder/effect of treatment interventions
> evaluative measure
what does the DASH include?
- 30-item questionnaire + 2 optional 4-item modules (measure impact of UE issues on writing, music, and sport)
what does the DAS measure?
the capacity to do a task NOT if they have performed it
how is the DASH administered?
- questionnaire
- circle appropriate responses to question in the PAST WEEK
> if did not do action in past week, asked to make best estimate - designed in paper/pencil format but also done on tablet
how is the DASH scored?
- disability/symptom score
- need to complete at least 27/30 items
- values summed and averaged to get score out of 5
- transform value to score out of 100
- higher score = higher disability - work/sports/music module
- need to do all 4 modules to get score
- add values and divide by 4
- transform to get a score out of 100
what happens if there is missing data in the DASH?
if >10% is missing (>3) = cannot calculate DASH score
what theories were used to develop the DASH?
- item generation - defines potential questions being considered to guide content of questionnaire
- done to identify items that fell outside targeted components - item reduction - eliminates redundant items to make number of questions feasible
- psychometric strategies - math techniques to make scale to measure single patient attributes (homogenous scale)
- clinimetric strategies - judgements of patients and clinicians to measure clinical phenomena that comprise several unrelated patient characteristics (heterogenous scale)
- disablement process
what is the clinical utility of the DASH w/ respect to specificity?
- in defining area of assessment…
- DASH considers that disability is not owed to a single anatomical site but instead kinetic chain
- centered on entire UE to benefit the busy clinic setting - in wording of questions…
- have non-attributed wording since concerned with overall performance of the task
what is the clinical utility of the DASH w/ respect to availiabity?
- downloaded from DASH website
- free
- common assessment
- available in many languages
- no set age limits (usually 18-65)
- used for acute and chronic conditions
what is the clinical utility of the DASH w/ respect to time and training demands?
- self-administered –> minimize observer bias
- time efficiency for health care providers
- 10-15 minutes + modules
what is the clinical utility of the DASH w/ respect to acceptability to clients?
- considers balance between length of measure and info collection in psychometrically sound way
- have condensed version
- use this one assessment for comparative measures for different conditions of upper limb - saving time and preventing fatigue
what is the clinical utility of the DASH w/ respect to cost?
- low administration costs
- free online
what is the clinical utility of the DASH w/ respect to cross-cultural validity?
- translated into 28 languages and look at relevance of each item to different cultures
- moderate to high construct validity scores
what are strengths of the DASH standardization?
- multiple languages
- used in original form without changes
- using single mesaure allows for standardized comparisons between different conditions
- normative data from large population survey available
what are limitations of the DASH standardization?
- no dialect variations
- designed to be competed in paper format (telephone admin not tested yet)
- may perceive intensity of items differently (ex. pain)
how does the DASH function as a descriptive measure?
- compare impact of upper limb disorders among individuals or groups
- high internal consistency and construct validity
> distinguishes between different groups
> shown to vary along w/ other measures of UE function
how does the DASH function as an evaluative measure?
- assess change over time related to history or intervention
- be sensitive to show high test-retest reliability
- detect clinical changes that are not necessarily large
what is the DASH’s test-retest reliability?
high - 0.90 to 0.98
- reflections of good standardization
what is the DASH’s inter-rater reliabilty?
- self-administered therefore not inter-rater
what is the DASH’s internal consistency?
high - 0.96
- too high; due to too many items
what is the DASH’s face validity?
- good face validity
- why does it matter? –> won’t choose assessment if it doesn’t look like it’ll measure
what is the DASH’s content validity?
- good content validity
- why does it matter? –> needs to cover all aspects of what it’s intended to measure and best current knowledge
what is the DASH’s criterion validity?
- good criterion validity
- why does it matter? –> should correlate to gold standard
> concurrent not pursued
> predictive could be pursued
what is the DASH’s construct validity?
- good construct validity
- convergent: compare to other UE measures
- divergent: mental health measures and work distress
- discriminative: compare groups of mild and severe patients
what is the DASH’s responsiveness validity?
- good responsiveness validity (+15 = meaningful)
- why does it matter? need to measure change overtime to see treatment function
is the DASH a norm-based assessment?
- yes
- norms based on sample of 1800 US general population broken into male/female and age groups
what are the general strengths of the DASH?
- holistic approach to defining UE
- have modified version (quickDASH)
- lots of psychometric data
- translated into different languages
- free
- scoring method of 0-100 for ease of interpretation
what are the general weakness of the DASH?
- holistic - non-specific
- age limitation (18-65)
- cannot do virtually (over the phone)
- does not say if it can be done by proxy (if cog impairment)
- poor internal consistency
