Disabilities of the Arm, Shoulder and Hand (DASH)

The Disabilities of the Arm, Shoulder and Hand (DASH) is a validated, widely used self-report questionnaire with 30 items designed to measure functional limitations and symptom burden in individuals with one or more musculoskeletal disorders of the upper extremity.¹ ² ³ It is considered a gold-standard outcome measure in both clinical rehabilitation and research for upper limb conditions.

A shorter version, the QuickDASH, contains 11 items and is particularly useful when time efficiency is essential.⁵ ⁶

Target Population

DASH was developed for patients with:

• One or more musculoskeletal disorders affecting the arm, shoulder, or hand¹ ² ³

• Conditions that impact daily activities, work ability, or sports performance

QuickDASH provides a briefer alternative while maintaining high validity and reliability.

Questionnaire Structure

Core DASH

• 30 items covering daily activities and symptom burden

• Rated on a 5-point Likert scale:

  • 1 = No difficulty

  • 5 = Unable to perform the activity

Examples of items:

• “Place an object on a shelf above your head.”

• “Use a knife to cut food.”

• “Wash your back.”

The final items assess pain, tingling, weakness, stiffness, as well as the impact on work and sports.

Optional Modules

Both DASH and QuickDASH include two optional 4-item modules:

• Work Module – for patients with work-related upper limb disorders

• Sport/Performing Arts Module – for athletes or musicians

⚠️ Note: A module cannot be scored if any item is missing.¹

Scoring

• DASH scoring: 0 (no disability) → 100 (severe disability)

• QuickDASH scoring: Same scale, but based on 11 items

Rules:

• DASH cannot be scored if >3 items are missing¹

• QuickDASH cannot be scored if >1 item is missing¹

Higher scores = greater disability.

Measurement Properties

Reliability

Instrument	ICC (2,1)
DASH	0.96²
QuickDASH	0.90⁷

Validity

• Pearson’s r > 0.70 for both DASH and QuickDASH² ⁸

• Strong validity in assessing functional limitations across a wide range of upper extremity disorders

Responsiveness

• DASH: High responsiveness to pre-/post-treatment changes in most upper extremity conditions³

• QuickDASH: Slightly higher responsiveness in some cases, and more efficient in time-pressured clinical settings⁵ ⁸

MDC & MCID

Property	DASH	QuickDASH
MDC (Minimal Detectable Change)	12.75–17.23 %³	11.2 %⁷
MCID (Minimal Clinically Important Difference)	10.83–15³	15.91–20⁹

Availability

• DASH and QuickDASH are translated and validated in 27+ languages, including Norwegian, making them globally applicable.¹ ⁸

Advantages

• Widely validated across diagnoses

• Sensitive to functional change

• Available in over 27 languages

• QuickDASH provides a faster, efficient alternative in busy clinical practice⁸

Clinical Relevance

DASH and QuickDASH are highly effective for:

• Evaluating functional limitations in the upper extremities

• Measuring treatment response

• Monitoring progress over time

• Comparing outcomes across clinical and research populations

They remain essential tools in orthopedics, rheumatology, physiotherapy, and occupational therapy for standardized patient-reported outcomes.

Sources:

1. The DASH outcome measure. http://www.dash.iwh.on.ca,

2. 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. Journal of Hand Therapy. 2001 Apr 1;14(2):128-42.

3. Beaton DE, Davis AM, Hudak P, McConnell S. The DASH (Disabilities of the Arm, Shoulder and Hand) outcome measure: what do we know about it now?. The British Journal of Hand Therapy. 2001 Dec;6(4):109-18..

4. Sigirtmac IC, Oksuz C. Systematic review of the quality of the cross-cultural adaptations of Disabilities of the Arm, Shoulder and Hand (DASH). La Medicina del Lavoro. 2021;112(4):279.

5. Gummesson C, Ward MM, Atroshi I. The shortened disabilities of the arm, shoulder and hand questionnaire (Quick DASH): validity and reliability based on responses within the full-length DASH. BMC musculoskeletal disorders. 2006 Dec 1;7(1):44.

6. Matheson LN, Melhorn JM, Mayer TG, Theodore BR, Gatchel RJ. Reliability of a visual analog version of the QuickDASH. JBJS. 2006 Aug 1;88(8):1782-7.

7. Mintken PE, Glynn P, Cleland JA. Psychometric properties of the shortened disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) and Numeric Pain Rating Scale in patients with shoulder pain. Journal of Shoulder and Elbow Surgery. 2009 Nov 1;18(6):920-6.

8. Beaton DE, Wright JG, Katz JN, Upper Extremity Collaborative Group. Development of the QuickDASH: comparison of three item-reduction approaches. JBJS. 2005 May 1;87(5):1038-46.

9. Franchignoni F, Vercelli S, Giordano A, Sartorio F, Bravini E, Ferriero G. Minimal clinically important difference of the disabilities of the arm, shoulder and hand outcome measure (DASH) and its shortened version (QuickDASH). journal of orthopaedic & sports physical therapy. 2014 Jan;44(1):30-9.