Psychometric evaluation of the Disabilities of the Arm, Shoulder and Hand (DASH) with Dupuytren’s contracture: validity evidence using Rasch modeling

Abstract

BackgroundDupuytren’s contracture is a progressive, fibroproliferative disorder that causes fixed finger contractures and can lead to disability. With the advances of new therapeutic interventions, the necessity to assess the functional repercussions of this condition using valid, reliable and sensitive outcome measures is of growing interest. The Disabilities of the Arm, Shoulder and Hand (DASH) is one frequently used patient-reported outcome measure but its reliability and validity have never been demonstrated specifically for a population affected with Dupuytren’s contracture. The objective of this study was to evaluate the psychometric properties of the DASH, with focus on validity evidence using the Rasch measurement model.MethodsSecondary analysis was performed on data collected as part of a randomised clinical trial. One hundred fifty-three participants diagnosed with Dupuytren’s contracture completed the DASH at four time points (pre-op, 3, 6 and 12 months post-op). Baseline data were analysed using traditional analysis and to test whether they adhered to the expectations of the Rasch model. Post-intervention data were subsequently included and analyzed to determine the effect of the intervention on the items.ResultsDASH scores demonstrated large ceiling effects at all time points. Initial fit to the Rasch model revealed that the DASH did not adhere to the expectations of the Rasch partial credit model (χ2 = 119.92; p < 0.05). Multiple items displayed inadequate response categories and two items displayed differential item functioning by gender. Items were transformed and one item deleted leading to an adequate fit. Remaining items fit the Rasch model but still do not target well the population under study.ConclusionsThe original version of the 30-item DASH did not display adequate validity evidence for use in a population with Dupuytren’s contracture. Further development is required to improve the DASH for this population.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-361) contains supplementary material, which is available to authorized users.

Validity and reliability of the Disabilities of Arm, Shoulder, and Hand scale in dental students: A transnational study

“…Meanwhile, gender contributed significantly to physical function (p < .001) and symptoms/social function (p D .028), and women reported higher degrees of physical disability and symptoms than men. Similar results were found in studies conducted by Cheng et al 38 and Forget et al 33 Greenslade et al, 40 Jester et al, 41 and Forget et al 33 reported that these results might be explained by the items in the instrument because most items were related to domestic activities, which were primarily performed by women, including making the bed and domestic tasks. According to Hooftman et al, 42 a similar exposure to the same risk factor among men and women may have a greater effect on women due to biological differences (body size, muscular capacity, aerobic capacity, and hormonal conditions) or to psychological differences (such as coping strategies).…”

“…We used the classical theory for process validation, although Franchignoni et al, 31 Cano et al, 32 and Forget et al 33 consider the Rasch analysis a more robust method. In the present study, 3 factorial proposals were tested for the DASH scale (uni, bi, and trifactorial), and since the Rasch analysis considers unidimensionality to be an important assumption, its use would not be feasible.…”

“…The item eliminated from the bifactorial model for the Brazilian sample relates to recreational activities and involves playing cards or knitting; this elimination can be explained by the characteristics of the study population, which belongs to a generation in which recreational activities are correlated primarily with the use of technology. In terms of the American sample, the students may have responded to the excluded items with "no difficulties were experienced" because they were considered easy to perform and this group did not have established musculoskeletal problems; in addition, this might have caused the "ceiling" effect, which, according to Forget et al, 33 might affect the capacity of measuring symptoms/ social function in the DASH scale.…”

Anesthetic Management of a Patient With Ehlers-Danlos Syndrome

“…In addition, she had sprain or subluxation of the elbows and ankles countless times and had sustained dislocation of the knees, which had to be treated surgically, several times. Even though her father had Dupuytren's contracture, a chronic, progressive, fibroproliferative disorder of the palm with a predilection for men, 7 and her older brother was also suspected of having EDS, they had only mild symptoms of ankle sprains.…”

Methods of assessment of movement functions in the upper limb

“…DASH может помочь в оценке расстройств бытовых навыков, с которыми сталкиваются пациенты, а также подходит для длительного мониторин-га состояния больного. Опросник применим для исследо-вательских и клинических целей [41][42][43]. DASH может обнаруживать большие и малые изменения неспособно-сти с течением времени, при этом разницу в показателях в пределах 10 пунктов можно рассматривать как минималь-но важные изменения [44,45].…”