Quantitative Adjustment of the Influence of Depression on the Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire

Abstract

Upper extremity specific disability as measured with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire varies more than expected based upon variations in objective impairment influenced by depression. We tested the hypothesis that adjusting for depression can reduce the mean and variance of DASH scores. Five hundred and sixteen patients (352 men, 164 women) with an average of 58 years of age (range, 18-100) were asked to simultaneously complete the DASH and Center for Epidemiologic Studies Depression Scale (CES-D) scores at their initial visit to a hand surgeon. Pearson's correlations between each of the DASH items and the CES-D score were obtained. The DASH score was then adjusted for the influence of Depression for women and men using ordinary least-squares regression and subtracting the product of the regression coefficient and the CES-D score from the raw DASH score. The average DASH score was 24 points (SD, 19; range, 0-91), and the average CES-D score was 10 points (SD, 8; range, 0-42). Thirteen of the 30 items of the DASH demonstrated correlation greater than r = 0.20. Adjustment of these DASH items for the depression effect led to significant reductions in the mean (5.5 points; p < 0.01) and standard deviation (0.8 points; p < 0.01) of DASH scores. Adjustment for depression alone had a significant but perhaps clinically marginal effect on the variance of DASH scores. Additional research is merited to determine if DASH score adjustments for the most important subjective and psychosocial aspects of illness behavior can improve correlation between DASH scores and objective impairment.

Does Disability Correlate With Impairment After Hand Injury?

“…The moderate correlation between pain intensity and symptoms of depression is consistent with prior work [4,28]. In a longitudinal study on 500 patients with persistent pain, pain and depression had strong and similar effects on one another over a 12-month period [26].…”

Factors affecting functional recovery after surgery and hand therapy in patients with Dupuytren's disease

“…(1,17) The third variable in the final regression model was quality of life measured with the EQ-5D index. A higher DASH score has previously been shown to correlate with depression (14)(15)(16)21) and since one of the dimensions captured in the EQ-5D index is anxiety/depression, this might have contributed to the findings in the present study.…”

“…(15,21) One aspect that is often overlooked in patient reported outcomes, but identified as important to patients with hand injuries, are emotional functions. (7) For patients with DD, it could be assumed that improving the extension deficit would affect functional recovery measured with DASH.…”

Hand function in patients with Dupuytren’s disease : Assessment, results &amp; patients’ perspectives

“…Quality of life measured with the EQ-5D index was the third variable in the regression analysis best explaining functional recovery. DASH score has been shown to correlate with depression (115)(116)(117)(118), and as anxiety/depression is one of the dimensions in the EQ-5D index this may have contributed to the findings. Still, the great impact the three variables from the regression analysis had on patients' rating of DASH is an important finding.…”