Construct validity of the Chinese version of the disabilities of the arm, shoulder and hand questionnaire (DASH-HKPWH)

The study evaluated the construct validity of the Chinese Hong Kong version of the disabilities of the arm, shoulder and hand questionnaire (DASH-HKPWH). Three hundred and thirty four patients with a broad range of upper extremity disorders were recruited into the study. Each completed DASH-HKPWH and SF-36 forms and their pain intensity (numeric pain rating scale) and grip strength were also measured. The mean DASH-HKPWH score was 40 (SD=20). Principal component factor analysis identified a single factor, which accounted for 47% of the total variance. Pearson correlation was applied to assess convergent and divergent validity of the DASH-HKPWH by comparison with the above-mentioned subjective and objective measurements. Our findings were comparable to the DASH of other languages.     

Use of a subjective health measure on Chinese low back pain patients in Hong Kong.

STUDY DESIGN: A prospective observational study on the use of the Aberdeen Low Back Pain Disability Scale. OBJECTIVE: To evaluate the reliability, validity, and responsiveness of the Chinese adaptation of the Aberdeen Low Back Pain Scale in Chinese patients in Hong Kong who have back pain. SUMMARY OF BACKGROUND DATA: Frontline clinicians, researchers, and health care managers in Hong Kong are urgently in need of a Chinese adaptation of a low back pain outcome measure that has been subjected to a rigorous process of psychometric and clinical testing. METHODS: Four samples with 473 consecutive adult patients with low back pain from six physiotherapy outpatient departments in Hong Kong who completed the Aberdeen Low Back Pain Scale were observed and measured at time points including the beginning physiotherapy; 10 days, 3 weeks, and 6 weeks after physiotherapy; and when discharged from treatment. RESULTS: The test-retest reliability coefficient was 0.94 (0.94 in the original English version; figures from the English version are reported in parentheses). The Cronbach alpha coefficient was 0.85 (0.80). The Spearman correlation coefficient, when the Aberdeen score was correlated with that of a generic current 42-item questionnaire regarding the patient's perceived health to establish cross-sectional construct validity, was 0.59 (0.36-0.66, with the Short Form 36 scale). The effect sizes (responsiveness) at weeks 3 and 6 after treatment began were 0.59 and 0.81, respectively (a high of 0.62 reported in the English version). CONCLUSIONS: The Chinese version of the Aberdeen Low Back Pain Disability Scale retained the high levels of reliability, validity, and responsiveness of the original English version when tested in Hong Kong in four samples of Chinese patients with low back pain.     

Reliability and validity of the Danish version of the disabilities of arm, shoulder, and hand questionnaire in patients with fractured wrists

The disabilities of arm, shoulder, and hand (DASH) questionnaire is a 30-item region-specific questionnaire that is used to measure the effect of treatment of the upper extremity. The purpose of this study was to assess the reliability of, and validate, the Danish version of the DASH score in patients with fractured wrists. Sixty patients were studied. We investigated internal consistency and test-retest reliability, convergent validity, content validity and responsiveness. Time to complete questionnaire was 11 minutes and two questionnaires were not usable. The internal consistency was sufficient (Cronbach's alpha 0.96 and intraclass correlation coefficient 0.89). The difference in the mean was 4.6 (CI: 0.48 to 8.72, p = 0.03). Convergent validity at first and last control was high for both pain, 0.46 and 0.40 respectively, and for physical mobility, 0.64 and 0.65 respectively, indicating that results confirmed other similar scores. We conclude that the Danish version of the 30-item DASH questionnaire is valid and practical for patients with fractured wrists.     

Italian version of the Disability of the Arm,Shoulder and Hand (DASH) questionnaire. Cross-cultural adaptation and validation

An Italian version of the Disability of the Arm, Shoulder and Hand (DASH) questionnaire has been devised and its reliability and validity have been assessed in a cross-sectional study of 108 consecutive patients with upper extremity pathologies. A sub-sample of 30 patients was used to assess re-test reliability. The principal DASH scale showed a high correlation with other patient-oriented measures and demonstrated good reproducibility, consistency and validity, which were similar to those for other languages' versions of DASH. These findings suggest that the evaluation capacities of the Italian DASH are equivalent to those of other language versions of the DASH.     

Translation into Greek, cross-cultural adaptation and validation of the Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH).

The purpose of this study was to translate, adapt, and validate a Greek version of the Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire. The English version of DASH was translated into Greek (DASH-GR) and cultural adaptation was performed. Subsequently, psychometric properties and validity were assessed in 106 consecutive eligible patients presenting with a variety of unilateral upper limb disorders. All patients completed the Short Form 36 Health Survey questionnaire and the DASH-GR. Test-retest reliability was assessed in a subgroup of 35 patients who filled in the questionnaire seven days later. The internal consistency of the 30 items of the DASH-GR, estimated by the internal consistency coefficient (Cronbach's alpha) was 0.96. The difference between the individual scores of the initial assessment and reassessment of the DASH ranged from -6.5 to 14.5 (mean difference was 3.74 (SD+/-6.1)). The correlation coefficient between total scores of the initial assessment and reassessment was high (Pearson's r=0.918, p<0.0005) (Kentall tau-b=0.72, p<0.001). The correlation coefficient between the DASH-GR and SF-36 total scores was 0.625 (p<0.001), showing a strong correlation between the two questionnaires. The Greek version of the DASH retains the characteristics of the English original and is a reliable and valid instrument that can provide a standardized measure of patient-centered outcomes in Greek-speaking patients with unilateral disorders of the upper limb.     

Validation of the Japanese Society for Surgery of the Hand version of the Disability of the Arm, Shoulder, and Hand questionnaire

Background The Disability of the Arm, Shoulder and Hand (DASH) questionnaire is a region-specific self-administered questionnaire that consists of a disability/symptom (DASH-DS) scale, and two optional modules, the work (DASH-W) and the sport/music (DASH-SM) modules. The DASH was cross-culturally adapted and developed by the Impairment Evaluation Committee, Japanese Society for Surgery of the Hand. The purpose of this study was to test the reliability, validity, and responsiveness of the Japanese version of DASH (DASH-JSSH). Methods A series of 72 patients with upper extremity disorders completed the DASH-JSSH, the medical outcomes study 36-item short-form health survey (SF-36), and the Visual Analog Scale (VAS) for pain. Thirty-eight of the patients were reassessed for test-retest reliability 1 or 2 weeks later. Reliability was investigated by reproducibility and internal consistency. To analyze the validity, a principal component analysis and correlation coefficients between the DASH-JSSH and the SF-36 were obtained. Responsiveness was examined by calculating the standardized response mean (mean change/SD) and effect size (mean change/SD of baseline value) after carpal tunnel release of the 17 patients with carpal tunnel syndrome. Results Cronbach’s alpha coefficients in the DASH-DS and DASH-W were 0.962 and 0.967, respectively. The intraclass correlation coefficients for the same were 0.82 and 0.85, respectively. The unidimensionality of the DASH-DS and DASH-W were confirmed. The correlations between the DASH-DS score and the subscale of the SF-36 scale ranged from −0.29 to −0.73. The correlation coefficient between the DASH-DS and the DASH-W was 0.79. The standardized response mean/effect size of DASH-DS, DASH-W, and VAS for pain were −0.48/−0.26, −0.68/−0.41, and −0.40/−0.40, respectively. DASH-DS and DASH-W were as moderately sensitive as VAS for pain. Conclusion The DASH-DS and DASH-W Japanese version have evaluation capacities equivalent to those of the original and other language versions of the DASH. An erratum to this article is available at .     

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.

The Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure was developed to evaluate disability and symptoms in single or multiple disorders of the upper limb at one point or at many points in time. PURPOSE: The purpose of this study was to evaluate the reliability, validity, and responsiveness of the DASH in a group of diverse patients and to compare the results with those obtained with joint-specific measures. METHODS: Two hundred patients with either wrist/hand or shoulder problems were evaluated by use of questionnaires before treatment, and 172 (86%) were re-evaluated 12 weeks after treatment. Eighty-six patients also completed a test-retest questionnaire three to five days after the initial (baseline) evaluation. The questionnaire package included the DASH, the Brigham (carpal tunnel) questionnaire, the SPADI (Shoulder Pain and Disability Index), and other markers of pain and function. Correlations or t-tests between the DASH and the other measures were used to assess construct validity. Test-retest reliability was assessed using the intraclass correlation coefficient and other summary statistics. Responsiveness was described using standardized response means, receiver operating characteristics curves, and correlations between change in DASH score and change in scores of other measures. Standard response means were used to compare DASH responsiveness with that of the Brigham questionnaire and the SPADI in each region. RESULTS: The DASH was found to correlate with other measures (r > 0.69) and to discriminate well, for example, between patients who were working and those who were not (p<0.0001). Test-retest reliability (ICC = 0.96) exceeded guidelines. The responsiveness of the DASH (to self-rated or expected change) was comparable with or better than that of the joint-specific measures in the whole group and in each region. CONCLUSIONS: Evidence was provided of the validity, test-retest reliability, and responsiveness of the DASH. This study also demonstrated that the DASH had validity and responsiveness in both proximal and distal disorders, confirming its usefulness across the whole extremity.     

Reliabilität und Veränderungssensitivität der deutschen Version des Fragebogens Arm, Schulter und Hand (DASH)

BACKGROUND: Whilst there are some studies which have focussed on the validity and also others partially on the reliability of the German version of the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), studies regarding test-retest reliability and responsiveness do not exist. The purpose of this study was to analyse these two meaningful properties of the officially approved German version of the DASH. METHODS: Of 101 consecutive patients with distal radius fractures, 72 were followed prospectively at three time intervals. To evaluate the reliability, internal consistency (Cronbach's alpha) and correlation between the DASH points from the 12- and 13-week examinations (Spearman's correlation coefficient and intra-class coefficient) were calculated. Responsiveness was assessed using the parameters change score, standardised effect size and standardised response mean. These values were compared with the same values obtained from the traditional measures of grip strength and range of motion. RESULTS: Internal consistency and test-retest reliability of the DASH were excellent (Cronbach's alpha >0.95, Spearman's correlation coefficient r=0.912, ICC=0.945). Responsiveness of the DASH was moderate (change score=8.93, SRM=0.55, SES=0.41). Responsiveness of the ROM deficit and grip strength were larger than that for data from the DASH. CONCLUSION: The German DASH is a reliable and responsive measure. It can detect changes in disabilities over time in patients with distal radius fractures. Traditional impairment measures reflect important functional aspects and should be included in clinical outcome evaluation.     

The Validity, Reliability, Responsiveness, and Bias of the Manchester-Modified Disability of the Arm, Shoulder, and Hand Score in Hand Injuries

The Manchester-Modified Disability of Arm, Shoulder and Hand questionnaire (M² DASH) was developed by the authors as a modification to the original DASH questionnaire. In this study, we assessed the validity, reliability, responsiveness, and bias of the M² DASH questionnaire for hand injuries using completed M² DASH, Patient Evaluation Measure, and Michigan Hand Outcome questionnaires from 40 patients. The M² DASH scores showed significant positive correlations with the Patient Evaluation Measure and Michigan Hand Outcome scores suggesting validity. There was also no evidence of a statistical difference in the M² DASH scores when the condition had stabilized suggesting good test–retest reproducibility and reliability. The effect size and the standardized response mean for the M² DASH score were greater than those for the Patient Evaluation Measure and Michigan Hand Outcome scores establishing that the M² DASH is highly responsive. There was no gender, hand dominance, or dominant side injured bias for the M² DASH score. There was, however, a relatively weak association between age and the M² DASH score at presentation. We conclude that the M² DASH questionnaire is a robust region-specific outcome measure. It is a valid and responsive questionnaire with test–retest reliability proven for hand injuries in this study. Gender, handedness, and side injured did not cause bias in the responses.     

Construct validity of the Chinese version of the Patient-rated Wrist Evaluation Questionnaire (PRWE-Hong Kong Version).

With increasing economic globalization, including health care, it is important to use standardized outcome measures applicable to a broad spectrum of patients in a wide array of countries. The purpose of this study was to verify construct and content validity and reliability of the Chinese version of the Patient-rated Wrist Evaluation Questionnaire (PRWE-Hong Kong version). The PRWE was translated into Chinese, and face validity was established by inviting experts and patients to participate in the panel review of the questionnaire. A correlation field study was performed using a convenience sample of 47 patients with wrist injuries. Patients were assessed at baseline and six weeks after the initial measurement. The following measures were taken: the Chinese version of the PRWE and the Medical Outcome Short Form (36) Health Survey (SF-36), Visual Analogue Scale (VAS) for pain, active wrist range of motion, grip strength, and the Jebsen Hand Function Test. Statistical analysis consisted of Pearson correlation coefficients (convergent validity), factor analysis (content validity), paired t-test (convergent validity), and the Cronbach alpha (internal consistency). Clinically relevant correlations existed between "Pain at rest" and the VAS "resting pain" (r=0.785, p<0.0001) as well as between "Pain on repeated wrist movement" and the VAS "exertion pain" (r=0.872, p<0.0001). The "Physical Component Summary" of the SF-36 was found significantly correlated with the PRWE function subset total score (r=-0.618, p<0.0001), and the PRWE total score (r=-0.645, p<0.0001). The specific function subset score also correlated with the wrist flexion range (r=-0.308, p<0.0001) and the grip strength (r=-0.488, p=0.035). Two factors were found that accounted for 61% of the variance. The Cronbach alpha coefficients ranged from 0.7805 to 0.9502, indicating that the internal consistency of the questionnaire items was sound and reliable. Positive correlations between the wrist ranges of motion (ROM) and the specific function subset score showed that the function subset measured dimensions related to wrist-specific performance in activities of daily living. Factor analysis results supported the construct validity of the PRWE-Hong Kong version in wrist-injured patients. Internal consistency testing results suggested that item consistency within subset items was good and persisted over time. In conclusion, the Chinese version of the PRWE is a reliable and valid self-rated tool in measuring treatment outcome. It supplements traditional objective clinical measures and is potentially applicable in Hong Kong clinical settings.     

Responsiveness of the disability of the arm, shoulder, and hand (DASH) and patient-rated wrist/hand evaluation (PRWHE) in evaluating change after hand therapy.

A hand therapy clinic used a systematic process to select an outcome tool for routine use. After a literature review of available instruments, the choice had been narrowed to two instruments: the Disability of the Arm, Shoulder, and Hand (DASH) and the Patient-Rated Wrist Evaluation (PWRE). The PRWE was modified to attribute to the hand/wrist. A cohort of 60 patients (36 hand problems, 24 wrist problems) completed a DASH and PRWHE at their initial clinic visit and three months later. Standardized response means (SRMs) and effect sizes indicated a large treatment effect. The PRWHE had slightly higher responsiveness than the DASH (SRM=1.51 vs. 1.37). Because this level of responsiveness was obtained with fewer items, it was considered more efficient. A supplementary esthetics question was less responsive than either scale, but was thought to be an important option for selected patients. On completion of the trial period, the therapists unanimously selected the PRWHE with a supplemental esthetics question to be routinely used in measurement of outcomes.     

Reliability and validity of the upper limb DASH questionnaire in patients with distal radius fractures

AIM: The purpose of the study was to verify test criteria of the upper-limb DASH questionnaire in patients with Colles' fractures. METHODS: 107 of 139 patients with Colles' fractures treated operatively were examined and asked to complete the questionnaire. To establish reliability, the item answers of all questionnaires were analysed by using Cronbach's Alpha correlation coefficient and corrected item total correlation. Construct validity was evaluated by comparing the DASH points with clinical measures according to Gartland/Werley and Castaing (Spearman correlation coefficient). Discriminant validity was assessed by comparing the DASH points of patients with AO-type A/B fractures and AO-type C fractures (Mann-Whitney U-Test). RESULTS: 2.7 percent of all questionnaires were unusuable. The time to fill out the questionnaire was on average 12 minutes. Cronbach's alpha values were high in all scales (alpha > 0.8). No items were found unsuitable (corrected item total correlation > 0.5 in 28 of 30 questions). DASH scores were correlated with ROM deficits and clinical measures of wrist function (r = 0.53; r = 0.59; r = 0.52, p < 0.01). The questionnaire could discriminate patients with different fracture types (p < 0.05). CONCLUSIONS: DASH is a workable, reliable and valid instrument for patients with Colles' fractures.     

Standardisation and validation of the German version 2.0 of the Disability of Arm,Shoulder,Hand (DASH) questionnaire

The Disability of Arm, Shoulder, Hand (DASH) Version 2.0 questionnaire captures the subjective experience of patients regarding their own health.This 78-item instrument was developed by the American Academy of Orthopedic Surgeons (AAOS), the Council of Musculoskeletal Specialty Societies and the Institute for Work and Health,Toronto and measures components of health-status relevant to upper-extremity conditions.We translated and validated DASH with the aim of producing a tool which could also be used in German-speaking countries.The paper reports the method of translation and cross-cultural adaptation which was carried out according to the AAOS guidelines.The result was a standardised German version of DASH.Psychometric testing of the translated questionnaire was carried out with 6 samples (n=342) who had undergone hand surgery for a variety of conditions. The study yielded good results across all groups with regard to the construct, criterion and content validity.We confirm that the German version is suitable for use in future studies.     

Five year analysis of Jockey Club horse-related injuries presenting to a trauma centre in Hong Kong

BACKGROUND: Professional horse riding-related injuries have not been studied before in Hong Kong, although horse racing takes place very regularly in the territory. In addition, the equestrian events of the 2008 Beijing Olympic Games will come to Hong Kong. This study analysed the pattern of horse-related injury among patients who presented to a trauma centre in a teaching hospital in Hong Kong. METHODS: Information from the trauma centre database was analysed retrospectively. The database includes trauma patients who had sustained potentially severe injuries that warranted initial assessment and resuscitation in a trauma resuscitation room (triage category 1 or 2). Data analysed included demographic variables, causes and mechanisms of injury, anatomical injuries, anatomical and physiological trauma scores, and patient outcome. RESULTS: Between January 2001 and June 2005, 2312 trauma patients were entered into the database. Thirty-six (1.6%) patients had sustained horse-related injuries (mean age 34 years, range 17-54; male to female ratio 32:4), all whilst at work in the Jockey Club. Twenty-two patients were injured between midnight and 09:00 h. This group stayed in the resuscitation room for longer prior to admission compared with patients presenting between 09:00h and midnight (median time 127 min (interquartile range [IQR] 57-183) versus 58 min (IQR 43-83), p=0.06). Twenty-five patients fell from horseback, whilst 11 were kicked by the horse. Twenty patients had a single injury and 16 patients had multiple injuries. Eighteen patients had injuries to the thorax, abdomen, thoracolumbar spine or pelvis. Eleven patients had head, face and cervical spine injuries and 11 had limb injuries. Twenty-five patients were admitted, including four admitted to the intensive care unit (ICU). Ten patients required surgery. Median (standard deviation [S.D.]) probability of survival was 0.996 (0.052) and median revised trauma score (RTS) (S.D.) was 7.841 (0.624). There were no fatalities. Potentially serious horse-related injuries presented once every 6 weeks. CONCLUSION: Most injuries are minor and affect the trunk but occur out of hours. Helmets, face shields and body protectors should be worn when riding or handling horses.     

The cross-cultural adaptation of the DASH questionnaire in Canadian French.

The purpose of this study was to perform a cross-cultural adaptation of the original version of the Disability of Arm, Shoulder and Hand (DASH) questionnaire to Canadian French. The cross-cultural adaptation followed five steps: forward translations into Canadian French, a synthesis of the translations, back translations into English, revision by a committee of experts, and test of the prefinal version. The content validity and the internal consistency of the Canadian French version of the questionnaire were assessed by experts involved in the study and by subjects who participated in the pilot study. Results indicate that the scores were adequately distributed without floor or ceiling effect. Item completion was excellent and item responses had a good distribution. Internal consistency of the total score was high (Cronbach alpha = 0.94) and item-total correlations were substantial for most items (0.43-0.88). These results are similar to previous studies on the DASH questionnaire supporting linguistic and conceptual equivalence of the Canadian French version.     

Construct validity of the Enneking score for measuring function in patients with malignant or aggressive benign tumours of the upper limb

We evaluated the construct validity of the Musculoskeletal Tumour Society rating scale (Enneking score) as a functional measure for patients with sarcoma involving the upper limb. We compared the Enneking score by examining the correlation between two patient-derived outcome measures, the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire and the Medical Outcomes Study Short Form-36 (SF-36) as indicators of functional status in 40 patients with malignant or aggressive benign bone and soft-tissue tumours of the upper limb who had undergone surgical treatment. The frequency distributions were similar among the three scoring systems. As for the validity, Spearman's rank correlation coefficient of the Enneking score to the DASH questionnaire was -0.79 and that of the Enneking to the SF-36 subscales ranged from 0.38 to 0.60. Despite being a measure from the surgeon's perspective, the Enneking score was shown to be a valid indicator of physical disability in patients with malignant or aggressive benign tumours of the upper limb and reflected their opinion.     

Reproducibility of a 3-dimensional gyroscope in measuring shoulder anteflexion and abduction

ABSTRACT: BACKGROUND: Few studies have investigated the use of a 3-dimensional gyroscope for measuring the range of motion (ROM) in the impaired shoulder. Reproducibility of digital inclinometer and visual estimation is poor. This study aims to investigate the reproducibility of a tri axial gyroscope in measurement of anteflexion, abduction and related rotations in the impaired shoulder. METHODS: Fifty-eight patients with either subacromial impingement (27) or osteoarthritis of the shoulder (31) participated. Active anteflexion, abduction and related rotations were measured with a tri axial gyroscope according to a test retest protocol. Severity of shoulder impairment and patient perceived pain were assessed by the Disability of Arm Shoulder and Hand score (DASH) and the Visual Analogue Scale (VAS). VAS scores were recorded before and after testing. RESULTS: In two out of three hospitals patients with osteoarthritis (n=31) were measured, in the third hospital patients with subacromial impingement (n=27). There were significant differences among hospitals for the VAS and DASH scores measured before and after testing. The mean differences between the test and retest means for anteflexion were -6 degrees (affected side), 9 (contralateral side) and for abduction 15 degrees (affected side) and 10 degrees (contralateral side). Bland & Altman plots showed that the confidence intervals for the mean differences fall within -6 up to 15 degrees, individual test - retest differences could exceed these limits. A simulation according to 'Generalizability Theory' produces very good coefficients for anteflexion and related rotation as a comprehensive measure of reproducibility. Optimal reproducibility is achieved with 2 repetitions for anteflexion. CONCLUSIONS: Measurements were influenced by patient perceived pain. Differences in VAS and DASH might be explained by different underlying pathology. These differences in shoulder pathology however did not alter the reproducibility of testing. The use of a tri axial gyroscope is a simple non invasive and reproducible method for the recording of shoulder anteflexion and abduction. Movements have to be repeated twice for reproducible results.     

Development of the Neck Pain and Disability Scale. Item analysis, face, and criterion-related validity.

STUDY DESIGN: The development and testing of a new comprehensive measure of neck pain and disability, the Neck Pain and Disability Scale. OBJECTIVES: To provide an initial evaluation of the Neck Pain and Disability Scale's reliability and validity. SUMMARY OF BACKGROUND DATA: Although several measures exist for generalized pain and disability, none is specific for neck pain. More specific measurements should improve assessment of treatments and clinical research aimed at cervical pain syndromes. METHODS: The Neck Pain and Disability Scale was designed using the Million Visual Analogue Scale as a template and consists of 20 items that assess neck pain. In this study, 100 patients with neck pain, 52 patients with lower back and leg pain, and 27 pain-free volunteers were rated by the Neck Pain and Disability Scale. In addition, a subset of the 47 patients with neck pain were rated by several other established psychometric instruments. RESULTS: An item analysis showed a high degree of internal consistency among the 20 items on the Neck Pain and Disability Scale (r = 0.93), and face validity was established by comparing patients who had neck pain as well as lower back and leg pain with a pain-free group. The Neck Pain and Disability Scale scores correlated with the Oswestry Disability Questionnaire, the Pain Disability Index, and psychological measures of depression and neuroticism. CONCLUSIONS: The results suggest a highly reliable instrument for evaluating neck pain with at least four underlying dimensions. Further work to address the predictive validity of this new tool are under way.     

Comparison of responsiveness of the Japanese Society for Surgery of the Hand version of the carpal tunnel syndrome instrument to surgical treatment with DASH, SF-36, and physical findings

Background The Japanese Society for Surgery of -the Hand version of the Carpal Tunnel Syndrome Instrument (CTSI-JSSH), which consists of two parts — one for symptom severity (CTSI-SS) and the other for functional status (CTSI-FS) — is a self-administered questionnaire specifically designed for carpal tunnel syndrome. The responsiveness of the CTSI-JSSH was compared with that of the JSSH version of the Disability of Arm, Shoulder, and Hand questionnaire (DASH), the official Japanese version of the 36-Item Short Form Health Survey (SF-36, version 1.2), and physical examinations to elucidate the role of the CTSI-JSSH for evaluating patients with carpal tunnel syndrome. Methods Preoperatively, a series of 60 patients with carpal tunnel syndrome completed the CTSI-JSSH, DASH, and SF-36. Results of physical examinations, including grip strength, pulp pinch, and static two-point discrimination of the thumb, index, and long fingers, were recorded. Three months after carpal tunnel release surgery the patients were asked to fill out the same questionnaires, and the physical examinations were repeated. The responsiveness of all the instruments was examined by calculating the standardized response mean (SRM) and effect size (ES). Correlation coefficients were calculated between questionnaire change scores and patient satisfaction scores as well as between the CTSI change scores and those of the DASH and SF-36. Results The largest responsiveness was observed in the CTSI-SS (SRM/ES: −1.00/−1.08) followed by the CTSI-FS (−0.76/−0.63), and bodily pain subscale of SF-36 (SF-36-BP, 0.45/0.55), and the DASH (−0.46/−0.47). Only the change scores of the CTSI-SS had significant correlation with patient satisfaction (r = 0.34, P < 0.01). An absolute value of Spearman's correlation coefficient of >0.5 was observed between the change scores of the CTSI-SS and the DASH, the CTSI-SS and the SF-36-BP, the CTSI-FS and the DASH, and the DASH and the SF-36-BP. Conclusion The CTSI-JSSH was proven to be more sensitive to clinical changes after carpal tunnel release than the other outcome measures and should be used to evaluate patients with carpal tunnel syndrome who speak Japanese as their native language.     

Validation of the Japanese Society for Surgery of the Hand Version of the Quick Disability of the Arm, Shoulder, and Hand (QuickDASH-JSSH) questionnaire

Background The Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) questionnaire is a region-specific, self-administered questionnaire, which consists of a disability/symptom (QuickDASH-DS) scale, and the same two optional modules, the work (DASH-W) and the sport/music (DASH-SM) modules, as the DASH. After the Japanese version of DASH (DASH-JSSH) was cross-culturally adapted and developed, we made the Japanese version of QuickDASH (QuickDASH-JSSH) by extracting 11 out of 30 items of the DASH-JSSH regarding disability/symptoms. The purpose of this study was to test the reliability, validity, and responsiveness of QuickDASH-JSSH. Methods A series of 72 patients with upper extremity disorders completed the QuickDASH-JSSH, the 36-Item Short-Form Health Survey (SF-36), and the Visual Analog Scale (VAS) for pain. Thirty-eight of the patients were reassessed for test–retest reliability 1 or 2 weeks later. Reliability was investigated by the reproducibility and internal consistency. To analyze the validity, a principal component analysis and the correlation coefficients between the QuickDASH-JSSH and the SF-36 were obtained. The responsiveness was examined by calculating the standardized response mean (SRM; mean change/SD) and effect size (mean change/SD of baseline value) after carpal tunnel release of the 17 patients with carpal tunnel syndrome. Results Cronbach's alpha coefficient in the QuickDASH-DS was 0.88. The intraclass correlation coefficient (ICC) for the same was 0.82. The unidimensionality of the QuickDASH-DS was confirmed. The correlation coefficients between the QuickDASH-DS and the DASH-DS, DASH-W, or the DASH-SM were 0.92, 0.81, or 0.76, respectively. The correlation coefficients between the QuickDASH-DS score and the subscales of the SF-36 ranged from −0.29 to −0.73. The correlation coefficient between the QuickDASH-DS score and the VAS for pain was 0.52. The SRM/effect size of QuickDASH-DS was −0.54/−0.37, which indicated moderate sensitivity. Conclusion The Japanese version of QuickDASH has equivalent evaluation capacities to the original QuickDASH.