Elsevier

Burns

Volume 33, Issue 7, November 2007, Pages 843-849
Burns

The QuickDASH is an appropriate tool for measuring the quality of recovery after upper limb burn injury

https://doi.org/10.1016/j.burns.2007.03.015Get rights and content

Abstract

Background

Upper limb (UL) burns commonly result in significant dysfunction. The measurement of disability is vital to assess recovery after burn injury. The QuickDASH questionnaire was developed to evaluate UL disorders. The aim of this study was to evaluate its validity, repeatability and responsiveness for burn patients.

Methods

In 2006, 85 patients with UL burns were recruited at Royal Perth Hospital. Each completed both QuickDASH and Burns Specific Health Scale-Brief (BSHS-B) at regular intervals after their burn. Further, 67 patients repeated the questionnaire 1 day after completing it at discharge.

Results

Validity—Criterion validity was demonstrated between QuickDASH and BSHS-B through good correlations (r2 = −0.79 to −0.89). Construct validity was demonstrated using burn severity markers. QuickDASH scores significantly differed when grouped according to major burn, full thickness burn, surgery and need for hospital admission. Repeatability—QuickDASH showed excellent repeatability (ICC = 0.93). Responsiveness—Effect size of QuickDASH was demonstrated to be greater than BSHS-B at all measurement points.

Conclusions

This longitudinal study confirms the validity, repeatability and responsiveness of the QuickDASH outcome measure in patients with upper limb burns. It supports the use of the QuickDASH in this population to help assess change in functional level.

Introduction

Upper limb function is vital for performance of activities of daily living and specific professional or sporting activities. At the Royal Perth Hospital (RPH), more than 83% of burn patients have an upper limb injury. When compared to other parts of the body, burns to the face and, or hands causes greater physical, psychological and body image dysfunction as measured by the Burns Specific Health Scale (BSHS) [1].

The Burns Specific Health Scale is a population specific, self-rated questionnaire developed to assess the quality of recovery after a burn injury. It has demonstrated validity and reliability [1]. The BSHS was revised to create the BSHS brief version (BSHS-B) to reduce the administration issues and increase user compliance (Appendix A). Again, it was demonstrated to have validity and reliability in the burns population [2]. However, neither version of the BSHS has a specific domain for upper limb function. Thus, in view of the high proportion of hand and upper limb injuries rehabilitated in the Western Australian (WA) Burns Service a more specific instrument was desired to detect smaller, yet clinically significant, changes in upper extremity recovery after a burn injury. It was proposed that the disability of the arm, shoulder and hand (DASH) questionnaire could constitute such a measure.

The DASH is a patient self-rated questionnaire that is upper extremity specific. It was introduced by the American Academy of Orthopaedic Surgeons, in 2001, to measure disability caused by various upper limb disorders [3]. The validity and reliability of the DASH has been demonstrated in the general population but not in burns [3]. As with the BSHS-B, the shorter QuickDASH, was developed [4] (Appendix B). Beaton et al. [4] established its validity and reliability while Gummesson et al. [5] have shown that it can be interchanged with DASH without loss of precision. Gummesson et al. also demonstrated the ability of the shortened instrument to detect changes in upper limb function, or measurement of response to treatment [5].

In patients with upper limb burn injuries, this study aimed to:

  • test the criterion and construct validity of QuickDASH,

  • examine the reliability of the QuickDASH, and

  • examine the responsiveness, or sensitivity to measuring change, of the QuickDASH.

Section snippets

Patients

Eligible participants consisted of all patients with upper limb burns who were either admitted to the burn unit or treated as an outpatient in burn clinic at RPH, Perth, WA from 1st January 2006 to 30th September 2006. The exclusion criterion was non-English speaking, as during the study timeframe, only an English version of the QuickDASH was available. Informed consent was obtained from all eligible patients to participate in this longitudinal study.

The QuickDASH questionnaire

The QuickDASH consists of 11 items from the

Sample description

Eighty-five patients with upper limb burns were serially recruited to the study. Of those, 63 were admitted to the burns unit and 22 attended the burn clinic. The demographic and clinical characteristics of the participants are shown in Table 1. Burns unit inpatients had significantly larger total body surface area burn and full thickness burns than burns clinic outpatients. The majority of burns clinic outpatients (90.9%) had burns to their upper limb only.

Sixty-nine, 56, 51 and 44 patients

Discussion

This longitudinal study has provided evidence of the validity, test–retest reliability, and level of responsiveness of the QuickDASH outcome measure in patients with upper limb burn injuries.

The mean QuickDASH scores showed a trend towards the admission score over time and therefore pre-admission upper limb functional level. This demonstrated the improvement in patient's upper limb outcomes over time and showed that the admission score should be one of the goals towards which patient

Conclusion

Due to advances in burn management, the focus of outcome assessment has shifted from mortality to morbidity. Patients’ functional recovery and quality of life now constitute an important part of burns care outcome assessment. This study demonstrates that for patients with upper limb burns, the QuickDASH questionnaire is a reliable and valid outcome measure. We have demonstrated that it is more sensitive to change than the BSHS-B in patients with upper limb burn injuries. This study has shown

Acknowledgements

Our thanks for their patience and organisational support goes to Sharon Rowe and Rhonda Harris in the Burns outpatient clinic and the remainder of the burns physiotherapy team at the Royal Perth Hospital.

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