Technical and measurement reportResponsiveness, minimal importance difference and minimal detectable change scores of the shortened disability arm shoulder hand (QuickDASH) questionnaire
Introduction
It has been reported that there are a number of barriers to clinicians using questionnaires to document treatment outcomes. These include the need to have numerous questionnaires to cover the multitude of musculoskeletal conditions seen in clinical practice, and the requirement to be able to calculate and interpret scores derived from these questionnaires easily (Abrams et al., 2006). Thus questionnaires that can cover a large range of musculoskeletal problems are valuable to the clinician. The Disability Arm Shoulder Hand (DASH) questionnaire is an example of an outcome measure focused on function that can be used across conditions affecting the entire upper limb (Hudak et al., 1996, Beaton et al., 2001).
A recognised limitation of the DASH is the length of time it takes to complete, thus a shortened version of the DASH, the QuickDASH has been developed (Beaton et al., 2005). Whilst the DASH has had robust psychometric scrutiny, (SooHoo et al., 2002, Bot et al., 2004, MacDermid and Stratford, 2004, Paul et al., 2004, Jester et al., 2005, Gummesson et al., 2006, Imaeda et al., 2006), the QuickDASH has had limited analysis to date. In particular the responsiveness of the QuickDASH has most often been calculated from the full DASH questionnaire (Gummesson et al., 2006, Fayad et al., 2009) with limited investigation in its shortened format independently, and this is a weakness noted by previous researchers (Fayad et al., 2009). Responsiveness refers to the accurate detection of change, and can be considered from the perspective of change in scores in the QuickDASH over a defined period of treatment. Within this change, the Minimal Important Difference (MID) can provide additional information that constitutes a score change that is related to a meaningful change in health status perceived by the patient (e.g. improved, much better). An additional statistic of interest is the Minimal Detectable Change (MDC) which provides the lowest change score outside of error that may reflect change in the patients’ condition (Liang et al., 2002). A recently published study by Mintken et al. (2009) has examined the psychometric properties of the QuickDASH, including the MID and MCD in subjects presenting with shoulder pathology undertaking treatment over a two to four week period. Thus, it would be of value to examine responsiveness and MID and MDC scores in a group of patients suffering from a variety of upper limb conditions, who are typical of those that might be seen in physiotherapy private practices and who had their treatment funded by both private and public sources.
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Recruitment
Private physiotherapy practices of convenience were contacted by the principal investigator (KP), and invited to participate in the study. The principal investigator met with the staff in the clinics and explained the methodological procedures. The investigator then remained in contact with the clinics via phone and site visits to ensure that procedures were being adhered to and was sent the completed data sets for analysis when participants had completed the requirements of the study.
The
Demographics
Thirty-five participants completed the QuickDASH questionnaires and the GCSQ. Recruitment was stopped when the six week time frame had been met or the participant had been discharged from care. All data sets were complete. Demographic data is presented in Table 1. Table 2 shows the pathologies for which the subjects presented for treatment and the corresponding QuickDASH mean scores. The most common condition was rotator cuff injury (n = 17) followed by tennis elbow pathology (n = 5).
Responsiveness
The mean
Discussion
The magnitude of the effect sizes in the current study provides evidence that the QuickDASH is a responsive questionnaire. In comparison to other research that has calculated QuickDASH scores from the full DASH, this study had a large ES and SRM. Other studies by Beaton et al., 2005, Gummesson et al., 2006 and Imaeda et al. (2006) reported moderate to low ES and SRM (ES 0.5, SRM 0.63; ES 0.3 SRM 0.5; SRM 0.7 respectively). A contributing factor that may influence the difference in results could
Limitations
The main limitation of the study is the sample size, which may not be representative of a broad enough range of upper limb conditions presenting to private practice physiotherapist in New Zealand. As well, the number of potential participants who declined to be part of the study was not known, as this was not recorded by the recruiting clinics.
A further limitation is that the data collection period was limited to a maximum of six weeks, however if an outcome measure is to be of use clinically,
Summary
This study investigated the responsiveness, MID and MDC of the QuickDASH. The results indicate that the QuickDASH is highly responsive to change in patients with a range of upper limb pathologies managed in private physiotherapy clinics. The MID and MDC differed notably, with the latter at 11 points being as the name indicates a ‘minimal’ score change free of error, while the MID of 19 points is more indicative of those patients who were ‘much improved’. These results indicate that the
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