Elsevier

Manual Therapy

Volume 16, Issue 2, April 2011, Pages 177-182
Manual Therapy

Original article
Psychometric properties of QuickDASH – A classical test theory and Rasch analysis study

https://doi.org/10.1016/j.math.2010.10.004Get rights and content

Abstract

The aim of this study was to perform a comprehensive psychometric analysis of QuickDASH, using both classical test theory and Rasch analysis, in order to examine in detail its metric properties. A convenience sample of 283 patients with upper limb disorders was enrolled. The QuickDASH item responses were extracted from the subjects’ responses to the official full-length Italian version of DASH. Rating scale diagnostics showed disordered thresholds in some response categories, that were collapsed to optimize categorization. Exploratory factor analysis established unidimensionality of the QuickDASH, except for item 10 ‘tingling’. Similarly, QuickDASH items fitted the Rasch model (MnSq between 0.7 and 1.3) except for item 10, that showed an underfit (Infit MnSq = 1.62; Outfit MnSq = 2.01) and thus was deleted. The Rasch reliability indices of this 10-item QuickDASH were good but not excellent.

In conclusion, the unidimensionality of QuickDASH has not been confirmed. Item 10 ‘tingling’ did not belong to the dominant trait. Moreover, the number (and/or wording) of the QuickDASH response categories should undergo further investigation, and the QuickDASH seems more useful for group decisions than for everyday clinical application (i.e. monitoring outcome in single patients). Future studies should consider a QuickDASH revision, restarting from the full-length DASH.

Introduction

In 2005, a short measure of physical function and symptoms related to upper-limb musculoskeletal disorders (QuickDASH) was developed (Beaton et al., 2005), by reducing the full 30-item Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH) (Hudak et al., 1996). This 11-item QuickDASH was created to reduce respondent and administrative burden and eliminate item redundancy. Items for this shortened version were selected with the goal of retaining the key concepts outlined in the conceptual framework of the DASH (Beaton et al., 2005).

The DASH has been extensively studied, translated into many languages, and used in a broad variety of studies (Beaton et al., 2001, Bot et al., 2004, Roy et al., 2009). Recent studies have analyzed the psychometric properties of the QuickDASH by classical test theory (Gummesson et al., 2006, Imaeda et al., 2006, Fayad et al., 2009, Angst et al., 2009, Mintken et al., 2009). Among these papers, the validation studies of the Japanese (Imaeda et al., 2006) and French (Fayad et al., 2009) versions of the QuickDASH examined also its dimensionality, using principal component analysis. Recently, Gabel et al. (2009) noted that “the validity of the QuickDASH has been questioned as a consequence of conflicting findings on the factor structure” and proposed a new 9-item QuickDASH, obtained by deleting two original items.

To date, no study has made full use of the features available with a mix of classical test theory and Rasch analysis models to assess dimensionality and metric properties of the QuickDASH.

Rasch analysis is a statistical method for evaluating psychometric properties of a questionnaire that are not analyzed by classical test theory techniques, e.g. how well an item performs in terms of its relevance or usefulness for measuring the underlying construct, the amount of the construct targeted by each question, the possible redundancy of an item relative to other items in the scale, and the appropriateness of the response categories (Tesio, 2003, Bond and Fox, 2007, Wolfe and Smith, 2007).

Thus, Rasch analysis is being increasingly used in the development and evaluation of clinical tools for health care (Conrad and Smith, 2004).

The aim of this study was to perform a comprehensive psychometric analysis of the QuickDASH, using both classical test theory and Rasch analysis, in order to examine in detail its psychometric properties.

Section snippets

Patients

A convenience sample (recruited with a consecutive sampling method) of 283 patients - 157 men, 126 women; mean age 52.3 years (SD 15.9) - with upper limb disorders was recruited for the study. Subjects were both out- and in-patients referred to the Scientific Institute of Veruno for rehabilitation assessment and treatment.

Subjects aged 18 years and over who suffered from a musculoskeletal disorder of the upper extremity requiring physiotherapy and with a symptom duration of more than 2 months

Results

Only two out of 2618 responses (0.07%) were left blank by the respondents (one item each by two subjects). To allow Factor Analysis on the entire sample, data were imputed with the subject’s mean response. Median QuickDASH score (n = 283) was 43 (interquartile range: 25–58): in patients with fractures (n = 76) the median score was 48; in patients with surgery (n = 70) it was 50; in the remaining (n = 137) it was 34. Cronbach’s alpha for QuickDASH was 0.87. All items showed an item-to-total

Discussion

The ability of outcome measures to improve decision-making in clinical research relies heavily on their psychometric strength. The QuickDASH has been studied by classical psychometric assessments, but recently new and detailed approaches, including a mix of classical test theory and item response theory methods, have been recommended to provide reliability and validity estimates of a rating scale (Frost et al., 2007, Mokkink et al., 2010). This is the first study assessing the measurement

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