Standardized questionnaires, known as patient-reported outcome measures (PROMs), provide a consistent way to measure a patient’s physical well-being from their own perspective. PROMs help doctors and therapists understand how a condition impacts daily life, moving beyond simple physical examination findings. This approach is valuable for conditions affecting the limbs, where function and symptoms vary greatly. This article focuses on the Disabilities of the Arm, Shoulder, and Hand (DASH) Outcome Measure, a tool that provides a numerical score for upper extremity function.
Defining the DASH Outcome Measure
The Disabilities of the Arm, Shoulder, and Hand (DASH) Outcome Measure is a 30-item self-report questionnaire. It assesses the symptoms and physical function of the entire upper limb. It is widely used by physical therapists, occupational therapists, and orthopedic surgeons to evaluate musculoskeletal disorders. The questionnaire helps describe the severity of a patient’s disability and monitors changes in function over time.
The standard DASH covers a range of daily activities, such as turning a key, opening a jar, or using a computer. It also includes questions about symptoms like pain, tingling, and stiffness. Patients rate their difficulty or severity on a five-point scale for each of the 30 items.
The DASH also includes two optional, four-item modules scored separately from the main questionnaire. These modules measure symptoms and function for activities requiring high physical performance, such as work or playing a musical instrument or sport. They help address the unique demands placed on the upper limb by certain professions or hobbies.
How the Score is Calculated
The DASH score converts the patient’s subjective responses into a single, standardized number ranging from 0 to 100. Each of the 30 core items is rated on a scale of 1 (no difficulty/symptom) to 5 (inability to perform/most severe symptom).
To calculate the final score, the assigned values for all completed responses are summed and averaged. This average is then mathematically transformed using a formula that scales the result to 100. This transformation ensures the final score is comparable to other common 0-to-100 outcome measures.
A higher raw score, representing more difficulty and severe symptoms, translates directly to a higher final DASH score. For the final score to be calculated, a patient must complete at least 27 of the 30 core items. The optional work and sports modules use the same calculation method but require all four items to be answered.
Interpreting the Score: What is “Normal”?
The 0-to-100 scale provides a direct interpretation of the level of disability. A score of 0 represents perfect, unrestricted function with no symptoms, making it the ideal “normal” score. Conversely, a score of 100 indicates the most severe functional impairment possible.
In a healthy, non-clinical population of employed adults, the average DASH score is low, often reported around 13 points. This suggests that even healthy individuals may report minimal difficulty or mild, intermittent symptoms. Scores below 20 represent a minimal impact on function and are often seen in patients nearing discharge from therapy or returning to full activity.
Scores between 40 and 69 suggest the patient is experiencing significant functional limitations and difficulty with upper limb function. Scores above 50 often represent severe disability and are seen in the acute phase following a major injury or surgery. The interpretation of any score is always specific to the patient, as a 30-point score impacts a concert pianist differently than someone with a sedentary job.
The optional modules are also scored on the 0-to-100 scale, providing a separate measure of high-demand activities. A patient might score well on the core DASH but have a high score on the sports module, indicating difficulty specific to high-performance tasks. These optional scores should be considered alongside the main DASH score for a complete functional picture.
Tracking Progress: Understanding Meaningful Change
A single DASH score is a snapshot; its greatest value is comparing scores over a period of rehabilitation or recovery. Clinicians use two specific concepts to determine if a score change is truly meaningful and not just random variation. The first is the Minimal Detectable Change (MDC), which is the smallest change in the score considered a true change beyond measurement error.
The MDC for the DASH score is often cited around 10 to 13 points. A change less than this amount may not represent a real difference in the patient’s status. The second measure is the Minimal Clinically Important Difference (MCID).
The MCID is the smallest change in score that a patient actually perceives as beneficial or important to their daily life. Research suggests the MCID typically falls between 10 and 15 points. If a patient’s score decreases by 10 points or more after therapy, they will likely report a noticeable improvement in function. This focus on change helps both patient and provider understand the trajectory of recovery.