DASH and QuickDASH: the 11-point threshold and its margin

Q: What does DASH stand for?

DASH stands for Disabilities of the Arm, Shoulder and Hand. The questionnaire was published in 1996 by Hudak, Amadio and Bombardier for the Upper Extremity Collaborative Group.

Q: How much change counts?

The pooled minimal important difference is 11.00 points for the DASH and 11.97 for the QuickDASH. The minimal detectable change is 10.81 and 12.85 points respectively.

Posted by

Anthony BAILLON

Physiotherapist

The DASH, short for Disabilities of the Arm, Shoulder and Hand, measures disability across the whole upper limb with 30 items, and its short form the QuickDASH with 11. The score runs from 0 to 100, a high score signalling high disability. The questionnaire and its calculation are right below.

DASH and QuickDASH, questionnaire and scoring

Pick the version, then answer each item. The score is calculated as you go, following the publisher's rule; the blank PDF form is there for paper administration.

Patient name

Date

Version used

This questionnaire asks about your symptoms as well as your ability to do certain activities. Please answer every question, based on your condition in the last week, by circling the appropriate number. If you did not do an activity in the last week, please give your best guess which response would be the most accurate. It doesn't matter which hand or arm you use to do the activity; please answer based on your ability regardless of how you do the task.

Please rate your ability to do the following activities in the last week by circling the number below the appropriate response.

1Open a tight or new jar

2Write

3Turn a key

4Prepare a meal.

5Push open a heavy door

6Place an object on a shelf above your head

7Do heavy household jobs (e.g. wash windows, clean floors)

8Garden or outdoor property work

9Make a bed

10Carry a shopping bag or briefcase

11Carry a heavy object (over 10 lbs/ 5kgs)

12Change a lightbulb overhead

13Wash or blow dry your hair

14Wash your back

15Put on a jumper

16Use a knife to cut food

17Recreational activities which require little effort (e.g. card playing, knitting, etc)

18Recreational activities which require you to take some force or impact through your arm, shoulder or hand (e.g. golf, hammering, tennis etc)

19Recreational activities in which you move your arm freely (e.g. playing Frisbee, badminton etc)

20Manage transport needs (getting from one place to another)

21Sexual activities

22During the past week, to what extent has your arm, shoulder or hand problem interfered with your normal social activities with family. friends, neighbours or groups? (circle number)

23During the past week, were you limited in your work or other regular daily activities as a result of your arm, shoulder or hand problem? (circle number)

Please rate the severity of the following symptoms in the last week (circle number)

24Arm, shoulder or hand pain

25Arm, shoulder or hand pain when you do any specific activity

26Tingling (pins and needles) in your arm, shoulder or hand

27Weakness in your arm, shoulder or hand

28Stiffness in your arm, shoulder or hand

29During the past week, how much difficulty have you had sleeping because of the pain in your arm, shoulder or hand? (circle number)

30I feel less capable, less confident or less useful because of my arm, shoulder or hand problem (circle number)

WORK MODULE (OPTIONAL)

The following questions ask about the impact of your arm, shoulder or hand problem on your ability to work (including home-making, if that is your main work role). Please indicate what your job / work is: ___________________________________________ I do not work (you may skip this section). Please circle the number that best describes your physical ability in the past week. Did you have any difficulty:

1Doing your work in your usual way?

2Doing your usual work because of arm, shoulder or hand pain?

3Doing your work as well as you would like?

4Spending your usual amount of time doing your work?

SPORTS/PERFORMING ARTS MODULE (OPTIONAL)

The following questions relate to the impact of your arm, shoulder or hand problem on playing either your musical instrument or sport or both. If you play more than one sport or instrument (or play both), please answer with respect to that activity which is most important to you. Please indicate the sport or instrument which is most important to you: _________________________________ I do not play a sport or an instrument. (You may skip this section). Please circle the number that best describes your physical ability in the past week. Did you have any difficulty:

1Playing your instrument or sport in your usual way?

2Playing your musical instrument or sport because of arm, shoulder or hand pain?

3Playing your instrument or sport as well as you would like?

4Spending your usual amount of time practising or playing your instrument or sport?

Please rate your ability to do the following activities in the last week by circling the number below the appropriate response.

1Open a tight or new jar

2Do heavy household jobs (e.g. wash windows, clean floors)

3Carry a shopping bag or briefcase

4Wash your back

5Use a knife to cut food

6Recreational activities which require you to take some force or impact through your arm, shoulder or hand (e.g. golf, hammering, tennis etc)

7During the past week, to what extent has your arm, shoulder or hand problem interfered with your normal social activities with family. friends, neighbours or groups? (circle number)

8During the past week, were you limited in your work or other regular daily activities as a result of your arm, shoulder or hand problem? (circle number)

Please rate the severity of the following symptoms in the last week (circle number)

9Arm, shoulder or hand pain

10Tingling (pins and needles) in your arm, shoulder or hand

11During the past week, how much difficulty have you had sleeping because of the pain in your arm, shoulder or hand? (circle number)

WORK MODULE (OPTIONAL)

The following questions ask about the impact of your arm, shoulder or hand problem on your ability to work (including home-making if that is your main work role). Please indicate what your job / work is: ______________________________________________________________ I do not work (you may skip this section). Please circle the number that best describes your physical ability in the past week.

1Doing your work in your usual way?

2Doing your usual work because of arm, shoulder or hand pain?

3Doing your work as well as you would like?

4Spending your usual amount of time doing your work?

SPORTS/PERFORMING ARTS MODULE (OPTIONAL)

The following questions relate to the impact of your arm, shoulder or hand problem on playing your musical instrument or sport or both. If you play more than one sport or instrument (or play both), please answer with respect to that activity which is most important to you. Please indicate the sport or instrument which is most important to you: __________________________________________ I do not play a sport or an instrument. (You may skip this section). Please circle the number that best describes your physical ability in the past week.

1Playing your instrument or sport in your usual way?

2Playing your musical instrument or sport because of arm, shoulder or hand pain?

3Playing your instrument or sport as well as you would like?

4Spending your usual amount of time practising or playing your instrument or sport?

Items reproduced from the official version provided online by the Institute for Work & Health, copyright holder of the DASH and the QuickDASH, for use by clinicians treating or assessing a patient. Any other use requires the publisher's written permission.

Previous score

optional, to compare against the minimal detectable change

Answer the items to get the score.

The minimal detectable change is 10.81 points for the DASH and 12.85 for the QuickDASH, while the pooled minimal important difference is 11.00: the two touch, and that is the whole point. The detail is below.

Figures taken from the studies listed at the end of this page, every value carrying its source where it is written. The questionnaire items are reproduced from the official version of the Institute for Work & Health, which holds their copyright.

Where to get the official questionnaire

The Institute for Work & Health, which holds the copyright of the DASH and the QuickDASH, provides their reference French version, known as the Parisian version, free of charge: the DASH as a PDF and the QuickDASH as a PDF. The original English versions and their scoring instructions are on the publisher's pages for the DASH and the QuickDASH.

That free use is limited to clinicians treating or assessing a patient, non-commercial researchers and not-for-profit users. Any other use requires advance written permission from the publisher, and the questionnaire must not be modified. The scorer above reproduces the items of that official version, without changing a word, and applies the publisher's scoring rule.

What the DASH measures

The DASH measures disability across the whole upper limb, and that is its stance. Where the SPADI looks at the shoulder and the PRTEE at the elbow, the DASH holds that the upper limb works as a unit: you do not comb your hair with a shoulder, you comb it with an arm.

That bet is testable, and it has been tested. In 200 patients assessed before treatment then 172 seen again at twelve weeks, the questionnaire behaves as well in shoulder disorders as in wrist and hand disorders. Its test-retest reliability, measured in 86 patients at three to five days, reaches ICC 0.96.

The score runs from 0 to 100 and reads in the direction of disability: the higher it is, the more impaired the patient. That is the opposite of most functional scales, and the first source of misreading in a set of notes.

DASH or QuickDASH

The QuickDASH keeps 11 items out of 30. Its construction was not casual: three item-reduction methods were compared, including Rasch modelling, in 407 patients, before the properties of the retained version were assessed in 200 more.

The result is good: internal consistency of at least 0.92 and reliability of at least 0.94. The short form therefore costs almost nothing in measurement quality.

It does cost in follow-up precision, and that is measurable: its minimal detectable change is larger, 12.85 points against 10.81. In other words, a bigger gap is needed before claiming something has moved. For close longitudinal follow-up, the full DASH remains the better choice.

The eleven-point threshold, and its narrow margin

Two numbers meet here, and how close they are is the most important point on this page.

The minimal detectable change, the gap below which two measurements cannot be told apart from noise, is 10.81 points for the DASH in 255 patients followed in physiotherapy. The minimal important difference, the one patients perceive as a genuine improvement, is 11.00 points according to a meta-analysis of 12 studies and 1,677 patients, with a confidence interval of 8.59 to 13.41 and zero heterogeneity.

Eleven points on one side, ten point eight on the other. The clinically useful threshold therefore sits barely above the measurement error of the tool. The practical consequence is clear: a gain of 11 points is interpretable, a gain of 7 is not, and there is no comfortable middle ground.

DASH and QuickDASH, number by number
What is measured	DASH	QuickDASH	Source
Number of items	30	11	1996 and 2005
Test-retest reliability	0.96	0.94 or above	200 then 407 patients
Internal consistency	n. r.	0.92 or above	QuickDASH publication
Minimal detectable change, 90%	10.81	12.85	255 physiotherapy patients
Minimal important difference, pooled	11.00	11.97	12 studies, 1,677 patients

What the score does not tell you

It does not say which part of the upper limb is involved. That is the exact flip side of its stance: a score of 45 does not distinguish a frozen shoulder from a painful hand, and two patients with the same score may have unrelated problems.

Nor does it say whether the disability is high. No validated cut-off separating levels appears in the sources retained here, and the categories seen in circulation were not verified against a source in this evidence base. The score reads as a change.

Finally, the 1996 original publication describes how the tool was built, not how it performs: the abstract gives no reliability or responsiveness value. Citing Hudak 1996 for an ICC would be a common attribution error.

Three administration pitfalls

Reading the score backwards

Zero means no disability and one hundred means maximal disability. A patient going from 60 to 30 is better. The habit of functional scales where high is good drives the opposite mistake, especially when rereading older notes.

Mixing the two versions

A DASH and a QuickDASH do not compare directly, and their change thresholds differ. The version goes in the notes next to the score, from the first administration.

Concluding below the threshold

A gain of 7 or 8 points feels good but stays within measurement noise. Announcing it as an established improvement means presenting uncertainty as a result.

Frequently asked questions

What does DASH stand for?

DASH stands for Disabilities of the Arm, Shoulder and Hand. The questionnaire was published in 1996 by Hudak, Amadio and Bombardier for the Upper Extremity Collaborative Group. The QuickDASH is its 11-item short form, published in 2005.

How is the DASH scored?

Each item is answered from 1 to 5. The score is the mean of the answers minus 1, multiplied by 25, which brings it to a 0 to 100 range, a high score signalling high disability. It is not calculated beyond 3 missing items out of 30, nor beyond one missing item out of the 11 of the QuickDASH: that is the publisher's rule, and the one the scorer applies.

How much change counts?

The pooled minimal important difference is 11.00 points for the DASH (95% CI 8.59 to 13.41) and 11.97 for the QuickDASH. The minimal detectable change is 10.81 and 12.85 points respectively: the two values touch.

Is there a French version?

Yes. The reference French cross-cultural adaptation is that of Dubert et al., 2001, credited by the Institute for Work & Health as the French Parisian version, tested in 223 patients.

Is the DASH free to use?

Not freely. Its copyright is the sole property of the Institute for Work & Health, which reserves all rights. Royalty-free use is conditional: clinicians treating or assessing a patient, non-commercial researchers, and not-for-profit users. For those uses, the publisher provides the official questionnaire free of charge, translations included. This page reproduces the questionnaire from that official version, for that clinical use, and refers to the publisher for any other use.

References

6 sources, PMIDs included

Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). Am J Ind Med 1996;29(6):602-8. PMID 8773720. The original DASH publication, for the Upper Extremity Collaborative Group. 13 existing scales reviewed, 821 items generated then reduced to 78. The abstract gives no psychometric value.
Beaton DE, Katz JN, Fossel AH, Wright JG, Tarasuk V, Bombardier C. Measuring the whole or the parts? Validity, reliability, and responsiveness of the DASH outcome measure in different regions of the upper extremity. J Hand Ther 2001;14(2):128-46. PMID 11382253. 200 patients assessed before treatment, 172 seen again at 12 weeks, 86 retested at 3 to 5 days. Reliability ICC 0.96, and the DASH behaves as well at the shoulder as at the wrist and hand.
Dubert T, Voche P, Dumontier C, Dinh A. Le questionnaire DASH. Adaptation française d'un outil d'évaluation international. Chir Main 2001;20(4):294-302. PMID 11582907. The reference French adaptation, the one the Institute for Work & Health credits as the French Parisian version. Five translations and two back-translations, tested in 223 patients.
Beaton DE, Wright JG, Katz JN; Upper Extremity Collaborative Group. Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am 2005;87(5):1038-46. PMID 15866967. The original QuickDASH publication. Item reduction in 407 patients, properties assessed in 200 more: internal consistency alpha of at least 0.92 and reliability ICC of at least 0.94.
Franchignoni F, Vercelli S, Giordano A, Sartorio F, Bravini E, Ferriero G. Minimal clinically important difference of the disabilities of the arm, shoulder and hand outcome measure (DASH) and its shortened version (QuickDASH). J Orthop Sports Phys Ther 2014;44(1):30-9. PMID 24175606. 255 patients before and after a physiotherapy programme. Minimal detectable change at 90% confidence: 10.81 points for the DASH and 12.85 points for the QuickDASH.
Galardini L, Coppari A, Pellicciari L, Ugolini A, Piscitelli D, La Porta F, Bravini E, Vercelli S. Minimal clinically important difference of the DASH and QuickDASH: a systematic review and meta-analysis. PMID 38438144. 12 studies and 1,677 patients, 17 estimates ranging from 8.3 to 18.0 points. Pooled minimal important differences: 11.00 points for the DASH (95% CI 8.59 to 13.41) and 11.97 for the QuickDASH, with zero heterogeneity.

Page written by Anthony Baillon, physiotherapist, co-founder of Physio Learning. The questionnaire itself is by Hudak, Amadio and Bombardier, 1996, and its copyright belongs to the Institute for Work & Health: this page reproduces it from its official version, for clinical use, and interprets it.

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Anthony Baillon

Physiotherapist · co-founder of Physio Learning

Marked for life by his first four-hour lecture without a single image, he took a master’s in instructional design so that it would never happen to anyone again. He hunts down publication bias and unreadable slides with the same intransigence.

PhysiotherapistInstructional designerCare design

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Physiotherapist specialising in neuro-musculoskeletal practice and holder of a master’s in public health. He checks the methodological rigour of every article: primary sources, levels of evidence, no exceptions.

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