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 interpreter is right below.
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. No item is reproduced: the copyright belongs to the Institute for Work & Health.
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.
| 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.
Why this page does not display the questionnaire
The copyright of the DASH and the QuickDASH is the sole property of the Institute for Work & Health, which reserves all rights. Royalty-free use does exist, but it is conditional: clinicians treating or assessing a patient, non-commercial researchers, not-for-profit users. Neither the items, nor the response options, nor the scoring instructions are reproduced here. The questionnaire and its manual are obtained from the publisher.
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?
The final score runs from 0 to 100, a high score signalling high disability. The scoring instructions belong to the Institute for Work & Health and are not reproduced here: they are in the official manual of the instrument.
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. That is why this page reproduces none of its items.
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 documents and interprets it, it reproduces none of its items.