The critical difference in the DASH (Disabilities of the Arm, Shoulder, and Hand) outcome measure after essential upper extremity tumor surgery Journal Article


Authors: Ogura, K.; Yakoub, M. A.; Christ, A. B.; Fujiwara, T.; Nikolic, Z.; Boland, P. J.; Athanasian, E. A.; Healey, J. H.
Article Title: The critical difference in the DASH (Disabilities of the Arm, Shoulder, and Hand) outcome measure after essential upper extremity tumor surgery
Abstract: Background: The DASH (Disabilities of the Arm, Shoulder, and Hand) is a scored questionnaire that is widely used to evaluate the health-related quality of life of patients with upper limb musculoskeletal disorders. However, numerical changes in the measure scores lack clinical significance without meaningful threshold change values of outcome measures that are diagnostically specific. The minimal clinically important difference (MCID) is useful for the interpretation of scores by defining the smallest change that a patient would perceive. However, the MCIDs of the scores in orthopedic oncology patients has not been reported. We aimed to determine the MCIDs of the measure in orthopedic oncology patients. Methods: Data from our health-related quality of life database from 1999 to 2005 were retrospectively reviewed after institutional review board approval. Seventy-eight patients who underwent surgery and completed 2 surveys during postoperative follow-up were evaluated. Two different methods were used to estimate the MCIDs: distribution-based and anchor-based approaches (the latter used receiver operating characteristic analysis). Results: Using distribution-based methods, the MCIDs of the DASH questionnaire were 7.4 and 8.3 by half standard deviation and the 90% interval of minimal detectable change, respectively. By anchor-based method (receiver operating characteristic analysis), the MCID was 8.3. Conclusion: The MCID values calculated by each method validates that the results for upper extremity oncology patients were similar to those reported in other orthopedic conditions. These results identify the threshold for meaningful improvements in DASH scores in orthopedic oncology patients and establish the reference to evaluate health-related quality of life and the outcomes of upper extremity oncology surgery. These data should be further refined for disease- and reconstruction-specific analyses. © 2021 Journal of Shoulder and Elbow Surgery Board of Trustees
Keywords: quality of life; sarcoma; patient-reported outcome measures; upper extremity; surveys and questionnaires; minimal clinically important difference; basic science study; dash; modems; validation of outcome instrument
Journal Title: Journal of Shoulder and Elbow Surgery
Volume: 30
Issue: 9
ISSN: 1058-2746
Publisher: Elsevier Inc.  
Date Published: 2021-09-01
Start Page: e602
End Page: e609
Language: English
DOI: 10.1016/j.jse.2020.11.027
PUBMED: 33484830
PROVIDER: scopus
PMCID: PMC8289920
DOI/URL:
Notes: Article -- Export Date: 1 September 2021 -- Source: Scopus
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MSK Authors
  1. Patrick J Boland
    150 Boland
  2. John H Healey
    480 Healey
  3. Alexander Bryant Christ
    7 Christ
  4. Koichi Ogura
    11 Ogura
  5. Mohamed Ahmed Ali Yakoub
    8 Yakoub