/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/questionnaires/,

/clinical/cckm-tools/content/questionnaires/name-97252-en.cckm

201605147

page

100

UWHC,UWMF,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Questionnaires

DASH Questionnaire

DASH Questionnaire - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Questionnaires


DISABILITIES OF THE ARM, SHOULDER AND HAND
DASH
INSTRUCTIONS
This questionnaire asks about your
symptoms as well as your ability to
perform certain activities.
Please answer every question, based
on your condition in the last week,
by circling the appropriate number.
If you did not have the opportunity
to perform an activity in the past
week, please make your best estimate
on which response would be the most
accurate.
It doesn’t matter which hand or arm
you use to perform the activity; please
answer based on your ability regardless
of how you perform the task.
THE


Please rate your ability to do the following activities in the last week by circling the number below the appropriate response.
NO MILD MODERATE SEVERE
UNABLE
DIFFICULTY DIFFICULTY DIFFICULTY DIFFICULTY
1. Open a tight or new jar. 12345
2. Write. 12345
3. Turn a key. 12345
4. Prepare a meal. 12345
5. Push open a heavy door. 1 2 345
6. Place an object on a shelf above your head. 12345
7. Do heavy household chores (e.g., wash walls, wash floors). 12345
8. Garden or do yard work. 12345
9. Make a bed. 1 2 3 45
10. Carry a shopping bag or briefcase. 1 2 3 4 5
11. Carry a heavy object (over 10 lbs). 12345
12. Change a lightbulb overhead. 12345
13. Wash or blow dry your hair. 12345
14. Wash your back. 1 2 345
15. Put on a pullover sweater. 12345
16. Use a knife to cut food. 12345
17. Recreational activities which require little effort
(e.g., cardplaying, knitting, etc.). 12345
18. Recreational activities in which you take some force
or impact through your arm, shoulder or hand
(e.g., golf, hammering, tennis, etc.). 12345
19. Recreational activities in which you move your
arm freely (e.g., playing frisbee, badminton, etc.). 12345
20. Manage transportation needs
(getting from one place to another). 1 23 45
21. Sexual activities. 12345
DISABILITIES OF THE ARM, SHOULDER AND HAND

NOT AT ALL SLIGHTLY MODERATELY
QUITE
EXTREMELY
A BIT
22. During 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) 12345
NOT LIMITED SLIGHTLY MODERATELY VERY
UNABLE
AT ALL LIMITED LIMITED LIMITED
23. During 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) 12345
Please rate the severity of the following symptoms in the last week. (circle number)
NONE MILD MODERATE SEVERE EXTREME
24. Arm, shoulder or hand pain. 12345
25. Arm, shoulder or hand pain when you
performed any specific activity. 12345
26. Tingling (pins and needles) in your arm, shoulder or hand. 12345
27. Weakness in your arm, shoulder or hand. 1 2 345
28. Stiffness in your arm, shoulder or hand. 1 2 3 4 5
NO MILD MODERATE SEVERE
SO MUCH
DIFFICULTY DIFFICULTY DIFFICULTY DIFFICULTY
DIFFICULTY
THAT I
CAN’T SLEEP
29. During the past week, how much difficulty have you had
sleeping because of the pain in your arm, shoulder or hand?
(circle number) 12345
STRONGLY NEITHER AGREE STRONGLY
DISAGREE
DISAGREE
NOR DISAGREE
AGREE
AGREE
30. I feel less capable, less confident or less useful
because of my arm, shoulder or hand problem.
(circle number) 12345
DISABILITIES OF THE ARM, SHOULDER AND HAND
A DASH score may not be calculated if there are greater than 3 missing items.
DASH DISABILITY/SYMPTOM SCORE = [(sum of n responses) - 1] x 25, where n is equal to the number of completed responses.
n

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: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
p
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:
NO MILD MODERATE SEVERE
UNABLE
DIFFICULTY DIFFICULTY DIFFICULTY DIFFICULTY
1. using your usual technique for your work? 123 45
2. doing your usual work because of arm,
shoulder or hand pain? 123 45
3. doing your work as well as you would like? 123 45
4. spending your usual amount of time doing your work? 1 2 3 45
DISABILITIES OF THE ARM, SHOULDER AND HAND
© INSTITUTE FOR WORK & HEALTH 2006. ALL RIGHTS RESERVED.
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: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
o 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:
NO MILD MODERATE SEVERE
UNABLE
DIFFICULTY DIFFICULTY DIFFICULTY DIFFICULTY
1. using your usual technique for playing your
instrument or sport? 123 45
2. playing your musical instrument or sport because
of arm, shoulder or hand pain? 1 2 3 4 5
3. playing your musical instrument or sport
as well as you would like? 123 45
4. spending your usual amount of time
practising or playing your instrument or sport? 1 23 45
SCORING THE OPTIONAL MODULES: Add up assigned values for each response;
divide by 4 (number of items); subtract 1; multiply by 25.
An optional module score may not be calculated if there are any missing items.