Abstract
BackgroundPatient-reported outcome measures (PROMs) are important tools in both clinical practice and research. However, no upper extremity PROM to assess physical disability is available in Nepali. The most commonly used and recommended questionnaire for the shoulder is the Disability of Arm, Shoulder and Hand (DASH). Therefore, the aim of the study was to translate and cross-culturally adapt the DASH into Nepali and determine its measurement properties.MethodsThe translation and cultural adaptation process followed international standard procedures. The translated Nepali version of the questionnaire (DASH-NP) was completed by 156 patients with shoulder pain from three Nepali hospitals at an initial assessment and by 121 at follow-up. A Nepali version of Global Rating of Change (GROC-NP) was completed at follow-up to dichotomise improved and stable participants. Measurement properties testing included: internal consistency (Cronbach's alpha), test-retest reliability (Intraclass Correlation Coefficient, ICC), Minimal Detectable Change (MDC), construct validity - factor analysis, hypothesis testing with the Shoulder Pain and Disability Index (SPADI) (Pearson Correlation = r) and responsiveness - Area Under the Curve with minimal important change.ResultsSignificant adaptations such as changing measurement units, activities and terminology were incorporated to improve cultural relevance. Internal consistency (α = 0.92) and test-retest reliability (ICC = 0.97, 95% CI: 0.94–0.98, p < 0.001) were excellent. The MDC was 11 out of 100 points. There were moderate-high positive correlations with the SPADI pain and disability items (rs = 0.63 and 0.81, P < 0.001). Four factor solution was retrieved for the DASH-NP. The Area Under the Curve was 0.69 (95% CI: 0.57 - 0.81, p < 0.001) with minimal important change of 11.2/100 points.ConclusionsThe Nepali translation of the DASH is comprehensible, easy to administer via self-report or interview. It is found to be a reliable, valid, and responsive measure in patients with shoulder pain in Nepal. The DASH-NP can be used to assess shoulder pain related disability in Nepal for clinical practice or research.
Highlights
Shoulder pain is a common musculoskeletal complaint, with lifetime prevalence in developed nations of up to 67% [1]
Approval to translate was obtained from the original developers and the translation was completed in close collaboration with them
The participants were engaged in the following occupations; business owner (18%), agriculture (11%), office worker (7%), students (4%) and other - including home duties (60%)
Summary
Shoulder pain is a common musculoskeletal complaint, with lifetime prevalence in developed nations of up to 67% [1]. The DASH is a reliable and valid tool for the assessment of shoulder pain and disability both in clinical practice and research [6], and is reported to have among the best psychometric properties of all upper limb PROMs [4, 5, 7]. It is the preferred PROM if a variety of shoulder conditions and social and emotional function are to be assessed [5]. The aim of the study was to translate and cross-culturally adapt the DASH into Nepali and determine its measurement properties
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