Abstract
PurposeThis study aimed to evaluate and improve the accuracy and efficiency of the QuickDASH for use in assessment of limb function in patients with upper extremity lymphedema using modern psychometric techniques.MethodWe conducted confirmative factor analysis (CFA) and Mokken analysis to examine the assumption of unidimensionality for IRT model on data from 285 patients who completed the QuickDASH, and then fit the data to Samejima’s graded response model (GRM) and assessed the assumption of local independence of items and calibrated the item responses for CAT simulation.ResultsInitial CFA and Mokken analyses demonstrated good scalability of items and unidimensionality. However, the local independence of items assumption was violated between items 9 (severity of pain) and 11 (sleeping difficulty due to pain) (Yen’s Q3 = 0.46) and disordered thresholds were evident for item 5 (cutting food). After addressing these breaches of assumptions, the re-analyzed GRM with the remaining 10 items achieved an improved fit. Simulation of CAT administration demonstrated a high correlation between scores on the CAT and the QuickDash (r = 0.98). Items 2 (doing heavy chores) and 8 (limiting work or daily activities) were the most frequently used. The correlation among factor scores derived from the QuickDASH version with 11 items and the Ultra-QuickDASH version with items 2 and 8 was as high as 0.91.ConclusionBy administering just these two best performing QuickDash items we can obtain estimates that are very similar to those obtained from the full-length QuickDash without the need for CAT technology.
Highlights
The disabilities of the arm, shoulder, and hand (DASH) outcome measure is a widely used patient-reported outcome measure (PROM) assessing different disorders of the upper limb as well as the extent of impairments [1].The shortened version of the DASH named the QuickDASH (Online Appendix A), was developed in 2005 and comprises 11 items from the original 30-item DASH while still maintaining a strong correlation with the original DASH scores [2,3,4,5]
As unidimensionality and scalability assumptions for the item response theory (IRT) model were met through confirmative factor analysis (CFA) and Mokken analyses, and no differential item function (DIF) items were detected in the groups of adults and older adults (≥ 65), the graded response model (GRM) based on the IRT framework was conducted using all 11 items
We showed that the QuickDASH could be made to fit the IRT model, with minor modification, for evaluation of limb function in patients with upper extremity lymphedema
Summary
The disabilities of the arm, shoulder, and hand (DASH) outcome measure is a widely used patient-reported outcome measure (PROM) assessing different disorders of the upper limb as well as the extent of impairments [1].The shortened version of the DASH named the QuickDASH (Online Appendix A), was developed in 2005 and comprises 11 items from the original 30-item DASH while still maintaining a strong correlation with the original DASH scores [2,3,4,5]. The disabilities of the arm, shoulder, and hand (DASH) outcome measure is a widely used patient-reported outcome measure (PROM) assessing different disorders of the upper limb as well as the extent of impairments [1]. Assessment using the QuickDASH takes about five minutes [6]. The use of the DASH is established for upper extremity lymphedema evaluation. As upper extremity functioning and related activities are undoubtedly affected by the presence of lymphedema relating breast cancer treatment [9]. Compared to women without breast cancer related lymphedema, women with lymphedema have greater upper limb impairment and more movement restrictions [10]. As a measure of upper limb function, the DASH PROM has been used to measure the effect of lymphedema treatment,
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