The Cross-cultural Adaptation of the Disabilities of the Arm, Shoulder and Hand (DASH) Patient-Reported Outcome Measure Into Bulgarian

Abstract

Objective: The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire is a well-recognized measure of upper limb function and symptoms. This patient-reported outcome measure (PRO) has been translated and culturally adapted into 50 different languages. To date, there is no PRO measure available in the Bulgarian language to measure outcomes for upper extremity pathology. The purpose of this study was to translate and culturally adapt the DASH questionnaire into Bulgarian. Methods: The process of translation and cross-cultural adaptation consisted of a 5-step process: forward translation into Bulgarian, synthesis of the Bulgarian translations, back translation into English, review and revision of the pre-final Bulgarian version, and pilot testing of the pre-final Bulgarian version. The pre-final version was given to 45 patients in order to perform a preliminary assessment of content validity and internal consistency. Results: Forty-five patients (35 males, 10 females) participated in the pilot testing of the Bulgarian DASH. All patients had posttraumatic or postsurgical conditions to the digits, thumb, or wrist. The completeness of item response was good, and individual question responses were well distributed (1-5) except for 1 question about the ability to manage transportation needs (1-3). The mean DASH score was 30.34 (SD: 18.51), with a range of 0 to 67.50. Internal consistency of the total score was high (Cronbach α = 0.948). Conclusions: This pilot assessment of the Bulgarian DASH demonstrates excellent internal consistency and good content validity when compared with similar studies of cross-cultural adaptation of the DASH questionnaire. A more thorough investigation into the reliability, validity, and responsiveness of the Bulgarian DASH is still needed.