The Validity and Clinical Utility of the Disability of the Arm, Shoulder and Hand (DASH) Questionnaire for Upper Limb Injuries in Developing Country Contexts

Abstract

Objective: South Africa is a developing country with inequality and diversity in terms of culture, language and occupations. The high incidence of violence and trauma contributes to upper limb injuries. Patient rated outcome measures, such as the Disability of the Arm Shoulder and Hand Questionnaire (DASH), should be routinely implemented in order to evaluate the end result of intervention. Specific outcomes of interest are aspects of activity and participation according to the nine domains outlined in the International Classification of Functioning Disability and Health (ICF). This paper will review the evidence available on the validity and clinical utility of the DASH as a measure of activity and participation in patients with upper limb injuries in developing country contexts where inequality exists. Methods: A comprehensive search of key electronic databases, including MEDLINE (PubMed), EBSCOHost, CINAHL, Science Direct, Scopus and Web of Science, will be conducted. Grey literature will also be considered as far as possible. Articles meeting the following inclusion criteria will be included in the review: 1) reporting on the use of the DASH as an outcome measure for upper limb injured patients; 2) from countries with a Gini coefficient of 0.50 and above and; 3) that provide evidence on the validity and clinical utility of the instrument. The methodological quality of selected studies will be independently assessed by two researchers using the critical appraisal tool developed by the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) group. Results: Results will be reported by means of a study flow diagram showing the search strategy. Study characteristics will be summarized including psychometric properties assessed and results. Risk of bias will be assessed and reported using the COSMIN criteria. Conclusion: This review will provide a critical analysis of the psychometric properties of validity and clinical utility of the DASH in traumatic hand injuries assessed in developing countries. Recommendations for practice and future research will be made.