Validation of the QuickDASH and DASH in Patients With Distal Radius Fractures Through Agreement Analysis

OBJECTIVE: To examine the agreement of scores between the Disabilities of the Arm, Shoulder and Hand (DASH) and QuickDASH questionnaires in patients with distal radius fractures (DRFs) and their score's concurrent validity with Patient-Rated Wrist Evaluation (PRWE) scores. DESIGN: Validity study. SETTING: Hand and upper limb clinic. PARTICIPANTS: Patients with DRFs (N=177) aged >18 years were included in this study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Measurements of the DASH, QuickDASH, and PRWE were taken at baseline and 1-year follow-up. QuickDASH scores were extracted from the DASH scores. Agreement analysis of the DASH and QuickDASH were evaluated using Bland-Altman technique. Item difficulty analysis was performed to examine the distribution of QuickDASH items among DASH items. Responsiveness of the DASH, QuickDASH, and PRWE were also evaluated by calculating standardized response means. RESULTS: QuickDASH scores were higher than DASH scores, particularly at baseline. A mean difference of 3.8 and 1.2 points were observed at baseline and 1-year follow-up, respectively. The limits of agreement were wide at baseline, with a range of 24.8 points at baseline, but decreased to 12.5 points at 1-year follow-up. Item difficulty analysis revealed that QuickDASH items were not evenly distributed at baseline. Finally, the responsiveness of the DASH, QuickDASH, and PRWE were similar from baseline to 1-year follow-up (standardized response mean of 2.13, 2.17, and 2.19, respectively). CONCLUSIONS: When changing from the DASH to the QuickDASH in the context of DRF, a systematic bias of higher scores on the QuickDASH should be considered by the user. However, the QuickDASH still demonstrated good concurrent validity and responsiveness.