Beaton Dorcas E, Wright James G, Katz Jeffrey N
Institute for Work and Health, 481 University Avenue, Suite 800, Toronto, ON M5G 2E9, Canada.
J Bone Joint Surg Am. 2005 May;87(5):1038-46. doi: 10.2106/JBJS.D.02060.
The purpose of this study was to develop a short, reliable, and valid measure of physical function and symptoms related to upper-limb musculoskeletal disorders by shortening the full, thirty-item DASH (Disabilities of the Arm, Shoulder and Hand) Outcome Measure.
Three item-reduction techniques were used on the cross-sectional field-testing data derived from a study of 407 patients with various upper-limb conditions. These techniques were the concept-retention method, the equidiscriminative item-total correlation, and the item response theory (Rasch modeling). Three eleven-item scales were created. Data from a longitudinal cohort study in which the DASH questionnaire was administered to 200 patients with shoulder and wrist/hand disorders were then used to assess the reliability (Cronbach alpha and test-retest reliability) and validity (cross-sectional and longitudinal construct) of the three scales. Results were compared with those derived with the full DASH.
The three versions were comparable with regard to their measurement properties. All had a Cronbach alpha of > or = 0.92 and an intraclass correlation coefficient of > or = 0.94. Evidence of construct validity was established (r > or = 0.64 with single-item indices of pain and function). The concept-retention method, the most subjective of the approaches to item reduction, ranked highest in terms of its similarity to the original DASH.
The concept-retention version is named the QuickDASH. It contains eleven items and is similar with regard to scores and properties to the full DASH. A comparison of item-reduction approaches suggested that the retention of clinically sensible and important content produced a comparable, if not slightly better, instrument than did more statistically driven approaches.
本研究的目的是通过缩短完整的、包含30个条目的上肢功能障碍评定量表（DASH，即手臂、肩部和手部功能障碍评定量表），开发一种简短、可靠且有效的与上肢肌肉骨骼疾病相关的身体功能和症状测量工具。
对来自407例患有各种上肢疾病患者的横断面现场测试数据采用了三种条目缩减技术。这些技术分别是概念保留法、等区分度条目-总分相关法和条目反应理论（拉施模型）。创建了三个包含11个条目的量表。随后，将DASH问卷应用于200例肩部和手腕/手部疾病患者的纵向队列研究数据，用于评估这三个量表的信度（克朗巴赫α系数和重测信度）和效度（横断面和纵向结构效度）。将结果与完整DASH量表得出的结果进行比较。
这三个版本在测量特性方面具有可比性。所有版本的克朗巴赫α系数均≥0.92，组内相关系数均≥0.94。确立了结构效度的证据（与疼痛和功能的单项指标的相关系数r≥0.64）。概念保留法是条目缩减方法中最主观的一种，在与原始DASH量表的相似性方面排名最高。
概念保留版本被命名为快速DASH量表。它包含11个条目，在得分和特性方面与完整DASH量表相似。对条目缩减方法的比较表明，保留具有临床意义和重要的内容所产生的工具即使不比更多基于统计学方法得出的工具稍好，至少也是相当的。
