Baltzer Heather, Novak Christine B, McCabe Steven J
University of Toronto Hand and Upper Extremity Program, Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada.
University of Toronto Hand and Upper Extremity Program, Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada.
J Hand Surg Am. 2014 Dec;39(12):2472-80. doi: 10.1016/j.jhsa.2014.07.050. Epub 2014 Sep 13.
To evaluate the variability of reported baseline Disabilities of the Arm, Shoulder, and Hand (DASH) scores for non-acute hand and wrist conditions. We hypothesized that DASH scores for evaluation of hand and wrist pathology would provide a map of scores that would correspond to severity. In addition to providing a catalog of DASH scores for various upper extremity pathologies, we hypothesized that this review would support the validity of the DASH instrument.
A literature search was performed using 3 databases (MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials) from the earliest available date through January 1, 2013. Search terms included "DASH" and "hand" and combinations of conditions found in the initial search. The search was restricted to studies with baseline DASH scores and DASH scores for isolated conditions, and written in the English language.
Our search identified 1,770 citations; 136 full-text articles were reviewed and 85 studies were included in the scoping review. This provided 100 DASH scores mapped for 24 different diagnoses. Most articles (67%) included chronic conditions for inflammatory or degenerative pathologies rather than posttraumatic disorders. Posttraumatic DASH score reporting ranged from 4 months to 11 years after injury, and final outcome scores varied among studies assessing the same pathology. The greatest variation and highest scores were for de Quervain tendinitis (range, 29-93) and scapholunate advance collapse (range, 17-89). These scores indicated higher disability in de Quervain tendinitis and wrist osteoarthritis compared with conditions such as thumb amputation and upper extremity replantation.
Substantial variation in the DASH scores and methodology was found and indicates a need for further study of the DASH to allow for standardized interpretation.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
评估报告的非急性手部和腕部疾病的基线手臂、肩部和手部功能障碍（DASH）评分的变异性。我们假设用于评估手部和腕部病理状况的DASH评分将提供一个与严重程度相对应的评分图谱。除了提供各种上肢病理状况的DASH评分目录外，我们还假设本综述将支持DASH工具的有效性。
使用3个数据库（MEDLINE、EMBASE和Cochrane对照试验中央注册库）进行文献检索，检索时间从最早可用日期至2013年1月1日。检索词包括“DASH”和“手”以及在初始检索中发现的疾病组合。检索仅限于具有基线DASH评分和孤立疾病DASH评分且以英语撰写的研究。
我们的检索共识别出1770条引文；对136篇全文文章进行了综述，85项研究纳入了范围综述。这提供了针对24种不同诊断的100个DASH评分。大多数文章（67%）纳入了炎症性或退行性病理的慢性疾病，而非创伤后疾病。创伤后DASH评分报告的时间范围为受伤后4个月至11年，在评估相同病理状况时，最终结果评分在不同研究中有所不同。变异最大且评分最高的是桡骨茎突狭窄性腱鞘炎（范围为29 - 93）和舟月骨进展性塌陷（范围为17 - 89）。与拇指截肢和上肢再植等情况相比，这些评分表明桡骨茎突狭窄性腱鞘炎和腕关节骨关节炎的残疾程度更高。
发现DASH评分和方法存在显著差异，这表明需要对DASH进行进一步研究以实现标准化解读。
研究类型/证据水平：治疗性III级。
