Covarrubias Oscar, Agaisse Ty, Portnoff Brandon, Hoffman Ryan, Molino Janine, Paxton E Scott, Green Andrew
Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Alpert Medical School, Brown University. Providence, Rhode Island.
Alpert Medical School, Brown University, Providence, Rhode Island.
J Bone Joint Surg Am. 2024 Dec 4;106(23):2187-2195. doi: 10.2106/JBJS.23.01288. Epub 2024 Oct 2.
The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and its abbreviated version, QuickDASH, are commonly used patient-reported outcome measures (PROMs) for the assessment of an upper-extremity disability. Theoretically, they can be used to compare the treatment outcomes of different upper-extremity conditions. Despite increasingly widespread use for some shoulder conditions, these questionnaires have not been rigorously validated for use to assess the outcomes of patients undergoing anatomic total shoulder arthroplasty (aTSA). The objective of this study was to validate the DASH and QuickDASH scores for a longitudinal outcome assessment of patients undergoing aTSA to treat advanced glenohumeral osteoarthritis (GHOA).
In this study, 450 patients with a median age of 70.3 years (interquartile range [IQR] width, 11.7 years) were included; 52.4% of the patients were female. The DASH and QuickDASH questionnaires, the American Shoulder and Elbow Surgeons (ASES) score, the Simple Shoulder Test (SST), and the EuroQol-5 Dimensions (EQ-5D) questionnaire were completed preoperatively and at follow-ups of 3 months, 6 to 12 months, and a minimum of 2 years by patients undergoing aTSA. The criterion validity, construct validity, reliability, and responsiveness of the DASH and QuickDASH were assessed.
The DASH and QuickDASH scores demonstrated moderate to very strong correlations with the ASES scores (ρ = -0.83 to -0.62), SST scores (ρ = -0.73 to -0.55), and EQ-5D scores (ρ = -0.72 to -0.57); minimal floor or ceiling effects; internal consistency (Cronbach alpha > 0.80); and large Cohen d and standardized response means (<1.6) at all time points. Very strong positive correlations were observed between the DASH and QuickDASH scores at all time points (ρ = 0.96 to 0.97).
The DASH and QuickDASH scores, which are region-specific rather than shoulder-specific, are valid, reliable, and responsive PROMs for the evaluation of patients with advanced GHOA treated with aTSA. Therefore, the DASH and QuickDASH scores can be used to compare the outcomes of aTSA for the treatment of advanced GHOA with the outcomes of treatment of other upper-extremity disorders, potentially facilitating comparative cost-effectiveness and value analysis studies.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
上肢、肩部和手部功能障碍（DASH）问卷及其简化版QuickDASH是常用的患者报告结局指标（PROMs），用于评估上肢残疾情况。理论上，它们可用于比较不同上肢疾病的治疗效果。尽管在某些肩部疾病中使用越来越广泛，但这些问卷尚未经过严格验证以用于评估接受解剖型全肩关节置换术（aTSA）患者的结局。本研究的目的是验证DASH和QuickDASH评分，用于对接受aTSA治疗晚期盂肱关节骨关节炎（GHOA）患者进行纵向结局评估。
本研究纳入了450例患者，中位年龄为70.3岁（四分位间距[IQR]宽度为11.7岁）；52.4%的患者为女性。接受aTSA的患者在术前以及术后3个月、6至12个月和至少2年的随访时完成DASH和QuickDASH问卷、美国肩肘外科医师（ASES）评分、简易肩关节测试（SST）以及欧洲五维健康量表（EQ-5D）问卷。评估了DASH和QuickDASH的效标效度、结构效度、信度和反应度。
DASH和QuickDASH评分与ASES评分（ρ = -0.83至-0.62）、SST评分（ρ = -0.73至-0.55）和EQ-5D评分（ρ = -0.72至-0.57）显示出中度至非常强的相关性；最小的地板效应或天花板效应；内部一致性（Cronbach α>0.80）；以及在所有时间点均有较大的Cohen d和标准化反应均值（<1.6）。在所有时间点，DASH和QuickDASH评分之间均观察到非常强的正相关性（ρ = 0.96至0.97）。
DASH和QuickDASH评分是针对特定区域而非特定肩部的，是评估接受aTSA治疗的晚期GHOA患者的有效、可靠且有反应性的PROMs。因此，DASH和QuickDASH评分可用于比较aTSA治疗晚期GHOA的效果与其他上肢疾病的治疗效果，可能有助于进行比较成本效益和价值分析研究。
预后水平III。有关证据水平的完整描述，请参阅作者指南。
