Abstract
Franchignoni F, Giordano A, Sartorio F, Vercelli S, Pascariello B, Ferriero G. Suggestions
for refinement of the Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH):
a factor analysis and Rasch validation study.
Objective
To perform a comprehensive psychometric analysis of Disabilities of the Arm, Shoulder
and Hand (DASH) to examine its properties and provide insights for an improved version.
Design
Methodologic research on cross-sectional data from a convenience sample.
Setting
A free-standing rehabilitation center.
Participants
Outpatients and inpatients (N=238; 56% men; mean age, 52.2y) with upper-extremity
musculoskeletal disorders.
Main Outcome Measure
The official Italian version of DASH was analyzed by factor (both explorative and
confirmatory) and Rasch analysis for evaluating dimensionality, functioning of rating
scale categories, item fit, hierarchy of item difficulties, and reliability indices.
Interventions
Not applicable.
Results
Factor analysis established the presence of 3 underlying constructs related to manual
functioning (items 1–5, 7–11, 16–18, 20, 21), shoulder range of motion (items 6, 12–15,
19), and symptoms and consequences (items 22–30). Rating scale diagnostics showed
category malfunctioning. The fit to the Rasch model was good for all items except
4 (items 20, 21, 25, 26). Ten item pairs had high residual correlations after subtraction
of the Rasch dimension (local dependency). A test model based on the 3 subscales suggested
by factor analysis and corrected categories still showed misfitting in items 21 (“Sexual
Activities”) and 26 (“Tingling”) and the presence of some dependent items.
Conclusions
Unidimensionality and the key domains identified by the original developers as the
theoretic framework of DASH were not confirmed by our analyses. The response categories
showed misfunctioning. “Sexual Activities” and “Tingling” misfit the Rasch model.
Further detailed investigations of DASH are warranted, both to confirm these results
in different health conditions and cultures, and to reanalyze in-depth content validity
issues regarding the questionnaire.
Key Words
List of Abbreviations:
CFA (confirmatory factor analysis), CFI (Comparative Fit Index), DASH (Disabilities of the Arm, Shoulder and Hand), EFA (exploratory factor analysis), IRT (item response theory), MnSq (mean-square statistics), RA (Rasch analysis), RMSEA (root mean square error of approximation), SRMR (standardized root mean square residual), TLI (Tucker-Lewis Index)To read this article in full you will need to make a payment
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© 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
