Psychometric properties of the Disability of Arm Shoulder and Hand (DASH) in subjects with frozen shoulder: a reliability and validity study

Fabrizio Brindisino; Davide Venturin; Matteo Bartoli; Serena Caselli; Leonardo Pellicciari; Antonio Poser

doi:10.1186/s12891-024-07371-8

Psychometric properties of the Disability of Arm Shoulder and Hand (DASH) in subjects with frozen shoulder: a reliability and validity study

BMC Musculoskelet Disord. 2024 Apr 2;25(1):260. doi: 10.1186/s12891-024-07371-8.

Authors

Fabrizio Brindisino¹, Davide Venturin¹, Matteo Bartoli², Serena Caselli³, Leonardo Pellicciari⁴, Antonio Poser^{5

6}

Affiliations

¹ Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise c/o Cardarelli Hospital, C/da Tappino, Campobasso, 86100, Italy.
² Physiotherapy private practice KinesiLab, via Marcantonio Colonna 88, Marino, Italy.
³ Unità Operativa di Medicina Riabilitativa, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy.
⁴ IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura, 3, Bologna, I-40139, Italy. leonardo.pellicciari@gmail.com.
⁵ Physiotherapy private practice Kinè, Kinè s.r.l, Viale della Quercia 2/B,, Treviso, Italy.
⁶ University of Siena, c/o via Banchi di Sotto, 55, Siena, Italy.

Abstract

Background: Frozen Shoulder (FS) is a painful condition characterized by severe pain and progressive restriction of shoulder movement, leading to functional impairment and reduced quality of life. While different Patient Reported Outcome Measurements (PROMs) tools exist for assessing shoulder diseases, few specific PROMs are validated for FS patients.

Purpose: This study aims to assess the psychometric properties of the Disability of Arm, Shoulder, and Hand (DASH) questionnaire in FS patients.

Methods: One hundred and twenty-four subjects (mean ± SD age = 55.4 ± 7.9 years; 55.6% female) diagnosed with FS were included and completed the DASH questionnaire, the Numerical Pain Rating Scale (NPRS), the Shoulder Pain and Disability Index (SPADI), and the Short-Form Health Survey 36 (SF-36). Floor or ceiling effects were investigated. Structural validity was analysed through a unidimensional Confirmatory Factor Analysis (CFA), internal consistency through Cronbach's alpha, test-retest reliability through the Intraclass Correlation coefficient (ICC), measurement error through the Standard Error of Measurement (SEM), and the Minimum Detectable Change (MDC), and construct validity through the hypothesis testing with the correlation with the other outcome measures used.

Results: No floor or ceiling effects were observed. CFA confirmed a one-factor structure after addressing local item dependency (Root Mean Square Error of Approximation = 0.055; Standardized Root Mean Square Residual = 0.077; Comparative Fit Index = 0.970; Tucker-Lewis Index = 0.968). Cronbach's alpha was high (= 0.951), and test-retest reliability was excellent (ICC = 0.999; 95% CI: 0.998-1.000). SEM was equal to 0.5 points, and MDC to 1.5 points. Construct validity was considered satisfactory as 80% of the a-priori hypotheses were met.

Conclusion: The DASH questionnaire demonstrated good psychometric properties in FS patients, supporting its use as a valuable tool for assessing the impact of FS in clinical and research settings.

Keywords: Adhesive capsulitis; Patient-reported outcome measures; Psychometrics; Rehabilitation; Reproducibility of results; Validation studies.

MeSH terms

Arm
Bursitis* / diagnosis
Disability Evaluation
Female
Humans
Male
Middle Aged
Psychometrics
Quality of Life
Reproducibility of Results
Shoulder Pain / diagnosis
Shoulder*
Surveys and Questionnaires