Article

OBJECTIVE: To perform a comprehensive psychometric analysis of Disabilities of
the Arm, Shoulder and Hand
- bras - épaule - main
(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.

Langue : ANGLAIS