Validity and reliability of the Arabic quick disabilities of the arm, Shoulder and Hand (QuickDASH-Arabic)

Highlights

• Arabic QuickDASH is a unidimensional outcome measure.

• Arabic QuickDASH has excellent internal consistency and test-retest reliability.

• Arabic QuickDASH is a valid measure of upper extremity activity limitation and symptoms.

Abstract

Background

The QuickDASH is a commonly used upper extremity region-specific outcome measure assessing activity limitation and symptoms. The Arabic version of QuickDASH is available in the official outcome measure website, but no prior studies have examined its psychometric properties.

Objective

To examine the psychometric properties of the Arabic QuickDASH in patients with upper extremity musculoskeletal disorders.

Methods

Participants with upper extremity musculoskeletal disorders were recruited (N = 109) using convenience sampling and completed the Arabic QuickDASH, Numeric Pain Rating Scale, Global Assessment of Function, and RAND 36-item Health Survey in two testing sessions (2–7 days apart). The Arabic QuickDASH structural validity, internal consistency, floor and ceiling effect, test-retest reliability, measurement error, and construct validity were examined.

Results

Exploratory factor analysis indicated a one factor underlying the Arabic QuickDASH. The Arabic QuickDASH had Cronbach's alpha of 0.90 and ICC_2.1 of 0.91 indicating excellent internal consistency and test-retest reliability. None of the participant reached the minimum or the maximum score. The scale's standard error of measurement and minimal detectable change were 7.0 and 16.3. Five out of the six construct validity predefined hypotheses were supported by the results.

Conclusion

The Arabic QuickDASH is a unidimensional scale with excellent internal consistency, test-retest reliability and acceptable measurement error. The Arabic Quick DASH is a valid and reliable outcome measure that can be used in Arabic speaking countries with Arabic patients suffering from various upper extremity activity limitations and symptoms.

Introduction

The Disabilities of the Arm, Shoulder and Hand short version (Quick DASH) is a commonly used patient-reported outcome measure (PROM) (Beaton et al., 2005). It is a short region-specific measure capturing important health-related construct (upper extremity activity limitation and symptoms) (Rudolf et al., 2012; Goldhahn et al., 2014; Ramiro et al., 2019) making it practical for busy clinicians where one scale is used with all upper extremity musculoskeletal disorders instead of using multiple joint-specific or disease-specific measures with different scoring methods and different interpretations (Chester et al., 2017; Dabija et al., 2019; Wormald et al., 2019). In a systematic review, Kennedy et al. indicated that the body of literature supports the psychometric properties of the QuickDASH (Kennedy et al., 2013). Additionally, the authors also indicated the need for studies with high methodological quality to examine the validity and reliability of QuickDASH adapted versions given the overall poor methodological quality of studies that examined the scale's adapted versions (Kennedy et al., 2013).

Kennedy et al. reviewed 11 adapted versions of the QuickDASH (Kennedy et al., 2013) and the number of QuickDASH adaptations are increasing in the literature given the scale's attractive features (Lee et al., 2013; Golicki et al., 2014; Ebrahimzadeh et al., 2015; Schønnemann and Eggers, 2016; Hammond et al., 2018; Cao et al., 2019; Da Silva et al., 2020). The longer version of the scale (DASH) has been translated into Arabic language and its content and face validity has been established (Alotaibi, 2010). The psychometric properties of the Arabic DASH were also examined in a study that established its internal consistency, test-retest reliability, construct validity and responsiveness (Alotaibi et al., 2016). The Arabic QuickDASH is currently available in the official DASH outcome measure website (http://www.dash.iwh.on.ca/) and number of research studies have used it to examine the construct validity of other PROMs (Alsanawi et al., 2015; Arab Alkabeya et al., 2020) or for outcome assessment in observational and experimental studies (Alhanafy et al., 2018; Ashour et al., 2018; Alruthia et al., 2019) despite the lack of evidence to support its validity and reliability. Research studies are needed to examine the psychometric properties of the Arabic QuickDASH using sound methodology before the Arabic QuickDASH can be recommended for either clinical purposes or for research purposes.

The aim of this study was to examine the psychometric properties of the Arabic QuickDASH including structural validity, internal consistency, test-retest reliability, measurement error, floor and ceiling effects, and construct validity. We hypothesized that the Arabic QuickDASH 1) would have a unidimensional structure; 2) would demonstrate very good to excellent internal consistency, test-retest reliability, acceptable measurement error with no floor or ceiling effects; 3) would demonstrate evidence to support its construct validity as a measure of upper extremity activity limitation and symptoms.