Minimal clinically important difference of the disabilities of the arm, shoulder and hand outcome measure (DASH) and its shortened version (QuickDASH)

J Orthop Sports Phys Ther. 2014 Jan;44(1):30-9. doi: 10.2519/jospt.2014.4893. Epub 2013 Oct 30.


Study design: Prospective, single-group observational design.

Objectives: To determine the minimal clinically important difference (MCID) for the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure and its shortened version (QuickDASH) in patients with upper-limb musculoskeletal disorders, using a triangulation of distribution- and anchor-based approaches.

Background: Meaningful threshold change values of outcome tools are crucial for the clinical decision-making process.

Methods: The DASH and QuickDASH were administered to 255 patients (mean ± SD age, 49 ± 15 years; 156 women) before and after a physical therapy program. The external anchor administered after the program was a 7-point global rating of change scale.

Results: The test-retest reliability of the DASH and QuickDASH was high (intraclass correlation coefficient model 2,1 = 0.93 and 0.91, respectively; n = 30). The minimum detectable change at the 90% confidence level was 10.81 points for the DASH and 12.85 points for the QuickDASH. After triangulation of these results with those of the mean-change approach and receiver-operating-characteristic-curve analysis, the following MCID values were selected: 10.83 points for the DASH (sensitivity, 82%; specificity, 74%) and 15.91 points for the QuickDASH (sensitivity, 79%; specificity, 75%). After treatment, the MCID threshold was reached/surpassed by 61% of subjects using the DASH and 57% using the QuickDASH.

Conclusion: The MCID values from this study for the DASH (10.83 points) and the QuickDASH (15.91 points) could represent the lower boundary for a range of MCID values (reasonably useful for different populations and contextual characteristics). The upper boundary may be represented by the 15 points for the DASH and 20 points for the QuickDASH proposed by the DASH website.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Arm Injuries / physiopathology
  • Disability Evaluation*
  • Female
  • Hand Injuries / physiopathology
  • Humans
  • Italy
  • Male
  • Middle Aged
  • Musculoskeletal Diseases / physiopathology*
  • Musculoskeletal Diseases / rehabilitation*
  • Outcome Assessment, Health Care
  • Prospective Studies
  • Psychometrics
  • ROC Curve
  • Reproducibility of Results
  • Severity of Illness Index
  • Shoulder / physiopathology
  • Shoulder Injuries
  • Upper Extremity / injuries
  • Upper Extremity / physiopathology*
  • Young Adult