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K. Gobinath1, C. Srikesavan2, T. Ramalingam3, S. Sabapathy4
1Ganga Medical Centre & Hospitals Pvt Ltd Coimbatore, Department of Physiotherapy, Coimbatore, India, 2University of Oxford, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), Oxford, United Kingdom, 3Sarvajanik College of Physiotherapy, Department of Physiotherapy, Surat, India, 4Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital Major Trauma Centre, Oxford, United Kingdom
Background: The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and its abbreviated version (QuickDASH) are patient-reported outcome measures that evaluate symptoms and function in people with a wide range of upper limb conditions. The scores range between 0 (no disability) and 100 (severe disability).
The Tamil DASH and QuickDASH were produced following Beaton’s cross-cultural adaptation guidelines and pilot tested in Tamil speaking people with different upper limb conditions. The approved Tamil translations of the DASH and QuickDASH questionnaires are available on the official DASH website.
The Tamil DASH and QuickDASH were produced following Beaton’s cross-cultural adaptation guidelines and pilot tested in Tamil speaking people with different upper limb conditions. The approved Tamil translations of the DASH and QuickDASH questionnaires are available on the official DASH website.
Purpose: To determine the feasibility, internal consistency, factorial and convergent validity of the Tamil DASH and QuickDASH in Tamil speaking people.
Methods: Adults (aged 18 years and above) with upper limb disorders and attending the outpatient physiotherapy centre at the Ganga Medical Centre & Hospitals in Coimbatore city in Tamil Nadu, South India were recruited consecutively. Other inclusion criteria were ability to understand and read Tamil and willingness to provide signed consent.
Participants were asked to complete the paper-based Tamil DASH, Tamil Health Assessment Questionnaire (HAQ) and Tamil EuroQoL-5D (EQ-5D) questionnaires. Cronbach alpha was used to measure reliability or internal consistency of the questionnaire items. Spearman correlation coefficient (r) was used to determine the magnitude of association between DASH, QuickDASH, HAQ and EQ-5D. Principal component analysis with varimax rotation method was used to demonstrate factorial validity.
Participants were asked to complete the paper-based Tamil DASH, Tamil Health Assessment Questionnaire (HAQ) and Tamil EuroQoL-5D (EQ-5D) questionnaires. Cronbach alpha was used to measure reliability or internal consistency of the questionnaire items. Spearman correlation coefficient (r) was used to determine the magnitude of association between DASH, QuickDASH, HAQ and EQ-5D. Principal component analysis with varimax rotation method was used to demonstrate factorial validity.
Results: A total of 101 participants took part. Most participants were males (74%). The mean age (standard deviation, SD) was 35.6 (12.2) years. About 53% of participants had traumatic musculoskeletal conditions and 25% had nerve injuries. The duration of the condition reported since diagnosis ranged from six months and above two years.
The mean (SD) Tamil DASH score was 36 (20.1), ranging between 0 and 86.2. The mean (SD) Tamil QuickDASH score was 36 (20), ranging between 0 and 93.
The Tamil DASH demonstrated excellent internal consistency with a Cronbach’s alpha of 0.94 (Confidence Interval, CI 0.92 to 0.96). The Tamil QuickDASH demonstrated adequate internal consistency with a Cronbach’s alpha of 0.86 (CI 0.82 to 0.9).
The Tamil DASH and QuickDASH very strongly correlated with each other with a Pearson r of 0.96. Both questionnaires showed significant strong correlations (Pearson r between 0.7 and 0.8) with Tamil EQ-5D index and HAQ disability index; and moderate correlation (r=0.5) with HAQ pain scores.
The Tamil DASH showed a six-factor structure and the principal component analysis explained 67.5% of the total variance. The Tamil QuickDASH demonstrated a two-factor structure and the principal component analysis explained 54.4% of the total variance. All factor loadings and communalities were above 0.4.
Both Tamil DASH and QuickDASH had no floor or ceiling effects.
The mean (SD) Tamil DASH score was 36 (20.1), ranging between 0 and 86.2. The mean (SD) Tamil QuickDASH score was 36 (20), ranging between 0 and 93.
The Tamil DASH demonstrated excellent internal consistency with a Cronbach’s alpha of 0.94 (Confidence Interval, CI 0.92 to 0.96). The Tamil QuickDASH demonstrated adequate internal consistency with a Cronbach’s alpha of 0.86 (CI 0.82 to 0.9).
The Tamil DASH and QuickDASH very strongly correlated with each other with a Pearson r of 0.96. Both questionnaires showed significant strong correlations (Pearson r between 0.7 and 0.8) with Tamil EQ-5D index and HAQ disability index; and moderate correlation (r=0.5) with HAQ pain scores.
The Tamil DASH showed a six-factor structure and the principal component analysis explained 67.5% of the total variance. The Tamil QuickDASH demonstrated a two-factor structure and the principal component analysis explained 54.4% of the total variance. All factor loadings and communalities were above 0.4.
Both Tamil DASH and QuickDASH had no floor or ceiling effects.
Conclusion(s): The Tamil DASH and QuickDASH were found to be feasible and valid measures for evaluating upper limb function in Tamil speaking patients.
Implications: The Tamil DASH and QuickDASH were shown to be suitable for use in daily practice and research in Tamil speaking patients with upper limb conditions.
Funding, acknowledgements: No funding.
Keywords: Tamil DASH questionnaire, Validation, Tamil Nadu, India
Topic: Musculoskeletal: upper limb
Did this work require ethics approval? Yes
Institution: Ganga Medical Centre & Hospitals Private Limited, Coimbatore, India.
Committee: Institutional Review Board
Ethics number: 43172
All authors, affiliations and abstracts have been published as submitted.
