QuickDASH: Reliability in the assessment of carpal tunnel syndrome

The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, along with its shortened version QuickDASH, are widely used self-assessment tools for evaluating upper limb function across various acute and chronic conditions. These tools aim to standardise outcome measures globally, contingent upon certified versions and adherence to calculation guidelines. While overall reliability of the QuickDASH is established, question-by-question reproducibility and methodology have not been rigorously assessed. Carpal tunnel syndrome was chosen for testing the reliability of the QuickDASH. This study aimed to evaluate the question-by-question reliability of the QuickDASH in carpal tunnel syndrome patients. Additionally, we surveyed members of the French Society of Hand Surgery regarding their QuickDASH usage practices and examined patients' functional expectations to correlate them with the questionnaire items. Our hypothesis suggested that response reliability might be affected by patient and practitioner factors or data collection methods.

A non-interventional, single-center study was conducted from July 2023 to June 2024, including patients whose carpal tunnel syndrome was confirmed by clinical and electrophysiological tests. Patients completed the QuickDASH three times on consecutive days. Demographic, clinical, and paraclinical data were collected, including pain medication, ease of completion, age, sex, body mass index, profession, occupational health status, smoking, diabetes, thoracic outlet syndrome, and electroneuromyogram data. In October 2023, an online survey queried SFCM members on their QuickDASH application methods, response management, and knowledge of guidelines. Finally, A separate group of patients was interviewed preoperatively to describe their symptoms openly and symptoms were then compiled for analysis.

The QuickDASH was found easy to complete by 93.3% of patients. The intraclass correlation scores indicated strong reliability for the overall QuickDASH, with 93% pre-operatively, 87% post-operatively and 92% in the overall population. However, question-specific intra-class correlations revealed less consistency, particularly for certain items post-operatively. Among surveyed practitioners, 65.5% reported that patients completed the QuickDASH autonomously, and 63.2% provided direct clarification when needed. While 58.1% of practitioners indicated the QuickDASH did not affect therapeutic decisions, 41.9% acknowledged its potential impact. Word clouds created from open-ended patient responses highlighted pain, tingling, and nocturnal symptoms as primary concerns pre-operatively.

The QuickDASH questionnaire demonstrated high reliability for measuring upper limb function in carpal tunnel syndrome patients, though some questions showed variability in their responses. Despite its widespread use, the implementation of the QuickDASH in clinical practice shows room for improvement, particularly regarding practitioner understanding and handling of missing data. The increased use of Patient-Reported Outcomes Measures should encourage us to develop more specific tools that are closer to patients' symptoms and functional requirements.