title: Specificity of the minimal clinically important difference of the quick Disabilities of the Arm Shoulder and Hand (QDASH) for distal upper extremity conditions.
abstract: Retrospective cohort design. The minimal clinically important difference (MCID) for the quick Disabilities of the Arm, Shoulder and Hand (QDASH) has been established using a pool of multiple conditions, and only exclusively for the shoulder. Understanding diagnoses-specific threshold change values can enhance the clinical decision-making process. Before and after QDASH scores for 406 participants with conditions of surgical distal radius fracture, non-surgical lateral epicondylitis, and surgical carpal tunnel release were obtained. The external anchor administered at each fourth visit was a 15-point global rating of change scale. The test-retest reliability of the QDASH was moderate for all diagnoses: intraclass correlation coefficient model 2, 1, for surgical distal radius = 0.71; non-surgical lateral epicondylitis = 0.69; and surgical carpal tunnel = 0.69. The minimum detectable change at the 90% confidence level was 25.28; 22.49; and 27.63 points respectively; and the MCID values were 25.8; 15.8 and 18.7, respectively. For these three distal upper extremity conditions, a QDASH MCID of 16-26 points could represent the estimate of change in score that is important to the patient and guide clinicians through the decision-making process.
authors.affiliation: Graduate Medical Education, Fort Sam Houston Clinic, Building 1179, Room 1A38, 3100 Schofield Road, Fort Sam Houston, TX 78234, USA. Electronic address: enrique.smith-forbes@uky.edu.
authors.forename: Enrique V
authors.initials: EV
authors.lastname: Smith-Forbes
authors.affiliation: Department of Rehabilitation Sciences, College of Health Sciences, University of Kentucky, Lexington, KY, USA; Department of Occupational Therapy, Eastern Kentucky University, Richmond, KY, USA.
authors.forename: Dana M
authors.initials: DM
authors.lastname: Howell
authors.affiliation: Kentucky Hand & Physical Therapy, Drayer Physical Therapy Institute, Lexington, KY, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Willoughby
authors.affiliation: Kentucky Hand & Physical Therapy, Drayer Physical Therapy Institute, Lexington, KY, USA.
authors.forename: Donald G
authors.initials: DG
authors.lastname: Pitts
authors.affiliation: Department of Rehabilitation Sciences, College of Health Sciences, University of Kentucky, Lexington, KY, USA.
authors.forename: Tim L
authors.initials: TL
authors.lastname: Uhl
mesh_terms: D000328:Adult; D002349:Carpal Tunnel Syndrome / Q000503:physiopathology*; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011594:Psychometrics; D011885:Radius Fractures / Q000503:physiopathology*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013716:Tennis Elbow / Q000503:physiopathology*; D034941:Upper Extremity / Q000503:physiopathology
keywords: Disability evaluation; Musculoskeletal diseases; Outcome assessment; Psychometrics; Rehabilitation; Upper extremity