DASH

Disabilities Of The Arm, Shoulder And Hand

DISABILITIES OF THE ARM, SHOULDER AND HAND

This questionnaire asks about your symptoms as well as your ability to perform certain activities. Please answer every question, based on your condition in the last week, by selecting the appropriate answer.

If you did not have the opportunity to perform an activity in the past week, please make your best estimate on which response would be the most accurate. It doesn’t matter which hand or arm you use to perform the activity; please answer based on your ability regardless of how you perform the task.

Patient name *

Date

Please rate your ability to do the following activities in the last week by selecting below the appropriate response.

Open a tight or new jar *

Write *

Turn a key *

Prepare a meal *

Push open a heavy door *

Place an object on a shelf above your head *

Do heavy household chores (e.g. wash walls, floors) *

Garden or do yard work *

Make a bed *

Carry a shopping bag or briefcase *

Carry a heavy object (over 10 lbs) *

Change a lightbulb overhead *

Wash or blow dry your hair *

Wash your back *

Put on a pullover sweater *

Use a knife to cut food *

Recreational activities which require little effort (e.g. cardplaying, knitting, etc.) *

Manage transportation needs (getting from one place to another) *

Recreational activities in which you take some force or impact through your arm, shoulder or hand (e.g. golf, hammering, tennis, etc.) *

During the past week, to what extent has your arm, shoulder or hand problem interfered with your normal social activities with family, friends, neighbours or groups? *

Recreational activities in which you move your arm freely (e.g., playing frisbee, badminton, etc.) *

Sexual activities *

During the past week, were you limited in your work or other regular daily activities as a result of your arm, shoulder or hand problem? *

Please rate the severity of the following symptoms in the last week.

Arm, shoulder or hand pain *

Weakness in your arm, shoulder or hand *

Stiffness in your arm, shoulder or hand *

Tingling (pins & needles) in your arm, shoulder or hand *

Arm, shoulder or hand pain when you performed any specific activity *

I feel less capable, less confident or less useful because of my arm, shoulder or hand problem *

During the past week, how much difficulty have you had sleeping because of the pain in your arm, shoulder or hand? *

DASH Score

Range of Motion & Pelvic Physical Therapy