Date of completion

www.orthopaedicscores.com May 21, 2014

The Disabilities of the Arm, Shoulder and Hand (DASH) Score

Clinician's name (or ref) Marcus Chan Patient's name (or ref A00001

INSTRUCTIONS: 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. 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 you ability regardless of how you perform the task.
Please rate your ability to do the following activities in the last week.
No Mild Moderate Severe
1. Open a tight or new jar Unable
difficulty difficulty difficulty difficulty
No Mild Moderate Severe
2. Write Unable
difficulty difficulty difficulty difficulty
No Mild Moderate Severe
3. Turn a key Unable
difficulty difficulty difficulty difficulty
No Mild Moderate Severe
4. Prepare a meal Unable
difficulty difficulty difficulty difficulty
No Mild Moderate Severe
5. Push open a heavy door Unable
difficulty difficulty difficulty difficulty
Place an object on a shelf above your No Mild Moderate Severe
6. Unable
head difficulty difficulty difficulty difficulty
Do heavy household chores (eg wash No Mild Moderate Severe
7. Unable
walls, wash floors) difficulty difficulty difficulty difficulty

No Mild Moderate Severe

8. Garden or do yard work Unable
difficulty difficulty difficulty difficulty
No Mild Moderate Severe
9. Make a bed Unable
difficulty difficulty difficulty difficulty
No Mild Moderate Severe
10. Carry a shopping bag or briefcase Unable
difficulty difficulty difficulty difficulty
No Mild Moderate Severe
11. Carry a heavy object (over 10 lbs) Unable
difficulty difficulty difficulty difficulty
No Mild Moderate Severe
12. Change a lightbulb overhead Unable
difficulty difficulty difficulty difficulty
No Mild Moderate Severe
13. Wash or blow dry your hair Unable
difficulty difficulty difficulty difficulty
No Mild Moderate Severe
14. Wash your back Unable
difficulty difficulty difficulty difficulty

No Mild Moderate Severe

15. Put on a pullover sweater Unable
difficulty difficulty difficulty difficulty
No Mild Moderate Severe
16. Use a knife to cut food Unable
difficulty difficulty difficulty difficulty
Recreational activities which require little No Mild Moderate Severe
17. Unable
effort (eg cardplaying, knitting, etc) difficulty difficulty difficulty difficulty
Recreational activities in which you take
some force or impact through your arm, No Mild Moderate Severe
18. Unable
shoulder or hand (eg golf, hammering, difficulty difficulty difficulty difficulty
tennis, etc)
Recreational activities in which you
No Mild Moderate Severe
19. move your arm freely (eg playing Unable
difficulty difficulty difficulty difficulty
frisbee, badminton, etc)
Manage transportation needs (getting No Mild Moderate Severe
20. Unable
from one place to another) difficulty difficulty difficulty difficulty
No Mild Moderate Severe
21. Sexual activities Unable
difficulty difficulty difficulty difficulty
 During the past week, to what extent has
your arm, shoulder or hand problem
22. interfered with your normal social Not at all Slightly Moderately Quite a bit Extremely
activities with family, friends, neighbours
or groups?

During the past week, were you limited

Not
in your work or other regular daily Slightly Moderately Very
23. limited at Unable
activities as a result of your arm, limited limited limited
all
shoulder or hand problem?
Please rate the severity of the
following symptoms in the last week
24. Arm, shoulder or hand pain None Mild Moderate Severe Extreme
Arm, shoulder or hand pain when you
25. None Mild Moderate Severe Extreme
performed any specific activity
Tingling (pins and needles) in your arm,
26. None Mild Moderate Severe Extreme
shoulder or hand
27. Weakness in your arm, shoulder or hand None Mild Moderate Severe Extreme
28. Stiffness in your arm, shoulder or hand None Mild Moderate Severe Extreme

During the past week, how much

difficulty have you had sleeping because No Mild Moderate Severe So much I
29.
of the pain in your arm, shoulder or difficulty difficulty difficulty difficulty can't sleep
hand?

I feel less capable, less confident or less Neither

Strongly Strongly
30. useful because of my arm, shoulder or Disagree agree nor Agree
disagree agree
hand problem disagree
Thank you very much for completing all the questions in this questionnaire.
The Disabilies of the Arm, Shoulder
Print page Close Window Reset and Hand (DASH) Score is 60.0
To save this data please print or Save As CSV
( NB. A DASH score may not be
Nb: This page cannot be saved due to patient data protection so please print the filled in form before
closing the window. calculated if there are greater than 3
missing items.)
There are two further small sections to this score. They are both optional. Just click below to select
SPORTS/PERFORMING ARTS
WORK MODULE
MODULE
Reference for Score: Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome
measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative
Group (UECG)
Am J Ind Med. 1996 Jun;29(6):602-8. Erratum in: Am J Ind Med 1996 Sep;30(3):372.
The Institute for Work & Health are the copyright owners of the DASH and QuickDASH Outcome Measures
(http://www.dash.iwh.on.ca/)

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