517722, 950M ‘The Disablties ofthe Arm, Shoulder and Hand (DASH) Score - Ohopaedic Scores www.orthopaedicscores.com The Disabilities of the Arm, Shoulder and Hand (DASH) Score Clinician’s name (or ref) Patient's name (or ref Date of completion May 7, 2022 INSTRUCTIONS: This questionnaire asks about your symptoms as well as your abilly 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 Ne wie Moderate Severe 4. Open aight or new jar O Giticuty —O itieuty © aiticuty—_O atmeutty © Unable Ne wit Moderate Severe 2 wie O Ncuty 0 om 3 © Unabie Sicuty © dieuty © dicuty—_O aieuty Ne wit Moderate Severe 3. Tum a key oO difficulty Oo O git oO © Unable ieuty © aieutty © atineuty © alfeuty Ne iit Moderate Severe 4 Prepare ameal O Nneuty © om 3 © Unabie iieuty © ateuty © aliteutyy © alfeuty Ne iit Moderate Severe 5. Push open a heavy door O Nee Ome ny © Moderate Severe, unable Place an oboe on a sellabove your Ne it Moderate Severe ®- Road O aitieuty —O aiieuty © attcutty—O aiteutyy © Unable Do heavy Fousohold chavs (ea wash Ne iit ‘Moderate Severe al wash or) O Gitteuty —O Sitieuty © aitcuty © atteuty © Unable No ma Moderate Severe 8. Garden or do yard work O Gitteuty —_O eiieuty © ateutty— © atmeutry © Unable Ne ite Moderate Severe 8. Make a bed O Gitteuty —O Sitieuty —O aimeutyy © atmeutty © Unable Ne wie Moderate Severe 10.Caryasnopsing beg orbieease Nay OMI Moderate Severe Unable 7 Ne me Moderate Severe 11, Caryaheavyobiect (ver T0lbs) ——_O neuty © ateuty © atmeuty—O ateuty © Unable Ne ie Moderate Severe 12. Change a ighbub overhead O Beaty Ome ny © Moderate Severe nable Ne me Moderate Severe 18, Wash or blow dy your hair O Gitcuty —O Sieuty —O aimeuty —O atmeuty © Unable Ne ie Moderate Severe 14, Wash your back O Giticuty —O Sieuty © aimeunty © aimeutty © Unable , No mua Mode Severe 416. Put on a pullover sweater O ditficutty © ditficutty © difficulty difficulty © Unable 18. Use a knife fo at food © Gncunty _O teuty © ermreuny, © armmennyy © Unable Tecreaonal aces which rue Te Ne mie Moderate Severe 17. Ghar (ea carping ening et) © aeuty © aliuty © aitcuty, © aiteutty © Unable Recreational activites in which you take Some force or moacl tough your arm, No ma Moderate Severe 18. SRouderorhond (eg go honmerng,” © aiuty © elficuty © aiticuty, © aiteutty © Unable tonne) Recreational adil h whch you nave ; caus ewes 18. Hear sts C2 Paine fsbo © Gftieuty © Siteuty © diicuty © Gieuny (© Unable Hanage Wanepotalon noods(alng We waa Moderate Severe 20. fam ano pace to anther O Gitneuty —O Sitieuty © aimcuty © atmeutyy © Unable ' Ne ite Moderate Severe 21, Sexual actives O Gitcuty —O aiieuty © aimeuty © atmeuty © Unable hitpsswww-orthopasciescore.comlscorepagesiasabilties_of_arm_shoulder_hand_score_dash.himl 12517722, 950M ‘The Disablties ofthe Arm, Shoulder and Hand (DASH) Score - Ohopaedic Scores During the past week, fo what extent has ‘your arm, shoulder or hand problem 22. interfered with your normal social © Notatall © Slightly © Moderately © Quite abit © Extremely activities with family friends, neighbours or groups? During the past week, were you limited in your work or other regular daily activities. Not limited. Slightly Moderately. Very 23 as a result of your arm, shoulder or hand © at all QO timited =O timited —O imitea =O Unable problem? Please rate the severity of the following symptoms in the last week 2a. Arm, shoulder or hand pain ONone Mild ©) Moderate © Severe Extreme 2m, shoulder or hand pain when you ; a5, Arm, shoulder orhand pain when YOU None Mild) Moderate © Severe © Extrome Tinaing (pins and needles) in your arm, 25, naling (pins and needles) in None Mild Moderate © Severe Extreme 27. Weakness in your arm, shoulder orhend © Nene Mild__©) Moderate_© Severe __O Extreme 28, Sifess in your arm, shoulder orhand ©) None) Mild Moderate © Severe Extreme During the past week how much ifcuty yg wits Moderate Severe So mucht 29, have you had sleeping because of the pain in your arm, snoulder or hand? difficulty © ditficuty © difticutty O difficuty © can't steep | ee! less capable, less confident or less 30, useful because of my arm, shoulder or Q) hand problem Neither SEIURE © Dlsuree © aureenor © Aaree —o See ‘Thank you very much for completing all the questions in this questionnaire. [rinpese The Dard (paar) goose Hand (DASH) Score is 0 Taner peee pit ESTAS) fo save this dota please print or [avsTASIGEN (NB. A DASH score may not be calculated if "No: This pao cana be avec ufo paint aaa protector sa leas prin los norm bore ‘soongie wndon 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 WORK MODULE SPORTS/PERFORMING ARTS MODULE Reference for Score: Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilties of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG) ‘Am J Ind Med. 1986 Jun;29(6)'602-8. Erratum in: Am J ind Med 1986 Sep;30(3):372. ‘The Institute for Work'& Health are the copyright owners of the DASH and QuickDASH Outcome Measures (nttp:iiwww dash.iwh.on.cal) ‘Web Design London - James Blake Internet hitpssiwww-orthopasciescore.comscorepagesiasabilties_of_arm_shoulder_hand_score_dash.himl 22