Validation of the Disabilities of the Arm, Shoulder, and Hand in Patients Undergoing Cervical Spine Surgery

Jawad M. Khalifeh, Syed Hassan A. Akbari, Umang Khandpur, William Johnston, Neill M. Wright, Ammar H. Hawasli, Ian Dorward, Paul Santiago, Wilson Z. Ray

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Study Design.Retrospective cohort study.Objective.To evaluate the performance and convergent validity of the disabilities of the arm, shoulder, and hand (DASH) in comparison with the visual analog scale (VAS) for pain, and neck disability index (NDI) in patients undergoing cervical spine surgery.Summary of Background Data.Neck-specific disability scales do not adequately assess concurrent upper extremity involvement in patients with cervical spine disorders. The DASH is a patient-reported outcomes (PRO) instrument designed to measure functional disability due to upper extremity conditions but has additionally been shown to perform well in patients with neck disorders.Methods.We identified patients who underwent cervical spine surgery at our institution between 2013 and 2016. We collected demographic information, clinical characteristics, and PRO measures - DASH, VAS, NDI - preoperatively, as well as early and late postoperatively. We calculated descriptive statistics and changes from baseline in PROs. Correlation coefficients were used to quantify the association between PRO measures. The analysis was stratified by radiculopathy and myelopathy diagnoses.Results.A total of 1046 patients (52.8% male) with PROs data at baseline were included in the analysis. The mean age at surgery±SD was 57.2±11.3 years, and postoperative follow-up duration 12.7±10.7 months. The most common surgical procedure was anterior cervical discectomy and fusion (71.1%). Patients experienced clinically meaningful postoperative improvements in all PRO measures. The DASH showed moderate positive correlations with VAS preoperatively (Spearman rho=0.43), as well as early (rho=0.48) and late postoperatively (rho=0.60). DASH and NDI scores were strongly positively correlated across operative states (Preoperative rho=0.74, Early Postoperative rho=0.78, Late Postoperative rho=0.82). Stratified analysis by preoperative diagnosis showed similar within-groups trends and pairwise correlations. However, radiculopathy patients experienced larger magnitude early and late change scores.Conclusion.The DASH is a valid and responsive PRO measure to evaluate disabling upper extremity involvement in patients undergoing cervical spine surgery.Level of Evidence: 3.

Original languageEnglish
Pages (from-to)1676-1684
Number of pages9
Issue number23
StatePublished - Dec 1 2019


  • cervical degenerative disease
  • cervical spine disease
  • concurrent validity
  • convergent validity
  • disabilities of the arm, shoulder, and hand
  • disability
  • myelopathy
  • neck disability index
  • pain
  • patient-reported outcomes
  • physical function
  • radiculopathy
  • spine surgery
  • upper extremity musculoskeletal disability
  • visual analog scale


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