Background: The Disabilities of the Arm, Shoulder and Hand (DASH)
questionnaire is the most widely used upper extremity-specific health-status
measure. The DASH score often demonstrates greater variability than would be
expected on the basis of objective pathology. This variability may be related
to psychosocial factors. The purpose of the present study was to investigate
the correlation between the DASH score and psychological factors for specific
diagnoses with relatively limited variation in objective pathology.
Methods: Two hundred and thirty-five patients with a single, common,
discrete hand problem known to have limited variations in objective pathology
completed the DASH questionnaire, the Eysenck Personality
Questionnaire-Revised (EPQ-R) to assess neuroticism, the Center for
Epidemiologic Studies-Depression (CES-D) scale to quantify depressive
symptoms, and the Pain Anxiety Symptoms Scale (PASS). Forty-five patients had
carpal tunnel syndrome, forty-four had de Quervain tenosynovitis, forty-eight
had lateral elbow pain, and seventy-one had a single trigger finger. In
addition, twenty-seven patients were evaluated six weeks after a
nonoperatively treated fracture of the distal part of the radius.
Relationships between psychosocial factors and the DASH score were
Results: A significant positive correlation between the DASH score
and depression was noted for all diagnoses (r = 0.38 to 0.52; p < 0.01 for
all). The DASH score also correlated with pain anxiety for four of the five
diagnoses (carpal tunnel syndrome, r = 0.40; de Quervain tendinitis, r = 0.46;
lateral elbow pain, r = 0.42; and trigger finger, r = 0.24) (p < 0.05 for
all). The DASH score was not correlated with neuroticism for any diagnosis.
There was a highly significant effect of depression (as measured with the
CES-D score) on the DASH score for all diagnoses. Both the CES-D score (F =
62.68, p < 0.0001) and gender (F = 11.36, p < 0.001) were independent
predictors of the DASH score.
Conclusions: Self-reported upper extremity-specific health status as
measured with the DASH score correlates with depression and pain anxiety but
not neuroticism. These data support the contention that psychosocial factors
have a strong influence on health-status measures.