The DASH: Disabilities of the Arm, Shoulder and Hand

Name

First NameLast Name

Date

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, by circling the appropriate number.

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.

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

Rows	No Difficulty	Mild Difficulty	Moderate Difficulty	Severe Difficulty	Unable
1. Open a tight or new jar.
2. Write.
3. Turn a key.
4. Prepare a meal.
5. Push open a heavy door.
6. Place an object on a shelf above your head.
7. Do heavy household chores (e.g., wash walls, wash floors).
8. Garden or do yard work.
9. Make a bed.
10. Carry a shopping bag or briefcase.
11. Carry a heavy object (over 10 lbs).
12. Change a lightbulb overhead.
13. Wash or blow dry your hair.
14. Wash your back.
15. Put on a pullover sweater.
16. Use a knife to cut food.
17. Recreational activities which require little effort (e.g., cardplaying, knitting, etc.).
18. Recreational activities in which you take some force or impact through your arm, shoulder or hand (e.g., golf, hammering, tennis, etc.).
19. Recreational activities in which you move your arm freely (e.g., playing frisbee, badminton, etc.).
20. Manage transportation needs (getting from one place to another).
21. Sexual activities.

Rows	Not At All	Slightly	Moderately	Quite A Bit	Extremely
22. 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?

Rows	Not Limited At All	Slightly Limited	Moderately Limited	Very Limited	Unable
23. 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?

Rows	None	Mild	Moderate	Severe	Extreme
24. Arm, shoulder or hand pain.
25. Arm, shoulder or hand pain when you performed any specific activity.
26. Tingling (pins and needles) in your arm, shoulder or hand.
27. Weakness in your arm, shoulder or hand.
28. Stiffness in your arm, shoulder or hand.

Rows	No Difficulty	Mild Difficulty	Moderate Difficulty	Severe Difficulty	So much Difficulty That I Can't Sleep
29. During the past week, how much difficulty have you had sleeping because of the pain in your arm, shoulder or hand?

Rows	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
30. I feel less capable, less confident or less useful because of my arm, shoulder or hand problem.

DASH DISABILITY/SYMPTOM SCORE

Does your arm, shoulder, or hand problem impact you in:

Please indicate what your job/work is:

Work Module

Rows	No Difficulty	Mild Difficulty	Moderate Difficulty	Severe Difficulty	Unable
1. using your usual technique for your work?
2. doing your usual work because of arm, shoulder or hand pain?
3. Doing your work as well as you would like?
4. spending your usual amount of time doing your work?

DASH DISABILITY/SYMPTOM SCORE - Work Module

Please indicate the sport or instrument which is most important to you:

Sports/Performing Arts Module

Rows	None	Mild	Moderate	Severe	Extreme
1. Using your usual technique for playing your instrument or sport?
2. Playing your musical instrument or sport because of arm, shoulder or hand pain?
3. Playing your musical instrument or sport as well as you would like?
4. spending your usual amount of time practicing or playing your instrument or sport?

DASH DISABILITY/SYMPTOM SCORE - Hobby Module

Total DASH Score