This paper describes the development of an evaluative outcome measure for patients
with upper extremity musculoskeletal conditions. The goal is to produce a brief, self-administered
measure of symptoms and functional status, with a focus on physical function, to be
used by clinicians in daily practice and as a research tool. This is a joint initiative
of the American Academy of Orthopedic Surgeons (AAOS), the Council of Musculoskeletal
Specialty Societies (COMSS), and the Institute for Work and Health (Toronto, Ontario).
Our approach is consistent with previously described strategies for scale development.
In Stage 1, Item Generation, a group of methodologists and clinical experts reviewed
13 outcome measurement scales currently in use and generated a list of 821 items.
In Stage 2a, Initial Item Reduction, these 821 items were reduced to 78 items using
various strategies including removal of items which were generic, repetitive, not
reflective of disability, or not relevant to the upper extremity or to one of the
targeted concepts of symptoms and functional status. Items not highly endorsed in
a survey of content experts were also eliminated. Stage 2b, Further Item Reduction,
will be based on results of field testing in which patients complete the 78-item questionnaire.
This field testing, which is currently underway in 20 centers in the United States,
Canada, and Australia, will generate the final format and content of the Disabilities
of the Arm, Shoulder, and Hand (DASH) questionnaire. Future work includes plans for
validity and reliability testing.