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Quick DASH
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Please rate your ability to do the following activities in the last week by circling the number below the appropriate response.
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1. Open a tight or new jar.
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7. During the past week, to what extent has your arm, shoulder or hand problem interfered with your normal social activities wit
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2. Do heavy household chores (e.g., wash walls, floors).
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8. During the past week, were you limited in your work or other regular daily activities as a result of your arm, shoulder or ha
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3. Carry a shopping bag or briefcase.
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9. Severity of arm, shoulder hand pain over the past WEEK
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4. Wash your back.
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10. Severity of tingling (pins and needles) in your arm, shoulder or hand over the past WEEK.
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5. Use a knife to cut food
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11. During the past week, how much difficulty have you had sleeping because of the pain in your arm, shoulder or hand?
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6. Recreational activities in which you take some force or impact through your arm, shoulder or hand (e.g., golf, hammering, ten
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Subtotal 1-6
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Subtotal 7-11
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Click for scoring instructions
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Quick DASH Score (Total 1-11):
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Lower scores correlate with better function (0-55)
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WORK MODULE (OPTIONAL)
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Is patient working? If NO, skip this section
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Please indicate what your job/work is:
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1. Using your usual technique for your work?
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3. Doing your work as well as you would like?
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2. Doing your usual work because of arm, shoulder or hand pain?
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4. Spending your usual amount of time doing your work?
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Click for scoring instructions
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Quick DASH + WORK MODULE Score:
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Lower scores correlate with better function (0-75)
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SPORTS/PERFORMING ARTS MODULE (OPTIONAL)
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I participate in sports play musical instruments (If NO you may skip this section).
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Please indicate the sport or instrument which is most important to you:
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1. Using your usual technique for playing your instrument or sport?
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3. Playing your musical instrument or sport as well as you would like
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2. Playing your musical instrument or sport because of arm, shoulder or hand pain?
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4. Playing your musical instrument or sport as well as you would like
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Click for scoring instructions
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Quick DASH + SPORTS/PERFORMING ARTS Score (0-75):
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Lower scores correlate with better function (0-75)
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