A COMPARISON OF UPPER LIMB AMPUTEES AND PATIENTS WITH UPPER LIMB INJURIES USING THE DISABILITY OF THE ARM, SHOULDER AND HAND (DASH).

Abstract

Amputation of a limb represents a catastrophe for the adult amputee and their family. However data regarding the prosthetic, functional and psychological outcomes achieved by these patients is limited. There is no well recognised outcome measure used throughout Australia, UK or America especially for aquired adult amputations of the upper limb. Most scales currently in use fail to identify the psychological adjustment problems which many of these amputees demonstrate. Many adult amputees continue to report significant behavioural limitations and discomfort, associated with low self-esteem, anxiety and depression when compared with an able-bodied control sample.(1) Phantom limb phenomena is also a well recognised problem for many upper limb amputees . Scales used to measure prosthetic use rarely investigate the impact pain has on the amputee and his or her well being. The Disability of the Arm Shoulder and Hand Scale (DASH) is an evaluative outcome measure for patients with upper extremity musculoskeletal conditions designed in the mid 1990s by the American Academy of Orthopaedic Surgeons and Toronto Institute for Work and Health. (2,3,4) It is a region specific questionnaire as opposed to diagnosis specific questionnaire. It measures function & symptoms of musculo-skeletal disorders in upper limb. The DASH was able to demonstrate change in all situations in which change was presumed to have occurred. The DASH was found to have comparable responsiveness to the joint specific measures. It demonstrated suitable levels of sensitivity and specificity.