The Disabilities of the Arm, Shoulder, and Hand questionnaire in intercollegiate athletes: Validity limited by ceiling effect

Hypothesis: The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire has been validated as an effective upper extremity specific outcome measure. Normative scores have not been established for young athletes. This study was conducted to establish normative DASH scores for intercollegiate athletes. We hypothesized that DASH scores in intercollegiate athletes differ from published values obtained from the general population. Materials and methods: The DASH questionnaire was administered to 321 athletes cleared for full participation in intercollegiate sports. Their scores were compared with normative values in the general population and 2 other age-matched cohorts. Results: Intercollegiate athletes had significantly better upper extremity function compared with the general population (1.37 +/- 2.96 vs 10.10 +/- 14.68, P < .001) and an age-matched cohort of employed adults (1.37 +/- 2.96 vs 5.40 +/- 7.57, P < .0001). The DASH was 0 for 65.1%. Within this cohort, men reported better upper extremity function than women (0.98 vs 1.82, P = .010). Athletes participating in overhead sports reported worse upper extremity function than nonoverhead athletes (1.81 vs 0.98, P = .042). Discussion: We report normative DASH values for a group of intercollegiate athletes and show a significant difference between the scores of these athletes and the general population. Within our cohort of competitive athletes, overhead sports and female gender are associated with significantly lower DASH scores and sports module scores. The utility of using these results are limited by a substantial ceiling effect in this population of competitive athletes. Differences within our cohort and differences between our cohort and other populations are minimized by this ceiling effect. Various upper extremity outcome measures may be similarly limited by a ceiling effect and should be examined for appropriateness before use. Conclusion: Intercollegiate athletes report significantly greater upper extremity function than the general population; however, validity of the DASH in these athletes is limited and population differences may be minimized by a substantial ceiling effect. Level of evidence: Level IV, Case-Control Study, Diagnostic Study (C) 2010 Journal of Shoulder and Elbow Surgery Board of Trustees.