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DASH questionnaire for the upper limb

Disabilità del Braccio, Spalla e Mano
Instructions: This questionnaire concerns your symptoms and your ability to perform certain actions. Please respond to each
requesting reference to your status during the last week. If you haven't had the opportunity to carry out a
some actions during the last week, answer the question trying to imagine how it could have been carried out.
It does not matter which hand or arm you use to perform the action; answer based on your ability to do it and without
take into account the way in which she does it.

Evaluate his/her ability to perform the following actions during the last week.
(Indicate a number)
None Dear Discrete Remarkable There are none
difficulty difficulty difficulty difficulty successful
Unscrew the lid of a tightly closed or new jar. 1 2 3 4 5
2. Write 1 2 3 4 5
3. Turn a key 1 2 3 4 5
4. Prepare a meal 1 2 3 4 5
5. Open by pushing a heavy door 1 2 3 4 5
6. Placing an object on a shelf above one's head 1 2 3 4 5
7. Do heavy housework (e.g. washing floors or windows) 1 2 3 4 5
8. Do gardening work 1 2 3 4 5
9. Make the bed 1 2 3 4 5
10. Carry the shopping bag or a briefcase 1 2 3 4 5
11. Carry a heavy object (over 5 kg) 1 2 3 4 5
12. Change a light bulb located above your head 1 2 3 4 5
13. Washing or drying hair 1 2 3 4 5
14. Washing the back 1 2 3 4 5
Put on a sweater 1 2 3 4 5
16. Use a knife to cut food 1 2 3 4 5
17. Recreational activities that require little effort (e.g., playing cards,
knitting 1 2 3 4 5
18. Recreational activities in which force is applied or blows are received on
1
arm, on the shoulder or on the hand (e.g. using the hammer, playing at 2 3 4 5
tennis or golf, etc.
19. Recreational activities that require free arm movement
(e.g. playing frisbee, badminton, etc.) 1 2 3 4 5
20. However, in the face of the need for movement (going from one place to
another) 1 2 3 4 5
21. Sexual activity 1 2 3 4 5

Institute for Work & Health (IWH) 2003. All rights reserved
Italian translation courtesy of GLOBE, Working Group for Evidence-Based Orthopedics
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Upper Extremity DASH Questionnaire
Disabilità del braccio, della spalla e della mano

During the past week, to what extent has your problem with your arm, shoulder, or hand interfered with daily activities?
small social activities with family, friends, neighbors, the groups they are part of?
(Indicate a number)
Not at all Very little A little Very Very much
22. 1 2 3 4 5
During the past week, he was limited in his work or other usual daily activities due to his pro-
problem in the arm, shoulder or hand?
(Indicate a number)
It hasn't me It has limited me. He/She has limited me. He has limited
There
me. are none
limited for slightly discreetly very succeeded
nothing
23. 1 2 3 4 5
Rate the intensity of the following symptoms over the past week.
Indicate a number for each line.
Nobody Dear Discrete Strong Extreme
24. Pain in the arm, shoulder, or hand 1 2 3 4 5
25. Pain in the arm, shoulder, or hand in
perform any specific activity 1 2 3 4 5
26. Tingling (sensation of pins and needles) at
arm, to the shoulder or to the hand 1 2 3 4 5
27. Weakness in the arm, shoulder, or hand 1 2 3 4 5
28. Rigidity of the arm, shoulder or hand 1 2 3 4 5
During the last week, how much difficulty have you encountered in sleeping due to pain in your arm, shoulder or
hand?
(Indicate a number)
None Dear difficulties["Slight difficulty","Significant difficulty","I was not able to"]
difficulty to sleep
29. 1 2 3 4 5
I feel less capable, less confident, or less useful due to my problem with my arm, shoulder, or hand.
Indicate a number
I am not I am
I am not No
absolutely I agree absolutely
agreed sorrows
okay Alright
30. 1 2 3 4 5

Institute for Work & Health (IWH) 2003. All rights reserved
Italian translation courtesy of GLOBE, Working Group for Evidence-Based Orthopedics
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Questionnaire for the upper limb DASH
(Disabilità del braccio, della spalla e della mano) Versione Italiana

WORK MODULE (OPTIONAL)

The following questions relate to the impact of your arm, shoulder, or hand problem on your work.
(including housework if this is their main activity).
Indicate what your job/activity is: __________________________

Indicate on each line the number that best describes your physical ability during the last week.

He/She had difficulties:

None Dear Discrete Remarkable There are none
difficulty difficulty difficulty difficulty successful
31. To use your usual technique to work? 1 2 3 4 5
32. To perform his usual work due to the
pain in the arm, shoulder or hand? 1 2 3 4 5
33. How would you like to do the job well? 1 2 3 4 5
34. To dedicate the usual amount to Your work
time? 1 2 3 4 5

MODULE FOR SPORTS/RECREATIONAL ACTIVITIES (OPTIONAL)

The following questions refer to the impact of your problem in your arm, shoulder, or hand on your ability to
playing your musical instrument or practicing your sport, or both activities.
If you practice more than one sport or play more than one instrument (or do both), please respond by referring to
the activity that is most important to her.
Indicate which sport or instrument is the most important to you: __________________________
Indicate on each line the number that best describes your physical ability during the last week.

He/She had difficulties:

None Dear Discrete Notable There are not
difficulty difficulty difficulty difficulty succeeded
35. To use your usual technique to play the
his instrument or practice his sport? 1 2 3 4 5
36. To play his instrument or practice his
due to pain in the arm, shoulder or 1 2 3 4 5
by hand?
37. To play his instrument or practice his
How would sports be good as you would like? 1 2 3 4 5
38. To dedicate to his instrument or to his sport the
usual amount of time? 1 2 3 4 5

Institute for Work & Health (IWH) 2003. All rights reserved
Italian translation courtesy of GLOBE, Working Group for Evidence-Based Orthopedics