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Predictive value of the DASH tool for predicting return to work of injured workers with musculoskeletal disorders of the upper extremity
  1. Susan Armijo-Olivo1,
  2. Linda J Woodhouse2,
  3. Ivan A Steenstra3,
  4. Douglas P Gross2
  1. 1Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
  2. 2Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
  3. 3Ted Rogers School of Management, Ryerson University, Toronto, Ontario, Canada
  1. Correspondence to Dr Susan Armijo-Olivo, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada; susanarmijo{at}


Objectives To determine whether the Disabilities of the Arm, Shoulder, and Hand (DASH) tool added to the predictive ability of established prognostic factors, including patient demographic and clinical outcomes, to predict return to work (RTW) in injured workers with musculoskeletal (MSK) disorders of the upper extremity.

Methods A retrospective cohort study using a population-based database from the Workers’ Compensation Board of Alberta (WCB-Alberta) that focused on claimants with upper extremity injuries was used. Besides the DASH, potential predictors included demographic, occupational, clinical and health usage variables. Outcome was receipt of compensation benefits after 3 months. To identify RTW predictors, a purposeful logistic modelling strategy was used. A series of receiver operating curve analyses were performed to determine which model provided the best discriminative ability.

Results The sample included 3036 claimants with upper extremity injuries. The final model for predicting RTW included the total DASH score in addition to other established predictors. The area under the curve for this model was 0.77, which is interpreted as fair discrimination. This model was statistically significantly different than the model of established predictors alone (p<0.001). When comparing the DASH total score versus DASH item 23, a non-significant difference was obtained between the models (p=0.34).

Conclusions The DASH tool together with other established predictors significantly helped predict RTW after 3 months in participants with upper extremity MSK disorders. An appealing result for clinicians and busy researchers is that DASH item 23 has equal predictive ability to the total DASH score.

  • Upper extremity disorders
  • Return to work
  • Disabilities of the Arm, Shoulder, and Hand (DASH)
  • Prognosis

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  • Contributors SA-O and DPG provided concept/idea/research design and writing. IAS and LJW provided feedback for concept/idea/research design and provided writing. SA-O performed statistical analysis. All authors critically revised the final version of the manuscript and provided final approval of the version to be published.

  • Funding The data for this study were obtained in a study funded by a research grant from the Workers’ Compensation Board of Alberta. SA-O is funded by a ‘Music in Motion’ Fellowship from the Faculty of Rehabilitation Medicine.

  • Competing interests None declared.

  • Ethics approval University of Alberta Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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