Systematic review of the quality of the cross-cultural adaptations of disabilities of the arm, shoulder and hand (Dash)

Background: The Disabilities of the Arm, Shoulder and Hand (DASH) Outcome Measure is a widely used patient reported outcome measure. Objective: The aim of this study is to evaluate the quality of translation procedures and assessment of the psychometric properties of cross-cultural adaptations of the DASH. Methods: We reviewed the literature to identify all published studies of cultural adaptations of the DASH questionnaire. For the quality assessment, we used Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures, Quality Criteria for Psychometric Properties of Health Status Questionnaire and COSMIN Checklist for Cross-Cultural Validity. Results: We included 25 articles with 26 versions of the DASH. Only the Puerto Rican version followed all six of the processes of cross-cultural adaptation. None of the versions assessed all eight measurement properties for Quality Criteria for Psychometric Properties of Health Status Questionnaire and none of them had a positive rating from agreement, internal consistency, responsiveness and interpretability. All the studies got a poor rating according to the COSMIN checklist. Discussion: None of the versions got a good rating from all three checklists. We observed that supplementary tests for the adaptations are necessary, especially for assessing agreement, responsiveness and interpretability. We con-cluded that all versions need more research on psychometric properties.