Exploração do Disabilities Arm, Shoulder and Hand (DASH) através da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) e da análise Rasch

Abstract

With advances in the health field and consequent elimination and control of a number of acute illnesses, there has been an increase in chronic and/or incapacitating illnesses. This situation has become one of the greatest concerns of health service professionals, clientele and managers, and has led to the systematization of clinical practices so as to facilitate communication among health professionals, clientele and institutions. The use of classifications and standardized measurement tools helps avoids subjective, biased opinions. In 2001, the World Health Organization (WHO) approved the International Classification of Functioning, Disability and Health (ICF) with the aim of providing a scientific basis for understanding and studying health and health-related conditions through determinants and effects. In 2003, the Disabilities of the Arm, Shoulder and Hand (DASH), which is a tool used to measure symptoms and functions of the upper limbs, was adapted to Portuguese. In Brazil, health professionals in the field of rehabilitation especially physical therapists providing care for individuals with musculoskeletal disorders of the upper limbs face the two-fold challenge of implementing the ICF in clinical practice and research, and adopting health measures that are compatible with the model the classification proposes. Thus, the aims of the present study were the following: (1) investigate the possibility of comparing DASH items to ICF categories; and (2) evaluate the psychometric properties of the Brazilian version of DASH through the Rasch methodology, and consequently assess its possible recommendation for clinical use among workers with repetitive strain injuries. A further aim was to describe the degree of functional compromise of such workers, codifying results through the ICF. The results of the investigations are presented in two articles. The first demonstrates that DASH adapts well to the theoretical ICF model. The second highlights the large number of erratic items in the Portuguese version of DASH, that is, items that allow a wide variety of responses and a number of "very easy" items for which the responses are quite predictable. This indicates problems related to the validity of the instrument for this sample. Taking the sample characteristics and the high degree of functional compromise into account, it is possible that the erratic items present different behavior in other groups. As DASH proved to be adapted to the theoretical ICF model, its use in rehabilitation services for individuals affected in the upper limbs can be indicated. For the specific case of workers with repetitive strain injuries, the results should be interpreted with special attention to the erratic items, and the use of DASH together with other instruments and measures may best quality to the clinical findings.