The Use of a Tablet Computer to Complete the DASH Questionnaire


      To determine whether electronic self-administration of the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire using a tablet computer increased completion rate compared with paper self-administration.


      We gave the DASH in self-administered paper form to 222 new patients in a single hand surgeon's practice. After a washout period of 5 weeks, we gave the DASH in self-administered tablet computer form to 264 new patients. A maximum of 3 questions could be omitted before the questionnaire was considered unscorable. We reviewed the submitted surveys to determine the number of scorable questionnaires and the number of omitted questions in each survey. We completed univariate analysis and regression modeling to determine the influence of survey administration type on respondent error while controlling for patient age and sex.


      Of the 486 total surveys, 60 (12%) were not scorable. A significantly higher proportion of the paper surveys (24%) were unscorable compared with electronic surveys (2%), with significantly more questions omitted in each paper survey (2.6 ± 4.4 questions) than in each electronic survey (0.1 ± 0.8 questions). Logistic regression analysis revealed survey administration mode to be significantly associated with DASH scorability while controlling for age and sex, with electronic survey administration being 14 times more likely than paper administration to yield a scorable DASH.


      In our retrospective series, electronic self-administration of the DASH decreased the number of omitted questions and yielded a higher number of scorable questionnaires. Prospective, randomized evaluation is needed to better delineate the effect of survey administration on respondent error.

      Clinical relevance

      Administration of the DASH with a tablet computer may be beneficial for both clinical and research endeavors to increase completion rate and to gain other benefits from electronic data capture.

      Key words

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        • Hudak P.L.
        • Amadio P.C.
        • Bombardier C.
        Development of an upper extremity outcome measure: the DASH (Disabilities of the Arm, Shoulder, and Hand) [corrected].
        Am J Ind Med. 1996; 29: 602-608
        • Alderman A.K.
        • Chung K.C.
        Measuring outcomes in hand surgery.
        Clin Plast Surg. 2008; 35: 239-250
        • Saleh K.J.
        • Radosevich D.M.
        • Kassim R.A.
        • Moussa M.
        • Dykes D.
        • Bottolfson H.
        • et al.
        Comparison of commonly used orthopaedic outcome measures using palm-top computers and paper surveys.
        J Orthop Res. 2002; 20: 1146-1151
        • Galliher J.M.
        • Stewart T.V.
        • Pathak P.K.
        • Werner J.J.
        • Dickinson L.M.
        • Hickner J.M.
        Data collection outcomes comparing paper forms with PDA forms in an office-based patient survey.
        Ann Fam Med. 2008; 6: 154-160
        • Institute for Work and Health
        Scoring the DASH outcome measure.
        (Accessed: August 10, 2012)
        • Lane S.J.
        • Heddle N.M.
        • Arnold E.
        • Walker I.
        A review of randomized controlled trials comparing the effectiveness of hand held computers with paper methods for data collection.
        BMC Med Inform Decis Mak. 2006; 6: 23
        • Coons S.J.
        • Gwaltney C.J.
        • Hays R.D.
        • Lundy J.J.
        • Sloan J.A.
        • Revicki D.A.
        • et al.
        Recommendations on evidence needed to support measurement equivalence between electronic and paper-based patient-reported outcome (PRO) measures: ISPOR ePRO Good Research Practices Task Force report.
        Value Health. 2009; 12: 419-429
        • Weinberger M.
        • Oddone E.Z.
        • Samsa G.P.
        • Landsman P.B.
        Are health-related quality-of-life measures affected by the mode of administration?.
        J Clin Epidemiol. 1996; 49: 135-140
        • Drummond H.E.
        • Ghosh S.
        • Ferguson A.
        • Brackenridge D.
        • Tiplady B.
        Electronic quality of life questionnaires: a comparison of pen-based electronic questionnaires with conventional paper in a gastrointestinal study.
        Qual Life Res. 1995; 4: 21-26
        • Kleinman L.
        • Leidy N.K.
        • Crawley J.
        • Bonomi A.
        • Schoenfeld P.
        A comparative trial of paper-and-pencil versus computer administration of the Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaire.
        Med Care. 2001; 39: 181-189
        • Caro J.J.
        • Caro I.
        • Caro J.
        • Wouters F.
        • Juniper E.F.
        Does electronic implementation of questionnaires used in asthma alter responses compared to paper implementation?.
        Qual Life Res. 2001; 10 (S): 683-691