This puper describes the development of an evaluative outcome measure .for patients with upper extremity musculoskeletal conditions. The goal is to produce a brieJ self-administered measure c$ symptoms und filnctional status, with a ,fi)cus on physical jirnction, to he used by clinicians in daily practice and as a research tool. This is a joint initiative of the American Acudemy id Orthopedic Surgeons (AAOS), the Council cfMusculoskeleta1 Specialty Societies (COMSS), and the Institute for Work and Health (Toronto, Ontario).
Our approach is consistent with previous1.y describrd strutegieshw .sr.ule cltvelopment. hi Stage I , Item Generation, a group qf methodologists and clinical experts reviewed 13 outcome measurement scales currently in use and generated a list of 821 items. In Stage 2a, Initial Item Reduction, these 821 items were reduced to 78 items using various strategies including removal of items which were generic, repetitive, not reflective of disability, or not relevunt to the upper extremity or to one ofthe targeted concepts of symptoms arid functionnl status. Items not highly endorsed in a survey of content experts were also eliminated, Stage Zb, Further Item Reduction, will be based on results rf ,field testing in which patients complete the 78-item questionnaire. This .field testing, which is currently underway in 20 centers in the United Stutes, Canada, and Australia, will generute the final jhrmut and content of the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Future work includes plans for validity arid reliability testing. o I996 W ; I ~~-L ; S S . IK.