Disability Assessment Scale (DAS)

Evidence Reviewed as of before: 19-06-2012
Author(s): Katie Marvin, MSc. PT
Editor(s): Annabel McDermott; Nicol Korner-Bitensky, PhD OT

Purpose

The Disability Assessment Scale (DAS) evaluates upper limb functional disability in patients with spasticity following stroke

In-Depth Review

Purpose of the measure

The Disability Assessment Scale (DAS) evaluates upper-limb functional disability in patients with spasticity following stroke. The DAS was developed as a tool that objectively evaluates functional impairment resulting from spasticity.

Available versions

None reported.

Features of the measure

Items:

  • Hand hygiene
    • Extent of palm maceration, ulceration or infection.
    • Cleanliness of the palm, ease of cleaning, nail trimming.
    • Effect of hygiene-related disability on other areas of functioning.
  • Dressing
    • Ability to dress.
    • Effect of dressing-related disability on other areas of functioning.
  • Limb position abnormality.
    • Amount of abnormal limb position.
  • Pain
    • Intensity of pain or discomfort related to upper-limb spasticity.
    • Interference with activities of daily living.

Description of tasks:

Patients are interviewed to determine the extent of functional impairment for the following 4 areas:

  • Hygiene: The rater assesses the extent of palm maceration, ulceration, or infection; cleanliness of the palm, ease of cleaning, and nail trimming; and the effect of hygiene-related disability on other areas of functioning.
  • Dressing: The rater assess the patient’s ability to dress and the effect of dressing-related disability on other areas of functioning.
  • Limb position: The rater assesses the amount of abnormal position of the limb; and
  • Pain: The rater assesses the intensity of pain or discomfort related to upper-limb spasticity and interference with activities of daily living.

Scoring and Score Interpretation:

The DAS Scale uses a 4-point rating scale according to the following criteria:

  • 0 – no disability.
  • 1 – mild disability (noticeable but does not interfere significantly with normal activities.
  • 2 – moderate disability (normal activities require increased effort and/or assistance).
  • 3 – severe disability (normal activities limited).

Time:

Not typically reported.

Training requirements:

None reported.

Subscales:

None

Equipment:

None reported.

Alternative Forms of the Disability Assessment Scale

None reported.

Client suitability

Can be used with:

  • Clients with stroke with spasticity.

Should not be used with:

  • Clients without spasticity.

Languages of the measure

None reported.

Summary

What does the tool measure? Functional disability in patients with spasticity.
What types of clients can the tool be used for? The Disability Assessment Scale can be used with, but is not limited to clients with post-strokespasticity.
Is this a screening or assessment tool? Assessment
Time to administer Not reported
Versions None
Other Languages None
Measurement Properties
Reliability

Intra-rater:y.

One study examined the intra-rater reliability of the DAS in patients with spasticity following stroke and found adequate to excellent intra-rater reliability.

Inter-rater:y.

One study examined the inter-rater reliability of the DAS in patients with spasticity following stroke and found adequate to excellent inter-rater reliability.

Validity No studies have examined the validity of the DAS.
Floor/Ceiling Effects No studies have examined the floor/ceiling effects of the DAS.
Does the tool detect change in patients? The responsiveness of the DAS has not formally been studied, however the DAS has been used to measure change in spasiticity in a clinical trial with patients with stroke.
Acceptability The DAS is one of the only tools available for evaluation of upper limb functional disability in patients with spasticity following stroke.
Feasibility There is a lack of information about the DAS, affecting ease of administration.
How to obtain the tool? See: Brashear, A., Zafonte, R., Corcoran, M., Galvez-Jimenez, N., Gracies, J-M., Gordon, M.F., et al. (2002). Inter- and Intrarater reliability of the Ashworth Scale and the Disability Assessment Scale in patients with upper-limb poststroke spasticity. Archives of Physical Medicine Rehabilitation, 83, 1349-1351.

Psychometric Properties

Overview

A literature search was conducted to identify all relevant publications on the psychometric properties of the Disability Assessment Scale when used with patients with stroke. Only one study was identified. Further studies are required before definitive conclusions can be drawn regarding the reliability and validity of the DAS for use with patients following stroke.

Floor/Ceiling Effects

No studies were identified examining the floor/ceiling effects of the DAS.

Reliability

Internal consistency:
No studies have examined the internal consistency of the DAS.

Intra-rater:
Brashear et al. (2002) investigated the intra-rater reliability of the DAS in nine patients with spasticity following stroke. All patients were evaluated twice on the same day by 10 trained evaluators. Inter-rater reliability, as calculated using overall weighted kappa scores, was adequate to excellent (k=0.520, 0.530, 0.775 and 0.776 for hygiene, dressing, limb position and pain respectively).

Inter-rater:
Brashear et al. (2002) investigated the inter-rater reliability of the DAS in nine patients with spasticity following stroke. All patients were evaluated twice on the same day (at least an hour apart) by 10 trained evaluators. Inter-rater reliability, as calculated using Kendall’s W, was adequate to excellent (Kendall’s W=0.494, 0.557, 0.626 and 0.772 for dressing, limb position, hygiene, and pain respectively).

Test-retest:
No studies have examined the test-retest reliability of the DAS.

Validity

Content:

No studies have examined the content validity of the DAS.

Criterion:

Concurrent:
No studies have examined the concurrent validity of the DAS.

Predictive:
No studies have examined the predictive validity of the DAS.

Construct:

Convergent/Discriminant:
No studies have examined the convergent/discriminant validity of the DAS.

Known Groups:
No studies have examined the known groups validity of the DAS.

Sensitivity/ Specificity:

No studies have examined the sensitivity/specificity of the DAS.

Responsiveness

Brashear et al. (2002) investigated the effect of Botulinum Toxin A on arm flexor spasticity in 126 patients with stroke over a 12-week period. The DAS was administered at baseline 4, 6, 8 and 12-weeks. Although the responsiveness of the DAS was not formally assessed in this study, the scale was sensitive enough to detect an improvement in function following botox treatment.

References

  • Brashear, A., Gordon, M.F., Elovic, E., Kassicieh, V.D., Marciniak, C., Do, M., Lee, C-H, Jenkins, S. et al. (2002). Intramuscular injection of botulinum toxin for the treatment of wrist and finger spasticity after a stroke. New England Journal of Medicine, 347(6), 395-400.
  • Brashear, A., Zafonte, R., Corcoran, M., Galvez-Jimenez, N., Gracies, J-M., Gordon, M.F., et al. (2002). Inter- and Intrarater reliability of the Ashworth Scale and the Disability Assessment Scale in patients with upper-limb poststroke spasticity. Archives of Physical Medicine Rehabilitation, 83, 1349-1351.

See The Measure

Further information on the DAS can be found in the following publication

Brashear, A., Zafonte, R., Corcoran, M., Galvez-Jimenez, N., Gracies, J-M., Gordon, M.F., et al. (2002). Inter- and Intrarater reliability of the Ashworth Scale and the Disability Assessment Scale in patients with upper-limb poststroke spasticity. Archives of Physical Medicine Rehabilitation, 83, 1349-1351.

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