Minimal Clinically Important Difference of the Disabilities of the Arm, Shoulder and Hand (DASH) and the Shortened Version of the DASH (QuickDASH) in People With Musculoskeletal Disorders: A Systematic Review and Meta-Analysis.

Most included studies followed people for 3 months or less, and only three followed them for 6 months, so the thresholds may not describe longer-term change. Most patients (1014 of 1677) had conservative physical therapy; the rest had surgery, shockwave or physical therapy after surgery, and for 180 the treatment was not described. The thresholds may differ by treatment. The studies disagreed about who counted as improved on their rating scales, and that changes the answer: in one study the threshold moved from 11.7 to 12.5 DASH points depending on which patients were counted. Quality was uneven. MCID reporting scored a median of 12.5 out of 18 points, the checklist used for that scoring has not been validated, and measurement-error reporting was inadequate in one study and doubtful in three. Publication bias could not be assessed because fewer than 10 studies went into each meta-analysis. The values come from adults with musculoskeletal upper limb disorders. The authors say they may not apply to people with neurological conditions or to one specific diagnosis, and children and people with neurological comorbidities were excluded. None of the included studies adjusted the analysis for how severe people were at the start, although the authors note that baseline severity affects the MCID.

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Do not use 12 points as a fixed pass mark for every patient. The studies behind it called people 'improved' at different points on their rating scales, and in one study the threshold moved from 11.7 to 12.5 DASH points depending on who was counted as improved. The authors themselves present these as ranges to choose within. The pooled values also come only from adults with upper limb musculoskeletal problems and may not hold for people with neurological conditions.