Examining the Disabilities of the Arm, Shoulder, and Hand outcome instrument in extended reality: X-DASH.

Background: Patient-reported outcome measures (PROMs) rely on individual interpretation of questions and recall ability, which limits their standardization. We developed an extended reality (XR) PROM, transforming questions from the Disabilities of the Arm, Shoulder, and Hand (DASH) measure into standardized tasks and assessed its usability, validity, and reliability (X-DASH). We hypothesized that the X-DASH would show equivalent preliminary validity and reliability as conventionally administered DASH questions (C-DASH). Methods: The X-DASH simulated 6 activities corresponding to the DASH questionnaire (jar opening, key turning, surface cleaning, back washing, bread cutting, and hammering) and was evaluated in 2 phases. In phase 1, usability was assessed with 20 healthy subjects using the System Usability Scale. In both phases, versions of the questionnaire were delivered conventionally via computer (C-DASH) and using X-DASH. Phase 2 included 40 patients with documented shoulder pathology using a randomized, cross-sectional design. Results: Phase 1: X-DASH scores were significantly higher (ie, worse) than C-DASH scores ( Conclusion: To our knowledge, this is the first study to evaluate XR-based PROM delivery. The X-DASH shows similarities to C-DASH in our proof of concept, though scoring differences compared to C-DASH warrant further investigation.