Introduction
The Duke Activity Status Index (DASI) is a self-administered questionnaire that estimates functional capacity and metabolic equivalents (METs) in patients, particularly those undergoing preoperative evaluation or cardiovascular care. Developed by Dr. Mark A. Hlatky and colleagues, the DASI has become a widely used tool in clinical settings to assess physical functioning and predict health outcomes.
This guide offers a detailed overview of the DASI, including its structure, clinical utility, scoring method, and relevance in modern healthcare.
Key Features of the Duke Activity Status Index
Purpose and Use
The DASI primarily assess functional capacity, estimates metabolic equivalents (METs) in patients, particularly for preoperative risk stratification, and monitors cardiovascular rehabilitation progress.
Target Population
The DASI is available for adults aged 18 and older, particularly those in the 40–80 age range. It is especially relevant for:
- Patients with cardiovascular disease
- Individuals preparing for surgery
- Those undergoing rehabilitation
Structure
The DASI consists of 12 items, each relating to a specific physical activity. These activities range from light tasks such as dressing to more intense activities like running or lifting. Each item is assigned a MET value, and the total score provides an estimate of the patient’s overall functional capacity.
Domains Covered include:
- Cardiovascular Health
- Activities of Daily Living
- Exercise Tolerance
Scoring Method
The DASI uses a True/False response format. Each of the 12 activities is assigned a specific metabolic equivalent (MET) value—(e.g, light housework corresponds to 2.75 METs).
The total score is calculated by summing the MET values of all activities the patient reports being able to perform, resulting in a possible range of 0 to 58.2 METs. A total score of 34 METs or higher indicates a functional capacity of at least 10 METs, which is associated with low surgical risk. Conversely, a score below 34 METs suggests a higher perioperative risk.
Administration Format
The DASI is available in paper-based, digital formats and in-person interview. The test typically takes less than 5 minutes to complete.
Applications of the Duke Activity Status Index
The DASI has broad clinical applications:
- Diagnosis: Helps identify reduced exercise tolerance
- Monitoring: Tracks progress during cardiac rehabilitation
- Treatment Planning: Guides interventions based on functional ability
- Research: Used in studies examining functional and cardiovascular outcomes
Languages Available
The DASI is available in multiple languages, including:
- English
- Spanish
- French
- German
- Portuguese
This wide range of languages makes it a versatile tool in international settings.
Reliability and Validity
The DASI has shown high reliability and validity, with a Cronbach’s alpha of 0.81–0.86. It has been validated across multiple languages and populations, including post-stroke patients and individuals in diverse cardiac care settings.
Limitations and Considerations
While the DASI is an effective tool, it has some limitations, including:
- Self-Report Measure: Results are based on the individual’s self-perceptions, which may introduce bias.
- Cultural Bias: Some scales may not be equally applicable across different cultural contexts.
Additional Resources
Access the following resources:
- The questionnaire as PDF
- The original validation study
- A recent validation study of the questionnaire by telephone here
Frequently Asked Questions (FAQ)
- What is the DASI used for?
The DASI assesses functional capacity, estimates metabolic equivalents (METs) in adults, cardiovascular health evaluations, and monitoring progress in cardiac rehabilitation programs. - How long does the DASI take to complete?
The DASI takes less than 5 minutes to complete - Is training required to administer the DASI?
No specialized training is required. The DASI is self-administered or can be administered with basic training. - What languages is the DASI available in?
The DASI is available in several languages, including English, Spanish, French, German, Portuguese, Hindi, and Italian.
A word from ResRef about Duke Activity Status Index
At ResRef, we recognize the importance of standardized, reliable assessments in advancing research and clinical practice. The DASI bridges subjective patient experiences with objective clinical data. Its ease of use, strong psychometric properties, and alignment with clinical guidelines make it an indispensable tool for enhancing preoperative care and cardiovascular health management.
References
- Hlatky MA, Boineau RE, Higginbotham MB, Lee KL, Mark DB, Califf RM, Cobb FR, Pryor DB. A brief self-administered questionnaire to determine functional capacity (the Duke Activity Status Index). Am J Cardiol. 1989 Sep 15;64(10):651-4. doi: 10.1016/0002-9149(89)90496-7. PMID: 2782256. Study link
- Dias C, Torriani-Pasin C, Galvão ACJ, Costa PHV, Polese JC. Validation of the Duke Activity Status Index questionnaire by telephone In individuals after stroke. Int J Cardiol Cardiovasc Risk Prev. 2023 Aug 23;19:200208. doi: 10.1016/j.ijcrp.2023.200208. PMID: 37663031; PMCID: PMC10472231. Study link
