Duke Activity Status Index
The Duke Activity Status Index (DASI) is a validated, 12-item self-administered questionnaire developed to assess patients' functional capacity by querying their ability to perform common daily activities, such as personal care, ambulation, and household or recreational tasks, each weighted by estimated metabolic equivalents (METs).[1] Scores range from 0 to 58.2, with higher values indicating greater functional capacity and correlating significantly with peak oxygen uptake (VO₂ max), a key measure of cardiorespiratory fitness (Spearman correlation coefficients of 0.80 in development and 0.58 in validation cohorts, both p < 0.0001).[1] Originally created in 1989 by Hlatky et al. at Duke University to provide a practical alternative to exercise testing for evaluating quality of life and physical limitations, the DASI has demonstrated strong reliability (e.g., test-retest intraclass correlation coefficient of 0.87 and internal consistency Cronbach's α of 0.93) and concurrent validity in diverse populations.[1][2] Primarily applied in cardiovascular medicine, the DASI evaluates functional status in conditions like coronary artery disease, heart failure, myocardial ischemia, and infarction, aiding in treatment monitoring, rehabilitation outcomes, and prognostic assessments.[2] It has also been integrated into preoperative risk stratification for noncardiac surgery, where a score of ≥34 suggests low perioperative cardiovascular risk, while lower scores predict higher rates of complications, mortality, and prolonged recovery.[3][4] Systematic reviews confirm its association with postoperative adverse events, supporting its use alongside clinical guidelines like those from the American College of Cardiology/American Heart Association.[5] The tool's brevity (administration time of 1–3.5 minutes) and patient-centered approach make it widely accessible in clinical settings worldwide, with translations and cultural adaptations enhancing its global utility.[2]Overview
Definition and Purpose
The Duke Activity Status Index (DASI) is a 12-item, self-administered questionnaire that evaluates an individual's functional capacity by querying their ability to perform a range of common daily activities, such as personal care, household tasks, ambulation, and recreational pursuits, without developing symptoms like shortness of breath, anginal pain, or excessive fatigue.[6] Developed specifically for use in patients with cardiovascular disease, it provides a subjective measure of physical limitations in routine functioning.[1] The primary purpose of the DASI is to estimate peak oxygen uptake (VO₂ max) and metabolic equivalents (METs) as indicators of cardiovascular fitness and exercise capacity, offering a practical tool for clinical decision-making.[4] These estimates facilitate risk stratification, such as identifying perioperative cardiac risks, prognostic evaluation in chronic conditions, and personalized treatment planning, including exercise prescriptions or surgical recommendations.[4][7] Functional capacity, as assessed by the DASI, encompasses the extent to which a person can engage in activities of daily living without symptom limitation, serving as a key proxy for overall cardiorespiratory health.[6] The tool demonstrates strong correlation with objective gold-standard measures, such as those from cardiopulmonary exercise testing (CPET), with Spearman correlation coefficients ranging from 0.58 to 0.80 in validation cohorts, thereby validating its utility as a reliable, non-invasive alternative in resource-limited settings.[6][8]Historical Development
The Duke Activity Status Index (DASI) was developed by Mark A. Hlatky and a team of colleagues, including Robert E. Boineau, Michael B. Higginbotham, Kerry L. Lee, Daniel B. Mark, Robert M. Califf, Frank R. Cobb, and David B. Pryor, all affiliated with the Duke University Medical Center in Durham, North Carolina. The instrument emerged from research supported by grants from the National Heart, Lung, and Blood Institute, the National Center for Health Services Research, the National Library of Medicine, the Andrew W. Mellon Foundation, and the Robert Wood Johnson Foundation. It was first published in 1989 in the American Journal of Cardiology under the title "A brief self-administered questionnaire to determine functional capacity (the Duke Activity Status Index)."[1] The development of the DASI addressed the need for a practical, patient-reported measure of functional capacity in cardiovascular care, serving as a noninvasive alternative to resource-intensive methods like cardiopulmonary exercise testing (CPET) or formal treadmill assessments with peak oxygen uptake measurement.[9] Researchers interviewed 50 subjects undergoing treadmill exercise testing to identify common daily activities and their metabolic equivalents, deriving a 12-item questionnaire that correlated strongly with objective peak oxygen uptake (Spearman correlation coefficient of 0.80).[1] This initial cohort primarily consisted of patients evaluated for known or suspected coronary artery disease via cardiac catheterization, reflecting the tool's origins in assessing functional limitations tied to cardiac conditions.[9] Validation in an independent group of 50 similar patients confirmed its utility, with a correlation of 0.58 (p < 0.0001).[1] Following its inception, the DASI evolved beyond its primary focus on coronary artery disease through targeted validations in the 1990s and 2000s, expanding applicability to diverse cardiovascular and related populations. In 1997, a reduced version demonstrated reliability and validity in chronic coronary patients post-myocardial infarction or revascularization.[10] By 2000, it was validated for women with suspected coronary disease, showing reasonable correlation with treadmill-derived functional capacity.[11] Into the early 2000s, adaptations extended to noncardiac groups, such as patients with chronic obstructive pulmonary disease (COPD), where it exhibited concurrent criterion validity against physiologic work capacity measures.[12] These milestones broadened the DASI's role as a versatile, self-reported tool for functional assessment across varied clinical contexts.[13]Questionnaire Design
Component Items
The Duke Activity Status Index (DASI) questionnaire consists of 12 yes/no questions designed to assess a patient's ability to perform a range of daily activities, categorized into personal care, sexual activity, household tasks, yard work, and recreational activities. Each item is weighted according to its estimated metabolic equivalent of task (MET) value, which quantifies the energy expenditure required for the activity. These weights were derived from established MET values in the Compendium of Physical Activities, allowing for a standardized measure of functional capacity.[9] The specific items and their corresponding weights are as follows:| Item | Activity Description | Weight (METs) |
|---|---|---|
| 1 | Can you take care of yourself, that is, eating, dressing, bathing, or using the toilet? | 2.75 |
| 2 | Can you walk indoors, such as around your house? | 1.75 |
| 3 | Can you walk a block or two on level ground? | 2.75 |
| 4 | Can you climb a flight of stairs or walk up a hill? | 5.50 |
| 5 | Can you run a short distance? | 8.00 |
| 6 | Can you do light work around the house like dusting or doing the dishes? | 2.70 |
| 7 | Can you do moderate work around the house like vacuuming, sweeping floors, or carrying groceries? | 3.50 |
| 8 | Can you do heavy work around the house like scrubbing floors or lifting or moving heavy furniture? | 8.00 |
| 9 | Can you do yard work like raking leaves, weeding, or pushing a power mower? | 4.50 |
| 10 | Can you have sexual relations? | 5.25 |
| 11 | Can you participate in moderate recreational activities like golf, bowling, dancing, doubles tennis, or throwing a baseball or football? | 6.00 |
| 12 | Can you participate in strenuous sports like swimming, singles tennis, football, basketball, or skiing? | 7.50 |