Measurement properties of the Dizziness Handicap Inventory by cross-sectional and longitudinal designs

Abstract

BackgroundThe impact of dizziness on quality of life is often assessed by the Dizziness Handicap Inventory (DHI), which is used as a discriminate and evaluative measure. The aim of the present study was to examine reliability and validity of a translated Norwegian version (DHI-N), also examining responsiveness to important change in the construct being measured.MethodsTwo samples (n = 92 and n = 27) included participants with dizziness of mainly vestibular origin. A cross-sectional design was used to examine the factor structure (exploratory factor analysis), internal consistency (Cronbach's α), concurrent validity (Pearson's product moment correlation r), and discriminate ability (ROC curve analysis). Longitudinal designs were used to examine test-retest reliability (intraclass correlation coefficient (ICC) statistics, smallest detectable difference (SDD)), and responsiveness (Pearson's product moment correlation, ROC curve analysis; area under the ROC curve (AUC), and minimally important change (MIC)). The DHI scores range from 0 to 100.ResultsFactor analysis revealed a different factor structure than the original DHI, resulting in dismissal of subscale scores in the DHI-N. Acceptable internal consistency was found for the total scale (α = 0.95). Concurrent correlations between the DHI-N and other related measures were moderate to high, highest with Vertigo Symptom Scale-short form-Norwegian version (r = 0.69), and lowest with preferred gait (r = - 0.36). The DHI-N demonstrated excellent ability to discriminate between participants with and without 'disability', AUC being 0.89 and best cut-off point = 29 points. Satisfactory test-retest reliability was demonstrated, and the change for an individual should be ≥ 20 DHI-N points to exceed measurement error (SDD). Correlations between change scores of DHI-N and other self-report measures of functional health and symptoms were high (r = 0.50 - 0.57). Responsiveness of the DHI-N was excellent, AUC = 0.83, discriminating between self-perceived 'improved' versus 'unchanged' participants. The MIC was identified as 11 DHI-N points.ConclusionsThe DHI-N total scale demonstrated satisfactory measurement properties. This is the first study that has addressed and demonstrated responsiveness to important change of the DHI, and provided values of SDD and MIC to help interpret change scores.

Adaptação brasileira do dizziness handicap inventory para a população infantil: confiabilidade dos resultados

“…Not only is the DHI clinically useful for evaluating the disadvantage of dizziness self-perceived by the patient (5) , but also for demonstrating the functional results of patients during (13)(14)(15)(16) and after treatment (8,26) . The internal consistency of the results obtained with the DHI-CA was shown to be adequate and close to the values of the original DHI, developed for the adult population 7) , and of the data found in the international literature (8,9,(11)(12)(13)(14)(15)(16)19,20,27) . The internal consistency values were lower in the subscales, taking as reference the Brazilian version of the DHI for adults, and this may be associated with the children's difficulty in precisely describing the symptoms of dizziness in their self--reports, considering the diversity of symptoms present (4) .…”

“…In turn, the correlations obtained between the scores in the test and retest ratified the stability of the measure; that is, a new indicator in favor of the reliability of the results of the inventory (8,9,15,20) .…”

“…In turn, physical incapacity is defined as a set of disadvantages experienced by individuals as a functional and/or organic deterioration of one or more systems (5) . The original American version of the DHI (7) has been translated and adapted to various cultures, such as Persia (8) , and countries such as Argentina (9) , Brazil (10) , Portugal (11) , Bulgaria (12) , Japan (13) , Israel (14) , Germany (15) , Italy (16) , France (17) , Spain (18) , China (19) , Norway (20) , Holland (21) , Colombia (22) , making it a widely accepted instrument (3) . However, there are no publications of the DHI in a version directed towards children, limiting its applicability by researchers in the child population.…”

Impact of carotid stenting in dizzy patients with carotid stenosis

“…It has high internal consistency and good testeretest reliability. 15,16 The production of the Chinese version of the DHI also followed the standard forward, backward, and pretest steps for instrument translation. 17 The Cronbach a coefficient values for the Chinese version of DHI were all above the criteria of 0.7 (range, 0.79e0.87) with good testeretest reliability.…”

Improving Balance through Virtual Reality and Physical Therapy Integration

“…To objectively measure the amount of adaptation and habituation, the Dizziness Handicap Inventory (DHI), with minimal detectable change (MCD) of 18, was used to quantify the patient's self-perception [10]. DHI has is valid and has high test-retest reliability for total score (r = 0.97, df = 12, p < 0.0001), for sub-scale scores (r = 0.92 -0.97, p < 0.001) [11].…”