Dizziness Handicap Inventory
Original Editor - Alyssa Brooks-Wells
Top Contributors - Alyssa Brooks-Wells, Jonathan Wong and Jess Bell
Objective
The Dizziness Handicap Inventory (DHI) is a patient-reported outcome measure designed to measure the disability perceived by someone with complaints of dizziness, vertigo, or unsteadiness. It comprises of 25 questions and has options for 'yes', 'no', and 'sometimes'[1]. The measure determines changes due to dizziness related to functional, emotional, and physical domains[2]. The DHI is available in 22 different languages including English, Spanish, Dutch, Norwegian, Swedish, Chinese, and German[3].
Intended Population
The DHI is intended as an outcome measure for patients with primary complaints of dizziness, vertigo, unsteadiness, or related symptoms.[4]
Some pathologies or diagnoses related include:
- Benign Paroxysmal Positional Vertigo (BPPV)
- Vestibular Neuritis and Labyrinthitis
- Neurologic Disorders (such as multiple sclerosis)
- Traumatic Brain Injury or Concussion
- Meniere's Disease
- Persistent Postural-Perceptual Dizziness
- Migraine (vestibular migraine)
Method of Use
The DHI is a 25-item self-reported measure with three categories: functional, emotional, and physical. It is an efficient outcome measure, taking about 10 min or less to complete. The patient rates their perceived disability due to their dizziness by answering each question with - yes, sometimes, or no. The measure is then scored with points for each answer: No = 0, Sometimes = 2, and Yes = 4 points, thus the greater the score, the greater the perceived disability out of a total of 100 points. It is recommended patients with scores greater than 10 points are referred to balance specialists for further evaluation. [5]
Further classification of scoring includes:
- Mild Handicap: 16-34 Points
- Moderate Handicap: 36-52 Points
- Severe Handicap: 54+ Points[5]
Evidence
Reliability
The test-retest reliability coefficient was 0.97[4]. These results suggest that the Dizziness Handicap Inventory is a reliable, valid, and responsive instrument for the assessment of perceived disability due to dizziness. The subscales also presented with high and statistically significant (p<0.001) correlation coefficients associated with the functional, emotional, and physical subscales (r=0.92-0.97). The DHI also exhibited an excellent internal consistency for the total score with alpha = 0.89. [5]
Validity
A moderately strong correlation between the Activities-Specific Balance Confidence (ABC) Scale and the DHI has been demonstrated (r=-0.64).[6] Also, Whitney, et al. 2005 demonstrated the criterion validity of a BPPV 5-item and 2-item subscales of the DHI correlating strongly with the diagnosis of BPPV. A score of 8 out of 8 on the 2-item BPPV scale (getting out of bed, rolling over in bed) were 4.3 times more likely to have a diagnosis of BPPV compared to those with a scale of 0.[7]
The DHI shows a strong correlation with functional balance testing, dynamic gait index, and functional reach tests[4]. Despite these findings, a recent systematic review suggests the DHI has limited content validity[8].
Responsiveness
The DHI was found to have moderate responsiveness for individuals participating in a vestibular rehabilitation program. It had a responsiveness score of 1.66 and required 7.24 patients to measure change.[9]
References
- ↑ Jacobson GP, Newman CW. The development of the Dizziness Handicap Inventory. Arch Otolaryngol Head Neck Surg. 1990 Apr;116(4):424-7. doi: 10.1001/archotol.1990.01870040046011. PMID: 2317323.
- ↑ Zamyslowska-Szmytke E, Politanski P, Jozefowicz-Korczynska M. Dizziness Handicap Inventory in Clinical Evaluation of Dizzy Patients. International Journal of Environmental Research and Public Health. 2021;18(5):2210.
- ↑ Koppelaar-Van Eijsden HM, Schermer TR, Bruintjes TD. Measurement Properties of the Dizziness Handicap Inventory: A Systematic Review. Otology & neurotology. 2022;43(3):E282–E297.
- ↑ 4.0 4.1 4.2 Mutlu B, Serbetcioglu B. A review of the Dizziness Handicap Inventory (DHI). J Vestib Res. 2013;23(6):271-277. doi:10.3233/VES-130488
- ↑ 5.0 5.1 5.2 Jacobson GP, Newman CW. The Development of the Dizziness Handicap Inventory. Arch Otolaryngol Head Neck Surg.1990;116(4):424–427.
- ↑ Whitney SL, Hudak MT, Marchetti GF. The activities-specific balance confidence scale and the dizziness handicap inventory: a comparison. J Vestib Res. 1999;9(4):253-259.
- ↑ Whitney SL, Marchetti GF, Morris LO. Usefulness of the dizziness handicap inventory in the screening for benign paroxysmal positional vertigo. Otol Neurotol. 2005;26(5):1027-1033.
- ↑ Koppelaar-van Eijsden, Hanna, et al. "Measurement Properties of the Dizziness Handicap Inventory: A Systematic Review". Otology & Neurotology, vol. 43, no. 3, March 2022, pp. e282-e297. doi: 10.1097/MAO.0000000000003448.
- ↑ Enloe LJ, Shields RK. Evaluation of health-related quality of life in individuals with vestibular disease using disease-specific and general outcome measures. Phys Ther. 1997;77(9):890-903.