Department Special Needs Education, University of Oslo, Oslo, Norway.
School of Occupational Therapy, Social Work and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, Australia.
Dysphagia. 2022 Feb;37(1):65-73. doi: 10.1007/s00455-021-10250-2. Epub 2021 Jan 30.
The Deglutition Handicap Index (DHI) is a self-report measure for patients at risk of oropharyngeal dysphagia on deglutition-related aspects of functional health status (FHS) and health-related quality of life (HR-QoL). The DHI consists of 30 items which are subsumed within the Symptom, Functional and Emotional subscales. The purpose of this study was to evaluate the psychometric properties of the DHI using Classic Test Theory according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria. A total of 453 patients with dysphagia with different aetiologies were recruited concurrently at two academic hospitals. Dysphagia was confirmed by fiberoptic endoscopic and/or videofluoroscopic evaluation of swallowing. In addition, a healthy control group of 132 participants were recruited. Structural validity was determined using exploratory and confirmatory factor analyses and internal consistency by calculating Cronbach's alpha coefficients. Hypothesis testing was evaluated using Mann-Whitney U-tests, linear regression analysis and correlations analysis. Diagnostic performance and receiver operating characteristic curves analysis were calculated. Factor analyses indicated that the DHI is a unidimensional measure. The DHI has good internal consistency with some indication of item redundancy, weak to moderate structural validity and strong hypothesis testing for construct validity. The DHI shows high diagnostic performance as part of criterion validity. These findings support that the DHI is an appropriate choice as a patient self-report measure to evaluate FHS and HR-QoL in dysphagia. Ongoing validation to assess the measure for possible item redundancy and to examine the dimensionality of the DHI using item response theory is recommended.
吞咽障碍指数（DHI）是一种自评量表，用于评估有发生吞咽困难风险的患者的吞咽相关功能健康状况（FHS）和健康相关生活质量（HR-QoL）。DHI 由 30 个项目组成，分为症状、功能和情绪三个子量表。本研究旨在根据共识标准选择健康测量仪器（COSMIN）标准，使用经典测量理论评估 DHI 的心理测量特性。共有 453 名不同病因的吞咽困难患者在两所学术医院同时入组。吞咽困难通过纤维内镜和/或吞咽视频透视检查得到确认。此外，还招募了 132 名健康对照组参与者。结构效度通过探索性和验证性因子分析以及计算 Cronbach's alpha 系数来评估内部一致性。假设检验采用 Mann-Whitney U 检验、线性回归分析和相关性分析进行评估。还计算了诊断性能和受试者工作特征曲线分析。因子分析表明，DHI 是一种单维度的测量工具。DHI 具有良好的内部一致性，部分项目存在冗余，结构效度较弱到中等，对结构效度的假设检验较强。DHI 在作为标准有效性的一部分时表现出较高的诊断性能。这些发现支持 DHI 是评估吞咽困难患者 FHS 和 HR-QoL 的一种合适的患者自评量表。建议进行进一步的验证，以评估该量表是否存在项目冗余，并使用项目反应理论检验 DHI 的维度结构。
