Cordier Reinie, Joosten Annette Veronica, Heijnen Bas J, Speyer Renée
Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne NE1 8ST, UK.
Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia.
J Clin Med. 2024 Apr 17;13(8):2331. doi: 10.3390/jcm13082331.
: The Dysphagia Handicap Index (DHI) is commonly used in oropharyngeal dysphagia (OD) research as a self-report measure of functional health status and health-related quality of life. The DHI was developed and validated using classic test theory. The aim of this study was to use item response theory (Rasch analysis) to evaluate the psychometric properties of the DHI. : Prospective, consecutive patient data were collected at dysphagia or otorhinolaryngology clinics. The sample included 256 adults (53.1% male; mean age 65.2) at risk of OD. The measure's response scale, person and item fit characteristics, differential item functioning, and dimensionality were evaluated. : The rating scale was ordered but showed a potential gap in the rating category labels for the overall measure. The overall person (0.91) and item (0.97) reliability was excellent. The overall measure reliably separated persons into at least three distinct groups (person separation index = 3.23) based on swallowing abilities, but the subscales showed inadequate separation. All infit mean squares were in the acceptable range except for the underfitting for item 22 (F). More misfitting was evident in the Z-Standard statistics. Differential item functioning results indicated good performance at an item level for the overall measure; however, contrary to expectation, an OD diagnosis presented only with marginal DIF. The dimensionality of the DHI showed two dimensions in contrast to the three dimensions suggested by the original authors. : The DHI failed to reproduce the original three subscales. Caution is needed using the DHI subscales; only the DHI total score should be used. A redevelopment of the DHI is needed; however, given the complexities involved in addressing these issues, the development of a new measure that ensures good content validity may be preferred.
吞咽障碍 handicap 指数（DHI）在口咽吞咽障碍（OD）研究中常用作功能健康状况和健康相关生活质量的自我报告指标。DHI 是使用经典测试理论开发并验证的。本研究的目的是使用项目反应理论（Rasch 分析）来评估 DHI 的心理测量特性。：在吞咽障碍或耳鼻喉科诊所收集前瞻性、连续的患者数据。样本包括 256 名有 OD 风险的成年人（男性占 53.1%；平均年龄 65.2 岁）。评估了该测量的反应量表、人与项目的拟合特征、项目功能差异和维度。：评分量表是有序的，但在整体测量的评分类别标签中显示出潜在差距。总体人的可靠性（0.91）和项目的可靠性（0.97）非常好。总体测量根据吞咽能力可靠地将人分为至少三个不同的组（人分离指数 = 3.23），但子量表显示分离不足。除了项目 22（F）拟合不足外，所有拟合均方均在可接受范围内。在 Z 标准统计中，更多的不拟合情况明显。项目功能差异结果表明，整体测量在项目层面表现良好；然而，与预期相反，OD 诊断仅呈现出边缘性 DIF。与原始作者建议的三个维度相比，DHI 的维度显示为两个维度。：DHI 未能重现原来的三个子量表。使用 DHI 子量表时需要谨慎；只应使用 DHI 总分。需要重新开发 DHI；然而，鉴于解决这些问题涉及的复杂性，开发一种确保良好内容效度的新测量方法可能更可取。
