Dizziness Handicap Inventory

Multiple sclerosis: (Cattaneo et al. 2007; n = 25 (males = 8, females = 17), mean age = 41.7 (12.5) years, mean time since onset of MS = 8.7 (8.8) years prior to beginning of study)

• SEM (calculated) = 7.1

Multiple sclerosis: (Cattaneo et al. 2007)

• MDC (calculated) = 19.67

Multiple sclerosis: (Cattaneo et al., 2006; n = 51, mean age = 45.3 (18.1), female = 35 (69%), mean onset of MS = 15.6 (7.6) years prior to beginning of the study; Italian translation of DHI)

• < 59 indicates less likelihood of falling (sensitivity = 50%; specificity = 74%)

Multiple Sclerosis: 

(Cattaneo et al, 2006) 

• Mean = 38.5 (Non-fallers)
• Mean = 56.0 (Fallers)
• Statistically significant differences between mean scores of fallers and non-fallers

(Cattaneo et al. 2007; n = 25, mean age = 41.7 (12.5) years, mean time since onset of MS = 8.7 (8.8) years prior to beginning of study; two consecutive tests by same rater three days apart at beginning of the study)

Descriptive Statistics for the Dizziness Handicap Inventory (DHI) (n = 20)

*Baseline assessment, first rater; retest = second assessment of the first rater.

(Marrie et al., 2013; n = 8123; mean age = 58 (10.4) years; average age of symptom onset = 30.3 (9.7) years; average age of diagnosis = 37.7 (9.6) years; persons w/diagnosis of MS from North American Research Committee on Multiple Sclerosis (NARCOMS) registry)

• Median (IQR) total DHI score: 20 (0-44)

Multiple Sclerosis (MS):

(Cattaneo et al. 2007; two consecutive tests by same rater three days apart at beginning of the study)

• Excellent test-retest reliability (n = 20): (ICC = 0.90)

Multiple Sclerosis: 

(Hebert et al, 2011; n = 38; 18 - 65 years; Intervention = vestibular rehabilitation (6 weeks); follow-up (4 weeks); able to walk 100 m; ≥ 45 on the Modified Fatigue Impact Scale Questionnaire and < 72 on the computerized Sensory Organization test) 

• Excellent internal consistency (Cronbach’s alpha = 0.91*)

(Marrie et al., 2013)

• Excellent: Cronbach’s alpha = 0.95*

*Scores higher than 0.9 may indicate redundancy in the scale questions.

Multiple Sclerosis (MS):

(Cattaneo et al., 2006)

• Adequate correlation with Berg Balance Scale (r = -0.32)
• Adequate correlation with Dynamic Gait Index (r = -0.39)
• Adequate correlation with Timed Up and Go (r = 0.35)
• Adequate correlation with Hauser Ambulation Index (r = 0.32)
• Excellent correlation with Activities Specific Based Confidence Scale (ABC) (r = -0.70)

Discriminate validity:

Multiple sclerosis: (Cattaneo et al., 2006)

• Significant ability of DHI total score to discriminate between fallers and non-fallers (p = 0.009)

   

Multiple sclerosis: (Hebert et al. 2011; n = 38 (Experiment group: n =12, mean age = 46.8 (10.5); Exercise Control group: n = 13, mean age = 42.6 (10.4); Wait-Listed Control group: n = 13, mean age = 50.2 (9.2)); age range = 18–65 years; clinically definite MS; able to walk 100 m; tested in outpatient clinical setting)

• Significant ability of DHI total score to discriminate between subject groups at the end of the intervention phase (p = 0.005)
  • The experimental group’s improvement was significant compared with the exercise control group (p = 0.018) and the wait-listed control group (p = 0.009), while no difference was found between the exercise control and wait-listed control groups (p = 1.00) 

Multiple Sclerosis (MS): (Cattaneo et al., 2006)

• Adequate ceiling effect (1.9%)

Multiple Sclerosis: (Marrie et al., 2013)

• Excellent: No floor effect found for total DHI score
• Adequate ceiling effect of 0.20% found for DHI total score

Multiple Sclerosis (MS): (Cattaneo et al., 2006)

• Sensitivity = 50%
• Specificity = 77%

Multiple Sclerosis: (Hebert et al., 2011)

• Large Change at end of intervention phase (10 weeks) in total score for the experimental group compared with the exercise control group (d = 1.03) and the wait-listed control group (d = 1.12) 
• Small Change at end of intervention phase (10 weeks) in total score for exercise control group compared to the wait-listed control group (d = 0.17)
• Moderate Change between end of intervention phase (10 weeks) to end of follow-up phase (14 weeks) for experimental group compared with exercise control group (d = -0.35) and exercise control group compared with wait-listed control group (d = 0.48)
• Small Change between end of intervention phase (10 weeks) to end of follow-up phase (14 weeks) for experimental group compared with wait-listed control group (d = -0.14)

Peripheral and central vestibular pathology:

(Jacobson & Newman, 1990; n = 14, mean age 45 (13.48) years)

• SEM = 6.23

Vestibular disorders: (Rizk et al., 2024; n = 294 (Meniere’s disease: n = 169), mean age = 54.1 (14.2) years, female = 68%; Vestibular migraines: n = 125, mean age = 49.9 (16.5) years, female = 80%)

• SEM for Total Group (n = 294): 3.85
• SEM for Vestibular migraine (n = 125): 3.96
• SEM for Meniere’s disease (n = 169): 3.74

Peripheral and central vestibular pathology. (Calculated from Jacobson & Newman, 1990) 

• MDC = 17.18

Vestibular disorders: (Rizk et al., 2024)

• MDC for Total Group (n = 294): 18.04
• MDC for Vestibular migraine (n = 125): 18.52
• MDC for Meniere’s disease (n = 169): 17.46

Vestibular Dysfunction:

(Jacobson and Newman, 1990; n = 14; mean age = 45 (13.48) years)

• Pretreatment and post-treatment scores would have to differ by at least 18 points (95% confidence interval for a true change before the intervention could be said to have effected a significant change in a self-perceived handicap)

Vestibular Rehabilitation:

(Cohen & Kimball, 2003; n = 53 individuals with chronic vertigo due to a peripheral vestibular impairment; mean age = 51.1 years)

• DHI scores decreased from pretest to posttest and then continued to decline over the 6-month follow- up period (P = 0.001) Changes on the DHI Total score were highly associated with VADL Total score (P = 0.001) and with VADL Ambulation score (P = 0.001)

(Cowand, et al, 1998;  n = 37; mean age = 69.8 (SD = 16.2) years) 

• The Sign test identified a significant difference between pre-rehabilitation and post-rehabilitation total DHI scores (p < 0.0001).  Significant before and after differences were found for the physical (p < 0.0001) and functional subscores (p < 0.0015)

(Jacobson & Calder, 1998).

• A four-point change in the DHI-S would be statistically significant at the p = 0.05 level

Vestibular Dysfunction:

(Whitney et al, 2004; n = 85 participants with a variety of vestibular diagnoses; mean age = 61 years) 

• Mild: 0 - 30
• Moderate: 31 - 60
• Severe: 61 - 100
• Individuals who perceive greater handicap as measured by the DHI demonstrate greater functional impairment

Vestibular disorders: (Graham et al., 2021; n = 85 (structural disorder: n = 34, mean age = 59 (13) years; functional disorder: n = 12, mean age = 55 (9) years; psychiatric disorder: n = 39, mean age = 52 (13) years; individuals who underwent multidisciplinary neurotologic evaluations)

• DHI score of 0-30: slight handicap
• DHI score of 31-60: mild handicap
• DHI score of 61-100: severe handicap

*Patients with DHI scores of 30 or less are likely to have structural disorders alone, whereas those with scores over 60 are likely to have functional or psychiatric disorders, with or without coexisting structural conditions.
 

Vestibular Dysfunction:

(Jacobson and Newman, 1990)

• Excellent  test-retest reliability for total score (r = 0.97, df = 12, p < 0.0001)
• Excellent  test-retest reliability for sub-scales scores (r = 0.92-0.97, p < 0.001)

(Jacobson & Calder, 1998)

• Excellent test-retest reliability of the DHI-S (r = 0.95, p < 0.001)
• Found the 95% confidence interval for test-retest reliability difference was 2.44 points.

(Perez et al., 2001)

• Cronbach's alpha = 0.9226 for the Spanish version of the questionnaire

(Jarlsäter & Mattsson, 2003) 

• Good test-retest reliability for the Swedish version of the DHI (k = 0.63)

(Kurre et al., 2009)

• Cronbach's a value for the DHI-German and the function, physical, and emotional subscales were 0.90, 0.80, 0.71, and 0.82 respectively

(Poon et al., 2004)

• The Chinese DHI has been shown to retain good test-retest reliability (intraclass correlation coefficient range, 0.64 to 0.87) and internal consistency (Cronbach alpha coefficient > 0.7)

(Tamber et al., 2009; n = 119 (n = 92 subjects recruited from the country, mean age = 47.2 (11.46) years, age range = 26-64 years, diagnostic groups: vestibular dizziness (64%), non-vestibular dizziness (10%), and dizziness of unknown origin (26%); n = 27 patients from hospital balance clinic, mean age = 47.5 (12.1) years, age range = 24-73 years, diagnostic groups: vestibular (100%); Norwegian population and translation of DHI into DHI-N) 

• Excellent test-retest reliability of the Norwegian version (ICC 1,1 = 0.90)

Vestibular Dysfunction:

(Jacobson and Newman, 1990)

• Excellent internal consistency for total score (alpha = 0.89)
• Adequate to excellent internal consistency for the 3 sub-scales (alpha = 0.72 - 0.85)

(Tamber et al., 2009)

• Excellent internal consistency for the Norwegian Version of the DHI (Cronbach's alpha = 0.88-0.95*)

*Scores higher than 0.9 may indicate redundancy in the scale questions.

Vestibular Dysfunction:

(Whitney et al., 1999; n = 71 subjects from a local balance and vestibular clinic; 15 males, 56 females; mean age = 65 (16.8) years)

• Excellent correlation with ABC (r = -0.64) 

(Fielder et al., 1996; n = 42)

• Good to Excellent correlation with SF-36 (r = 0.53-0.72; p < 0.001) 

(Jacobson et al., 1991)

• Total score DHI demonstrated a moderate statistically significant negative correlation with SOT conditions 2(r = -0.39, p = 0.001); 4(r = -0.36, p = 0.004); 5(r = -0.42, p = 0.0005); and 6(r = -0.35, p = 0.004)
• The functional subscale demonstrated a moderate statistically significant negative correlation with SOT conditions 2(r = -0.39, p = 0.001); 3(r = -0.29, p = 0.02); 4(r = -0.40, p = 0.001); 5(r = -0.48, p = 0.0001); and 6(r = -0.41, p = 0.0007)
• The emotional subscale demonstrated a moderate statistically significant negative correlation with SOT conditions 2(r = -0.35, p = 0.004); 4(r = -0.30, p = 0.01); 5(r = -0.39, p = 0.001); and 6(r = -0.37, p = 0.003)
• The physical subscale demonstrated a moderate statistically significant negative correlation with the equilibrium score on condition 2 of the SOT (r = -0.28, p = 0.02) 

(Jacobson & Calder, 1998).

• DHI-S highly correlated to the total score on the DHI (r = 0.86, p < 0.001) 

(Lim et al., 2012; n = 32; mean age = 55.6 years individuals with vestibular neuritis) 

• Discovered varying level of correlation between the DHI and the composite score of the SOT and the equilibrium scores of the HS-SOT conditions 2 and 5 depending on the level of acuity
  • Excellent correlation between DHI and SOT composite score at initial assessment (r = -0.787, p < 0.05)
  • Excellent correlation between DHI and SOT composite score at one week follow-up (r = -0.679, p < 0.05)
  • Adequate correlation between DHI and equilibrium score ratio of the HS-SOT condition 2 at initial assessment (r = -0.559, p < 0.05)
  • Excellent  correlation between DHI and equilibrium score ratio of the HS-SOT condition 2 at one week follow-up (r = -0.695, p < 0.05)
  • Adequate correlation between DHI and equilibrium score ratio of the HS-SOT condition 2 at one month follow-up (r = -0.385, p < 0.05)
  • Adequate correlation between DHI and equilibrium score ratio of the HS-SOT condition 2 at 2 month follow-up (r = -0.401, p < 0.05)
  • Adequate correlation between DHI and equilibrium score ratio of the HS-SOT condition 5 at initial assessment (r = -0.402, p < 0.05)
  • Adequate correlation between DHI and equilibrium score ratio of the HS-SOT condition 5 at one week follow-up (r = -0.539, p < 0.05)
  • Excellent correlation between DHI and equilibrium score ratio of the HS-SOT condition 5 at one month follow-up (r = -0.625, p < 0.05)
  • Adequate correlation between DHI and equilibrium score ratio of the HS-SOT condition 5 at 2 month follow-up (r = -0.461, p < 0.05)

(Perez et al., 2003; n = 226, mean age = 45.3 ± 9.4 years, individuals with vestibular pathology) 

• Adequate correlation between DHI and equilibrium score ratio of the HS-SOT condition 5 at 6 month follow-up (r = -0.394, p < 0.05)
• Adequate correlation between DHI total score and UCLA-DQ (r = 0.416; p < 0.01)
• Adequate correlation between DHI total score and SOT composite score (r = -0.345; p < 0.01)

Convergent validity:

Vestibular Dysfunction:  

(Jacobson and Newman, 1990)

• Adequate relationship between the number of dizzy spells per year and score on DHI (< 12, > 12, and permanent)

(Perez et al., 2001)

• Excellent correlation between vestibular handicap factor and DHI emotional (DHIe)  subscale r = 0.927 p < 0.001, and DHI functional subscale (DHIf) r = 0.743 p < 0.001
• Adequate correlation between vestibular handicap factor and the DHI physical (DHIp) subscale r = 0.317 p < 0.001
• Excellent correlation between vestibular disability factor and the DHI emotional r = 0.912 p < 0.001
• Poor correlation between vestibular disability factor and the DHIf subscale 0.425 p < 0.001
• Adequate correlation between vestibular disability factor and DHI physical subscale r = 0.714, p < 0.001

Vestibular Disorders:

(Alghwiri et al., 2012; n = 17 experts; and n = 58 patients with vestibular disorders)

• Adequate to excellent correlation of 0.54 to 0.74 (DHI vs. VAP) 

Peripheral and Central Vestibular Pathology:

(Fielder et al, 1996; n = 42; Participants with dizziness n = 21 with males = 3 and females = 18; mean age = 55.6 (17.2) years; duration of symptoms = 15.8 (16) months)

• Adequate to excellent correlation between scores of DHI and SF- 36 (r = 0.53 to 0.72)
• Directly proportional to the number of episodes of dizziness with validity increasing with seriousness.

Discriminant validity: 

(Graham et al., 2021)

• Significant ability of DHI scores to discriminate between diagnostic groups in univariable (ANOVA F = 27.2, df = 2, p = 0.001) and multivariable analyses (ANCOVA, adjusting for age and sex, F = 27.3, df = 2, p < 0.001).
  • Significantly lower mean total DHI score for the structural group compared to the mean scores for the functional and psychiatric groups (both p < 0.001), while mean DHI scores did not differ between the functional and psychiatric groups (p = 0.97)

Vestibular Dysfunction:

(Jacobson and Newman, 1990)

• The total score was show to be significantly poorer for patients reporting more frequent attacks of dizziness or unsteadiness.

(Jacobson & Calder, 2000)

• Self perceived balance handicap (DHI-total and DHI –physical subscale) experienced by patients with bilateral reductions in peripheral vestibular function is significantly greater than that experienced by individuals with balance complaints that have normal balance function tests but is not greater than those individuals that demonstrate unilateral vestibular impairments.

Vestibular disorders:

(Iglebekk et at., 2022)

• The DHI is a well-established tool for evaluating the effect of dizziness on daily functioning, contributing to its content validity given that it encompasses various dizziness-related experiences.

Vestibular disorders: (Graham et al., 2021).

• The structure of the DHI allows for the effect of dizziness to be determined due to the ranking of “yes, sometimes, no.” In particular, due to the severity of vestibular issues, individuals with PPPD and MdDS will be more likely to rank “yes”, therefore adhering to the DHI’s face validity through scoring.

Vestibular disorders: (Rizk et al., 2024)

• Excellent: no ceiling/floor effects for Physical, Functional, and Emotional domains

Peripheral and Central Vestibular Rehabilitation: (Enloe et al., 1997; n = 95; mean age = 25 - 88 (14.9) years)

• DHI was found to be moderately responsive. It required 7.24 patients to measure change and had a responsiveness score of 1.66

Vestibular Dysfunction

(Perez et al., 2001) 

• Performed a factor analysis on 337 individuals with dizziness and discovered that the DHI is a multidimensional questionnaire for the assessment of dizziness and has the ability to provide a good model for vestibular handicap and disability.  

(Whitney et al., 2000; n = 39, mean age = 54 ± 16 years, individuals with a diagnosis of migraine-related vestibulopathy)

• Demonstrated a 12 point average decrease in DHI score (P < 0.01) after a custom-designed physical therapy exercise program performed for a mean of 4.9 visits over a 4 month period 

(Wackym et al., 2008; n = 55 individuals with sporadic vestibular schwannomas treated with gamma knife)  

• Found a significant difference in total DHI score was seen only in the elderly (> 65 years old) patients pre-gamma knife surgery compared with post-gamma knife sugery  (t = 1.34, p = 0.05)

Vestibular rehabilitation program: 

(Bays, 2001; n = 49; received therapy between 1998 and 2000)

• Significant, positive changes in total DHI score were found in 57.1% of the subjects (p < 0.001)

Benign Paroxysmal Positional Vertigo:

(Lopez-Escamez, et al, 2003;  n = 40 individuals with pSCC BPPV)

• Dizziness Handicap Inventory Short Form total score significantly decreased from 18.05 ± 9.91 (mean ± standard deviation) at the first day to 9.54 ± 9.94 at 30 days (p < 0.001)
• All 36-Item Short Form Health Survey scale scores were correlated significantly with Dizziness Handicap Inventory Short Form total scores at 30 days after treatment

Benign Paroxysmal Positional Vertigo (BPPV):

(Whitney et al., 2005; n = 383 patients with a variety of vestibular diagnoses; mean age = 61 years)

• 5 item BPPV subscale developed from current DHI is a significant predictor of likelihood of having BPPV

Whiplash Associated Disorders:

(Treleaven et al., 2005; n = 100; 50 with dizziness including males = 12 & females = 38 having a mean age = 35.5 (19- 46) years and their time since injury = 1.4 (0.35- 3) years; 50 without dizziness including males = 12 & females = 38 having a mean age = 35 (18-46) years and their time since injury = 1.6 (0.3- 3) years; individuals had to refrain from medications 24 hours prior to study.)

• Adequate correlation of DHI to Smooth Pursuit Neck Torsion Test (r = 0.31)

Traumatic Brain Injury:

(Kaufman et al., 2006; n = 10; 6 men and 4 women; community living individuals with normal gait and balance before pathology; average duration since TBI = 2.8 (0.4 - 14.4) years) 

• Mean = 32 (23)

Mild Traumatic Brain Injury:

(Gottshall et al., 2003; n = 53 male active duty individuals who suffered mild TBI and 46 control subjects without TBI; Glascow Coma Scale score of 14-15; mean age = 22 years)

• Statistically significant correlation between all Dynamic Visual Acuity Test results measured and the DHI and the 1 week time point (p < 0.01)
• There was no significant or consistent correlation between the two tests after the 1 week period

Traumatic Brain Injury:

(Kaufman et al., 2006; n = 20; 10 patients with TBI (6 men and 4 women) and 10 matched controls for age, gender, weight, and height; mean age = 41 (11) years; Average duration since the TBI was 2.8 years (range 0.4-14.4); 6 subjects with TBI had abnormal imaging studies)

• Excellent correlation between physical aspects of the subject's complaints of dizziness on the DHI were related to SOT 6 (platform and surround sway referenced) (r = 0.72, p = 0.02)
• Excellent correlation between the physical aspect of the DHI and the A/P motion of the subject (r = 0.83, p = 0.003)
• Excellent correlation between the functional aspect of the DHI and the COM M/L velocity (r = 0.65, p = 0.04)
• Excellent correlation between the total DHI and the M/L velocity (r = 0.71, p = 0.02)

Traumatic Brain Injury:

(Gotshall et al., 2003; n = 53 with mild traumatic brain injury) 

• DHI significantly correlated with Dynamic Visual Acuity testing (After one week)

Traumatic Brain Injury:

(Basford et al., 2003; n = 20, 10 with TBI and complaints on instability, and 10 without TBI; 6 men and 4 women, ranging in age from 18 to 65 years; age, height and gender matched with controls)

• DHI scores were consistent with the subjects' complaints of unsteadiness and imbalance

Elderly:

(Whitney et al., 1999; n = 71, males = 15 & females = 56; age range = 26-88 years) 

• Excellent negative correlation between scores of DHI and ABC (Activity specific Balance Confidence Scale) (r = -0.64)