Psychometric Properties of the Persian Version of Dizziness Handicap Inventory

Document Type : Original


1 Kavosh Cognitive Behavioral Sciences and Addiction Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.

2 Otorhinolaryngology Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.

3 Department of Neurology, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran.

4 Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran.


The present study was designed to investigate the psychometric properties of the Persian version of the Dizziness Handicap Inventory (P-DHI). In addition, this research was targeted toward assessing the association of P-DHI withMedical Outcome Study 36-Item Short Form Health Survey (SF-36) and Hospital Anxiety and Depression Scale (HADS). The current study also involved a comparison of the scores of patients and healthy participantsand implementation of a factor analysis.
Materials and Methods:
This cross-sectional study was conducted on 113 patients with dizziness and 30 healthy individuals referring to tertiary centers for otolaryngology and neurology, affiliated to Guilan University of Medical Sciences, Rasht, Iran. The mean age of the patients was 44.5±13.6 years. All patients re-completed the P-DHI after 2 weeks. Internal consistency and reproducibility of the inventory were evaluated using the Cronbach’s alpha coefficient, Bland-Altman limits of agreement, and intraclass correlation coefficients. In addition, the relationships of the P-DHI with SF-36 and HADS were evaluated using the Spearman correlation coefficient. An exploratory factor analysis was also run to determine the factor structure of the questionnaire.
The Cronbach’s alpha coefficient of P-DHI scale was obtained as 0.86. In addition, the functional, physical, and emotional subscales of this instrument had the Cronbach’s alpha coefficients of 0.76, 0.52, and 0.80, respectively. The limits of agreement were 16 points for the total scale, and the range of intraclass correlation coefficients was 0.90-0.96. The P-DHI showed a fair correlation with vertigo severity which assesses functional disability subscale. This scale also demonstrated a moderate correlation with SF-36 and HADS. Factor analysis revealed a 2-factor solution which was different from the factor structure of the original DHI.
As the findings indicated, the P-DHI had good psychometric properties; therefore, it could serve as a useful tool for measuring disability in patients with dizziness and unsteadiness.


  1. Neuhauser HK, Von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, et al. Epidemiology of vestibular vertigo: a neurotologic survey of the general population. Neurology 2005; 65:898-904.
  2. Hansson EE. Vestibular rehabilitation for whom and how? A systematic review. Adv Physiother 2007;9:106-16.
  3. Jacobson GP, Newman CW. The development of the Dizziness Handicap Inventory. Arch Otolaryngol Head Neck Surg 1990;116:
  4. Jafarzadeh S, Bahrami E, Pourbakht A, Jalaie SH, Daneshi A. Validity and reliability of the Persian version of the dizziness handicap inventory. J Res Med Sci 2014;19(8):769-75.
  5. Porta F, Caselli S, Susassi S, Cavallini P, Tennant A, Frances chini M.Is the Berg Balance Scale an internally valid and reliable measure of balance across different etiologies in neurorehabilitation? A revisited Raschanalysis study. Arch Phys Med Rehabil 2012; 93(7):1209-16.
  6. Montazeri A, Goshtasebi A, Vahdaninia M, Gandek B. The short form health survey
    (SF-36): translation and validation study of the Iranian version. Qual Life Res 2005;14(3):875-82.
  7. Zigmond AS, Snaith RP: The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983;67:361-70.
  8. Terwee CB, Mokkink LB, Knol DL, Ostelo RW, Bouter LM, de Vet HC. Rating the methodological quality in systematic reviews of studies on measurement properties: a scoring system for the COSMIN checklist. Qual Life Res 2012;21(4):651-7.
  9. Mc Horney CA, Tarlov AR. Individual-patient monitoring in clinical practice: are available health status surveys adequate? Qual Life Res 1995;4:293-307.
  10. Weir JP. Quantifying test-retest reliability using the intra class correlation coefficient and the SEM. J Strength Cond Res 2005;19(1):231-40.
  11. Bland JM, Altman DG. Measuring agreement in method comparison studies. Stat Methods Med Res. 1999;8:135-60.
  12. Jalali MM, Soleimani R, Fallahi M, Aghajanpour M, Elahi M. Psychometric Properties of the Persian version of the Tinnitus Handicap Inventory (THI-P). Iran J Otorhinolaryngol 2015; 27 (79): 83–94.
  13. Costello AB, Jason O. Best practices in exploratory factor analysis: four recommendations for getting the most from your analysis. Practical Assessment Research & Evaluation, 2005:10(7). Available from: getvn. asp? v=10&n=7.
  14. Yong AG, Pearce S. A Beginner’s Guide to Factor Analysis: Focusing on Exploratory Factor Analysis. Tutorials in Quantitative Methods for Psychology 2013;9(2):79-94.
  15. Keszei AP, Novak M, Streiner DL. Introduction to health measurement scales. J Psychosom Res. 2010;68(4):319-23.
  16. Kurre A, Bastiaenen CH, van Gool CJ, Gloor-Juzi T, de Bruin ED, Straumann D. Exploratory factor analysis of the Dizziness Handicap Inventory(German version). BMC Ear Nose Throat Disord 2010;10:3.
  17. Poon DM, Chow LC, Au DK, Hui Y, Leung MC. Translation of the dizziness handicap inventory into Chinese, validation of it, and evaluation of the quality of life of patients with chronic dizziness. Ann Otol Rhinol Laryngol 2004;113:1006-11.
  18. Whitney SL, Hudak MT, Marchetti GF. The Activities-specific Balance Confidence Scale and the Dizziness Handicap Inventory: a comparison. J Vestib Res 1999;9:253-9.
  19. Honrubia V, Bell TS, Harris MR, Baloh RW, Fisher LM. Quantitative evaluation of dizziness characteristics and impact on quality of life. Am J Otol 1996;17:595-602.
  20. Cohen HS, Kimball KT, Adams AS. Application of the vestibular disorders activities of daily living scale. Laryngoscope 2000;110:1204-9.
  21. Documents for Meeting for the Finalisation of the Beta Draft of the ICIDH-2 for Field Trials. Geneva, 1997.
  22. Asmundson GJ, Stein MB, Ireland D. A factor analytic study of the dizziness handicap inventory: does it assess phobic avoidance in vestibular referrals? J Vestib Res 1999;9:63-8.
  23. Vereeck L, Truijen S, Wuyts FL, Van De Heyning PH. Internal consistency and factor analysis of the Dutch version of the Dizziness Handicap Inventory. Acta Otolaryngol 2007; 27:788-95.
  24. Hayton JC, Allen DG, Scarpello V. Factor retention decisions in exploratory factor analysis: a tutorial on Parallel Analysis. Organizational Research Methods 2004;7(2): 191-205.