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The DHI Calculator assesses dizziness-related disability across functional, emotional, and physical domains using 25 self-reported questions to guide vestibular rehabilitation treatment.
The Dizziness Handicap Inventory (DHI) is a 25-item self-assessment inventory designed to evaluate the self-perceived handicapping effects imposed by dizziness. It is an efficient outcome measure, taking about 10 minutes or less to complete. The DHI has demonstrated internal validity, with sub-domain item-total correlation scores supporting the validity of the physical, emotional, and functional aspects. This validated assessment tool serves as a cornerstone for clinicians evaluating patients with vestibular dysfunction, providing critical insights into how dizziness impacts quality of life across multiple domains.
The DHI is a reliable, valid, and responsive instrument for the assessment of perceived disability due to dizziness. Unlike objective vestibular tests that measure physiological function, the DHI captures the patient's subjective experience of disability and handicap. DHI scores do not correlate with severity of structural vestibular deficits; thus, high DHI scores may reflect other causes of morbidity. This disconnect between objective findings and subjective experience makes the DHI invaluable for understanding the true impact of vestibular disorders on patient wellbeing.
The DHI questionnaire total scoring and its vestibular subscale distinguished between patients with compensated and uncompensated vestibular dysfunction with positive predictive values of 76%. Research demonstrates that the DHI effectively identifies patients who require specialized balance intervention and guides treatment planning across diverse vestibular conditions.
The DHI employs a straightforward self-reporting methodology that makes it accessible across various clinical settings. The DHI is a 25-item self-report questionnaire that quantifies the impact of dizziness on daily life by measuring self-perceived handicap. The assessment evaluates three distinct domains that comprehensively capture the multifaceted nature of dizziness-related disability.
Functional Domain (F): 9 questions, 36 pointsAssesses restrictions in daily activities and mobility due to dizziness symptoms.
Emotional Domain (E): 9 questions, 36 pointsEvaluates psychological impact, anxiety, and emotional consequences of dizziness.
Physical Domain (P): 7 questions, 28 pointsMeasures physical symptoms and their direct impact on bodily function.
The three possible answers to the 25 questions are 'Yes', 'Sometimes', or 'No'. Yes yields 4 points, sometimes yields 2 points, and no yields 0 points. There is a maximum score of 100 and a minimum score of 0. The higher the score, the greater the perceived handicap due to dizziness.
Ensure a quiet, comfortable environment where the patient can concentrate on their responses. Provide clear instructions emphasizing that answers should reflect their experience over the previous month.
Explain that the questionnaire measures how dizziness affects their daily life. Instruct patients to consider each question carefully and respond honestly based on their recent experiences.
Present all 25 questions systematically. Each question requires selection from three response options: "Yes" (always), "Sometimes," or "No" (never).
Total Score Ranges:
Scores above 10 should be forwarded to balance experts for additional assessment.
Record total score, subscale scores, and any notable response patterns. Document specific areas of highest impact for targeted intervention planning.
Referring to the responses in each of these domains may help you to gauge the area of most handicap, and thus help to understand where you might place the emphasis in terms of rehabilitation strategies. Domain-specific scores guide clinicians toward targeted therapeutic approaches.
If you're using the DHI as an outcome measure to chart progress after a program of vestibular rehabilitation therapy, then you need a change of 18 points in the overall score to consider this a true change. This threshold ensures clinically meaningful improvement detection.
Patients with scores ≤30 were likely to have structural disorders alone, whereas those with scores >60 were likely to have functional or psychiatric disorders, with or without coexisting structural conditions. These patterns assist in differential diagnosis and treatment prioritization.
The Sign test identified a significant difference between pre-rehabilitation and post-rehabilitation total DHI scores. Significant before and after differences were found for the physical and functional subscores. Regular administration tracks therapeutic progress and guides treatment modifications.
Individual perception of handicap varies significantly among patients with similar objective vestibular findings. The authors found that the frequency of dizziness attacks could not always reflect the perceived severity of the handicap. Clinicians must interpret scores within the broader clinical context.
The DHI total scoring and subscales were correlated with anxiety and depression. Psychological factors significantly influence DHI scores, requiring comprehensive evaluation of mental health status alongside vestibular assessment.
The DHI is available in 22 different languages including English, Spanish, Dutch, Norwegian, Swedish, Chinese, and German. Ensure appropriate language version selection for accurate assessment.
A recent systematic review suggests the DHI has limited content validity. While psychometrically robust, the DHI should complement rather than replace comprehensive vestibular evaluation.
The Dizziness Handicap Inventory Calculator represents an essential tool in contemporary vestibular medicine. The test-retest reliability coefficient was 0.97, establishing its reliability for clinical use. By systematically quantifying the subjective impact of dizziness across functional, emotional, and physical domains, the DHI enables clinicians to develop patient-centered treatment plans, monitor therapeutic progress, and optimize rehabilitation outcomes. Its integration into routine clinical practice enhances both diagnostic accuracy and treatment effectiveness for patients experiencing vestibular dysfunction.
Q1. What is the minimum clinically important difference for the DHI?
A change of 18 points in the overall score is needed to consider this a true change when using the DHI as an outcome measure in vestibular rehabilitation.
Q2. How should DHI scores guide referral decisions?
Scores above 10 should be forwarded to balance experts for additional assessment. Scores above 30 may indicate moderate to severe handicap requiring specialized intervention.
Q3. Can the DHI differentiate between different types of vestibular disorders?
The DHI questionnaire total scoring and its vestibular subscale distinguished between patients with compensated and uncompensated vestibular dysfunction with positive predictive values of 76%, making it useful for monitoring rehabilitation progress and treatment planning
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