Translation and Validation of the Dysphagia Handicap Index in Hebrew-Speaking Patients

Reliability and Validity of the Chinese Mandarin Version of the Dysphagia Handicap Index

This study aimed to develop the Dysphagia Handicap Index-Chinese Mandarin (DHI-CM) and to assess its reliability and validity. This prospective study was conducted in China with individuals who speak Mandarin. The DHI-CM was developed according to a five-stage process. 264 patients with oropharyngeal dysphagia (OD) and 187 healthy individuals completed the study. Reliability was assessed using Cronbach's α and test-retest reliability. Differences between healthy participants and patients with OD were analyzed for instrument validity. Convergent and concurrent validity were assessed using the Swallowing Quality of Life Questionnaire (SWAL-QoL) and Functional Oral Intake Scale (FOIS), respectively. The Content Validity Index (CVI) was used to assess content validity. Exploratory and Confirmatory Factor Analyses (EFA and CFA, respectively) were used to assess structural validity. The Cronbach's alpha was > 0.9 for the total score and every individual subscale. The Pearson and intraclass correlation coefficients were both > 0.8. The patients with OD showed significantly higher scores in the DHI-CM and its subscales than the healthy individuals. Significant correlations were found between most subscales of the DHI-CM and both the SWAL-QoL and FOIS. The CVI of the DHI-CM was 0.892 and ranged between 0.878 and 1.000 for the subscales. The EFA identified three components that explained 24.33%, 23.99%, and 22.73% of the variance, respectively. The scale showed good structural validity through CFA. Conclusions. The DHI-CM demonstrated good reliability and validity among Mandarin-speaking Chinese adults.

Transadaptation and Validation of the Telugu Version of the Dysphagia Handicap Index

Dysphagia Handicap Index (DHI) is a clinically effective, concise, and user-friendly tool for assessing the functional impact of dysphagia in clinical populations. The present study aims to trans-adapt the DHI in the Telugu language and assesses its psychometric properties. The present study was conducted in two phases. The first phase includes translating and adapting the DHI tool into Telugu (T-DHI). The second phase includes an analysis of the psychometric properties of the trans-adapted Telugu version of the DHI. The DHI was translated into the Telugu language using the forward-backward translation method. The psychometric analysis was done on 100 participants. All the participants underwent a detailed clinical swallow examination after filling the T-DHI. The overall internal consistency and Guttmann split-half reliability for the Telugu version of the DHI were good. The correlation between the T-DHI subscales and the self-perceived severity of dysphagia was found to be high. The comparison of the T-DHI scores of the control and experimental groups revealed a significant difference. The T-DHI is a reliable and valid tool to assess the quality of life of the Telugu-speaking dysphagia population.

Translation and Validation of the Tamil Version of the Dysphagia Handicap Index in Tamil-Speaking Patients

Introduction Dysphagia is one of the general symptoms encountered in clinical practice. The impact of dysphagia can be devastating to a patient's physical condition and quality of life (QOL). To evaluate the QOL of patients with dysphagia there are numerous self-reported questionnaires. The most commonly used one such questionnaire is the Swallowing Quality-of-Life Questionnaire (SWAL-QOL). However, it is not concise and is incomplete as it does not address all the aspects of dysphagia. To overcome this, the Dysphagia Handicap Index (DHI) was developed. It focuses on the functional and emotional aspects in addition to the physical aspects of dysphagia. Objective To develop a Tamil version of the DHI (DHI-T) and assess its reliability, cultural adaptability and validity. Materials and method This cross-sectional study was conducted from May 2021 to December 2022 on 140 participants consisting of 70 dysphagia patients and 70 healthy individuals. Results The reliability and validity of the DHI-T were good with a high correlation between DHI-T and self-perceived severity scales of dysphagia. The mean total score in the Dysphagia group was 59.77 with the mean physical, functional and emotional scores being 23.86, 17.46 and 18.46 respectively. These scores were less compared to the Healthy group (p-value <0.01). Conclusion This study shows that DHI-T can be used as a reliable and valid tool to grade and study the different domains of dysphagia in our study population. Among the various causes of dysphagia studied in our population, it was noted that coronavirus disease 2019 (COVID-19)-related dysphagia patients had higher mean score in the emotional domain. To the best of our knowledge, the DHI scores for COVID-19-related dysphagia have not been done before. As the application of DHI in routine clinical practice and research is increasing, we believe this DHI-T can be of aid to Tamil-speaking patients.

Associations of Trunk Muscle Mass and Muscle Quality Indicators with Self-Reported Dysphagia in Older Inpatients

Recent studies have correlated dysphagia with ultrasound-measured quadriceps muscle mass and quality. Computed tomography (CT) is more precise than ultrasound for estimating muscle mass and quality. We aimed to investigate the possible associations of chest CT-determined trunk muscle mass and quality with dysphagia. A cross-sectional study. Older inpatients in a geriatric department of a university hospital. Self-reported dysphagia was determined by the Dysphagia Handicap Index. Unenhanced chest CT images were segmented to calculate skeletal muscle area (SMA) and intermuscular adipose tissue (IMAT). Skeletal muscle index (SMI) was calculated via SMA/ height squared. The percentage of IMAT (IMAT%) was calculated by IMAT% = IMAT/ (SMA + IMAT) × 100%. Mimics software was applied to calculate the mean skeletal muscle radio density (SMD).The semiquantitative food frequency method, the Barthel Index (BI), and the Mini Nutritional Assessment Short-Form (MNA-SF) were used to evaluate energy intake, activities of daily living, and nutrition status, respectively. Among the 212 participants (mean age: 84 years), 89 (42%) had self-reported dysphagia. After adjustment for age, nutrition status, energy intake, and other confounders, the SMI (adjusted OR 0.91, 95% CI 0.86, 0.96) was negatively associated with dysphagia, whereas the IMAT (adjusted OR 1.08, 95% CI 1.01, 1.16) and the IMAT% (adjusted OR 1.10, 95% CI 1.04,1.17) were positively associated with dysphagia. However, the SMD (adjusted OR 0.99, 95% CI 0.94, 1.05) was not significantly associated with dysphagia. The subgroup analyses indicated that only the SMI (adjusted OR 0.92, 95% CI 0.86, 0.97) and the IMAT% (adjusted OR 1.08, 95% CI 1.01, 1.17) were significantly associated with dysphagia in men. None of these indicators was significantly associated with dysphagia in women. Trunk muscle mass and quality (estimated by chest CT-derived SMI and IMAT%, respectively) were significantly associated with self-reported dysphagia in older inpatients, especially in men. IMAT% might be a more sensitive muscle quality indicator than IMAT (or SMD). These results merit further investigation in prospective studies.

Translation and Validation of the Dysphagia Handicap Index in Polish-Speaking Patients

Dysphagia Handicap Index (DHI) is a self-assessment questionnaire which consists of 25 statements to examine three aspects of dysphagia patients’ quality of life (QoL): functional, physical, and emotional. The patient can get a maximum score of 100 points. The study goal was to validate and translate the Polish version of the DHI (PL-DHI). One hundred and seventy-eight (178) individuals with oropharyngeal dysphagia with different etiology and 35 (thirty-five) asymptomatic adults with no history of swallowing disorders filled out the PL-DHI. Internal consistency was determined using Cronbach alpha coefficient, which was high for the total PL-DHI score (0.962). The reproducibility was high (r-Spearman correlation coefficient was 0.97 for total PL-DHI score). The PL-DHI’s total score and its subscales were significantly higher in the dysphagia patients study group (SG) than in the healthy controls group (CG) (SG median: 36; CG median: 4). A strong correlation was observed between the PL-DHI score and the self-reported dysphagia severity measure (Spearman’s correlation coefficient was 0.859, p < 0.001). The Polish DHI is a reliable and valid questionnaire for assessing dysphagia patients’ QoL.

The Quality of Life in Citizens with Oropharyngeal Dysphagia—A Cross-Sectional Study

Dysphagia is a risk factor that impaires an individual’s experience of mealtimes. Few studies contribute to the knowledge on the health-related quality of life (HRQoL) of citizens with oropharyngeal dysphagia (OD) living independently. The aim of this study involves evaluating the HRQoL in citizens living independently and suffering from OD. This cross-sectional study was performed in seven municipalities in Denmark between March 2019 and December 2020. The 90 citizens included (54% female, mean age 76.6 years (SD 0.8)) were ≥18 years, as well as diagnosed with OD using the volume-viscosity swallow test and Minimal Eating Observation Form version II. The Dysphagia Handicap Index-DK, Barthel 20, and European Quality of Life-5 Dimensions were fulfilled. Of the participating citizens, 66% of them needed additional time to eat, 64% coughed while eating, and 58% coughed while drinking. Additionally, 60% reported having a dry mouth, 62% needed to drink to succeed with swallowing foods, and 57% had to swallow multiple times. About one-third felt embarrassed when eating with others. They could not enjoy eating in the same manner as they had previously, and/or felt handicapped or limited. OD was shown to have had a high impact on the QoL in citizens with OD living independently. Focus is needed on xerostomia, as well as on the psychological aspects pertainings to mealtimes for citizens with OD.

Cross-Cultural Adaptation and Validation of the Italian Version of the Dysphagia Handicap Index (I-DHI)

The Dysphagia Handicap Index (DHI) is a valid Health-related Quality of Life (HRQOL) questionnaire for patients with oropharyngeal dysphagia (OD) of heterogeneous etiologies. The study aimed at crossculturally translating and adapting the DHI into Italian (I-DHI) and analyzing I-DHI reliability, validity, and interpretability. The I-DHI was developed according to Beaton et al. 5-stage process and completed by 75 adult OD patients and 166 healthy adults. Twenty-six patients filled out the I-DHI twice, 2 weeks apart, for test–retest reliability purposes. Sixty-two patients completed the Italian-Swallowing Quality of Life Questionnaire (I-SWAL-QoL) for criterion validity analysis. Construct validity was tested comparing I-DHI scores among patients with different instrumentally assessed and self-rated OD severity, comparing patients and healthy participants and testing Spearman’s correlations among I-DHI subscales. I-DHI interpretability was assessed and normative data were generated. Participants autonomously completed the I-DHI in maximum 10 min. Reliability proved satisfactory for all I-DHI subscales (internal consistency: α > .76; test–retest reliability: intraclass correlation coefficient > .96, k = .81). Mild to moderate correlations (− .26 ≤ ρ ≤ − .72) were found between I-DHI and I-SWAL-QoL subscales. Construct validity proved satisfactory as (i) moderate to strong correlations (.51 ≤ ρ ≤ .90) were found among I-DHI subscales; (ii) patients with more severe instrumentally or self-assessed OD reported higher I-DHI scores (p < .05); and (iii) OD patients scored higher at I-DHI compared to healthy participants (p < .05). Interpretability analyses revealed a floor effect for the Emotional subscale only and higher I-DHI scores (p < .05) for healthy participants > 65 years. In conclusion, the I-DHI is a reliable and valid HRQOL tool for Italian adults with OD.

Cultural Adaptation and Validation of Questionnaires for Evaluation of Health-Related Quality of Life with Dysphagia in Different Countries: A Systematic Review

Dysphagia can have devastating and long-lasting effects on the patient's health-related quality of life (HRQoL). In recent years, a number of questionnaires for the evaluation of the HRQoL of patients with dysphagia have been developed and have been adapted for use in different countries and cultures. However, problems may arise in the process of cultural adaptation and validation, which can affect the quality of the questionnaires and their measurements. This study was conducted to systematically summarize the cultural adaptation and validation of questionnaires for the evaluation of dysphagia-related HRQoL in different countries, assessing the varieties, measurement properties, and qualities of these questionnaires, with the aim of identifying the status of their adaptation and validation and ways in which they might be improved. Four databases were searched, and relevant articles were screened, with data from eligible reports extracted and reviewed. The methodological quality of the included articles was evaluated using the QualSyst critical appraisal tool. The HRQoL questionnaires for patients with dysphagia were assessed using the quality criteria for the measurement properties of health status questionnaires proposed by Terwee et al. and Timmerman et al. 29 studies published between 2008 and 2020 were included. The questionnaires described in these 29 studies were translated into 19 languages and culturally adapted to 21 countries. The adapted questionnaires were based on the Swallowing quality of life questionnaire (SWAL-QOL) by Mchorney et al., the Dysphagia Handicap Index (DHI) by Silbergleit et al., the M.D. Anderson Dysphagia Inventory (MDADI) by Chen et al., and the Eating Assessment Tool-10 (EAT-10) by Belafsky et al. It was found that the questionnaires were reliable and valid instruments for the assessment of dysphagia-related HRQoL, but the quality criteria for cultural adaptation and validation were not strictly followed, especially in the categories of criterion validity, agreement, responsiveness, and interpretability. In conclusion, although the questionnaires were found to be both reliable and valid, the quality criteria should be considered and strictly followed in the cultural adaptation and validation process in the future.

Clinical Usefulness of the Korean Version of the Dysphagia Handicap Index: Reliability, Validity, and Role as a Screening Test

This study aimed to measure the validity and reliability of the Korean version of the Dysphagia Handicap Index (K-DHI) and evaluate its diagnostic efficacy for predicting aspiration. We enrolled 104 patients with dysphagia symptoms (D group) and 88 controls (ND group). Among controls, there were 43 patients without dysphagia symptoms (ND patient group). All subjects completed the K-DHI survey. The D and ND group patients underwent the Gugging Swallowing Screen (GUSS) and videofluoroscopic swallowing study (VFSS). Two weeks later, the D group completed the second session of the K-DHI survey. The internal consistency of the K-DHI was good to excellent (Cronbach's α: 0.79-0.95). The test-retest reliability of the K-DHI survey was also high (interclass correlation coefficient = 0.88). There were moderate correlations between the K-DHI and GUSS (r = - 0.65, p < 0.001) as well as findings of VFSS-videofluoroscopic dysphagia scale (r = 0.55, p < 0.001) and American Speech-Language-Hearing Association National Outcome Measurement System swallowing scale (r = - 0.55, p < 0.001). For predicting aspiration, the K-DHI cutoff value was 11 (sensitivity, 0.82; specificity, 0.72; positive predictive value, 0.34; and negative predictive value, 0.96). K-DHI ≥ 11 [odds ratio (OR), 6.43; 95% Confidence Interval (CI) (1.87-22.16); p = 0.003] and GUSS ≤ 15 [OR 4.73; 95% CI (1.59-14.07); p = 0.005] were independent risk factors for aspiration on VFSS. The K-DHI is a reliable and valid self-reporting instrument for evaluating patient's quality of life associated with dysphagia among the Korean language population. It is also useful for the screening of aspiration.

The Dysphagia Handicap Index (DHI)-Normative Values. Systematic Review and Meta-Analysis

As the dysphagia handicap index (DHI) becomes more commonly used in clinical practice as a diagnostic tool, it is essential to establish the normative value of DHI. The main purpose of this study is to determine the normative value of DHI among subjects who had no history of dysphagia or neurological disease as well as no history of head or neck malignancy. A systematic literature search was performed using PubMed, Scopus and ScienceDirect to access relevant databases and to locate outcome studies. Eligibility criteria included type of publication, participant characteristics and report of outcomes. Data analysis were conducted using meta-analysis method. Five articles were included for the final analysis. The normative value of DHI was 2.49 with confidence interval of 0.51-4.48 for a group of 323 subjects, age range of 20-86 years.

Translation and Validation of Kannada Version of the Dysphagia Handicap Index

Background The Dysphagia Handicap Index (DHI) is a 25-item questionnaire that assesses the quality of life among individuals with dysphagia. The aim of this study was to translate and validate the Kannada version of DHI (DHI-K). Method Eighty-eight individuals with dysphagia and an equal number of healthy individuals filled out the DHI-K. Internal consistency and test-retest reproducibility were used for reliability testing. Validity was established by comparing DHI-K scores of patients with dysphagia and healthy controls. Results The overall Cronbach's α for DHI-K was .81, indicating good internal consistency. Cohen's κ agreement for test-retest reliability of self-perceived severity was found to be .9. Correlation between subscales of DHI and self-perceived severity was analyzed using Spearman correlation coefficient and was found to very high. The control group has significantly lower scores for all scales when compared to the dysphagia group (physical: t(174) = 31.74, p < .001; functional: t(174) = 32.65, p < .001; emotional: t(174) = 36.3, p < .001; total: t(174) = 34.08, p < .001). Conclusions This study demonstrates that DHI-K has good internal consistency, test-retest reliability, and concurrent validity. The results of the study also reveal that it is a reliable and valid tool for assessment of handicap in Kannada-speaking dysphagia population.