Validation of the Japanese translation of the Dysphagia Handicap Index

Abstract

BackgroundWe developed, and examined the reliability and validity of, a Japanese version of the Dysphagia Handicap Index (DHI; DHI-J), which is a self-reported measure to assess the quality of life (QOL) of individuals with dysphagia.Participants and methodsThe DHI-J was developed via the back-translation method: the DHI was translated into Japanese and then translated back into English by a native English speaker. The back translation was discussed with and approved by the DHI’s lead author. A total of 229 patients (119 males, 110 females; median age: 66 years) who underwent videofluorography at our hospital between January and December 2013 and 65 controls (23 males, 42 females; median age: 44 years) were included in the study. All the subjects completed the DHI-J and self-reported their dysphagia severity. Twenty-three patients repeated the procedure 1 week later. Patients’ swallowing function was classified as “normal”, “moderately impaired”, or “severely impaired”, and the DHI-J total scores were compared between the severity groups.ResultsThe internal consistency of the DHI-J was high (Cronbach’s α=0.95), as was the test–retest reliability of the 23 patients who answered the questionnaire twice (intraclass correlation coefficient =0.98, P<0.01). The DHI-J total score and its three subscale scores were significantly higher among the patients than among controls. A significant correlation (ρ=0.85) was observed between the DHI-J total score and self-reported dysphagia severity score. Regarding the comparison of DHI-J scores by severity groups, the DHI-J total scores significantly differed between the normal and moderately impaired groups, and the normal and severely impaired groups. However, the moderately and severely impaired groups showed no significant difference in scores.ConclusionThe DHI-J is a reliable and valid questionnaire for assessing the QOL of patients with dysphagia. However, we did not survey patients with cerebrovascular diseases; thus, the questionnaire must be validated for that patient group.

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

“…I-DHI construct validity proved satisfactory, since the results confirmed > 75% of the hypotheses made by the authors [48]. In particular, in accordance with the results of the previous validation studies [11,[30][31][32][33][34][35], direct moderate to strong (> .50-.70) correlations among I-DHI subscales, Total score, and self-rated OD severity were found. Nevertheless, due to the insufficient numerousness of the recruited sample, factor analysis was not performed in the present study nor in any of the previous DHI validations.…”

“…Concerning reliability analyses, similarly to the previous DHI validation studies [11,[30][31][32][33][34][35], the I-DHI internal consistency met satisfactory parameters (Cronbach's α = .70-.90). In particular, α values between 0.76 and 0.82 were detected for the I-DHI subscales and an α value equal to 0.90 for the I-DHI Total score.…”

An Investigation of the Factor Structure of the Persian Version of the Dysphagia Handicap Index

“…There was a positive correlation between the overall P-DHI scores and severity of dysphagia scores; in other words, the higher the severity, the greater the DHI score. This is also in line with previous findings from Silbergleit et al (9), Farahat et al (14), Barzegar-Bafrooei et al (15), Oda et al (16) and Shapira-Galitz et al (17). P-DHI score was not significantly related to age, sex, level of education, and duration of disease.…”

“…The scale and its subscales showed acceptable to excellent internal consistency. This result is in line with previous investigations that have reported acceptable to excellent internal consistency for this scale (9,14,16). The scale and its subscales also showed excellent test-retest reliability, indicating that the scores of the P-DHI were stable after the two-week interval.…”

“…It is a relatively new self-administered questionnaire that includes 25 items (9). The DHI has been translated into several languages such as Arabic (14), Persian (15), Japanese (16), and Hebrew (17). Factor structure analysis is a statistical method for investigating variable relationships for complex concepts such as socioeconomic status, quality of life, or psychological scales.…”