Dizziness Handicap Inventory



International Knee Documentation Committee (IKDC)

Dizziness Handicap Inventory

The Dizziness Handicap Inventory (DHI) is a 25-item PROM that quantifies the impact of dizziness on ADLs by measuring self-perceived handicap (Jacobsen et al. 1990). The DHI is often used in studies that evaluate the effects of dizziness and vertigo on a patient’s life.


Validity and Reliability

The Dizziness Handicap Inventory (DHI) has shown strong psychometric properties in various populations and languages. Studies have translated and validated versions of the DHI in Thai Emasithi et al. (2021), Polish (Szostek-Rogula & Zamyslowska-Szmytke, 2019), Gujarati (Neupane et al., 2019), and Filipino (Agustin et al., 2020).

The DHI has demonstrated internal validity, with sub-domain item-total correlation scores supporting the validity of the physical, emotional, and functional aspects (Agustin et al., 2020). Additionally, the DHI has been found to have good discriminatory ability between patients with and without dizziness handicap, with sensitivity and specificity around 80% (Szostek-Rogula & Zamyslowska-Szmytke, 2019).

The DHI has been used in various clinical contexts, such as Parkinson’s disease (Kwon et al., 2022), persistent postural-perceptual dizziness (Castillo-Bustamante, 2023), cognitive impairment (Lee et al., 2020), and multiple sclerosis (Zeigelboim, 2012).

Overall, the DHI is a reliable and valid tool for assessing the impact of dizziness on individuals’ lives in different populations and settings.


Scoring and Interpretation

The patient is asked to respond to each query as it relates to dizziness or unsteadiness issues, specifically taking into account their state over the previous month.

The functional (F), physical (P), and emotional (E) implications on disability are all included in the questions.

The following scores may be given to each item:

  • No=0
  • Sometimes=2
  • Yes=4

The maximum score is 100 and indicates maximal perceived disability. The minimal score is 0, which indicates no perceived disability due to dizziness.

Scores above 10 should be forwarded to balance experts for additional assessment.

  • 16–34 Points (Mild Handicap)
  • 36-52 Points (Moderate Handicap)
  • 54+ Points (Severe Handicap)

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Jacobson GP, Newman CW. The development of the Dizziness Handicap Inventory. Arch Otolaryngol Head Neck Surg. 1990;116(4):424-427. doi:10.1001/archotol.1990.01870040046011 

Emasithi A. , Pakdee S. , Isaradisaikul S. , Uthaikhup S.. Translation and Validation Of The Dizziness Handicap Inventory Into Thai Language. Otology ; Neurotology 2021;43(2):e252-e258. https://doi.org/10.1097/mao.0000000000003391

Szostek-Rogula S. , Zamyslowska-Szmytke E.. Validation Of the Polish Version Of The ≪i>dizziness Handicap Inventory</i>. Med Pr 2019. https://doi.org/10.13075/mp.5893.00879

Neupane A. , Kapasi A. , Patel N.. Psychometric Features Of Dizziness Handicap Inventory (Dhi): Development and Standardization In Gujarati Language. The International Tinnitus Journal 2019;23(2). https://doi.org/10.5935/0946-5448.20190015

Agustin S. , Ureta C. , Almazan N.. A Linguistic Validation Study On the Filipino Dizziness Handicap Inventory. Philipp J Otolaryngol Head Neck Surg 2020;35(2):37. https://doi.org/10.32412/pjohns.v35i2.1517

Kwon K., Park S., Lee E., Lee M., Ju H.. Impact Of Subjective Dizziness On Motor and Non-motor Symptoms In Patients With Early Stages Of Parkinson’s Disease. J. Integr. Neurosci. 2022;21(1):003. https://doi.org/10.31083/j.jin2101003

Castillo-Bustamante M. , García A. , Candelo E. , Zamorano A. , Escobar L. , Sánchez J. et al.. Therapies In Patients With Persistent Postural-perceptual Dizziness: Challenges and Elections: A Systematic Review. 2023. https://doi.org/10.21203/rs.3.rs-3064887/v1

Lee H. , Lim Y. , Kim S.. Dizziness In Patients With Cognitive Impairment. VES 2020;30(1):17-23. https://doi.org/10.3233/ves-190686

Zeigelboim B.. Balance Rehabilitation Unit (Bru Tm) Posturography In Relapsing-remitting Multiple Sclerosis. Rev. soc. bras. fonoaudiol. 2012;17(2):234-235. https://doi.org/10.1590/s1516-80342012000200022

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