Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Feb;37(1):65-73.
doi: 10.1007/s00455-021-10250-2. Epub 2021 Jan 30.

Using Classical Test Theory to Determine the Psychometric Properties of the Deglutition Handicap Index

Renée Speyer  1   2   3 , Reinie Cordier  4   5 , Clara Bouix  6 , Yohan Gallois  7 , Virginie Woisard  6   8   9
Affiliations

Using Classical Test Theory to Determine the Psychometric Properties of the Deglutition Handicap Index

Renée Speyer et al. Dysphagia. 2022 Feb.

Abstract

The Deglutition Handicap Index (DHI) is a self-report measure for patients at risk of oropharyngeal dysphagia on deglutition-related aspects of functional health status (FHS) and health-related quality of life (HR-QoL). The DHI consists of 30 items which are subsumed within the Symptom, Functional and Emotional subscales. The purpose of this study was to evaluate the psychometric properties of the DHI using Classic Test Theory according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria. A total of 453 patients with dysphagia with different aetiologies were recruited concurrently at two academic hospitals. Dysphagia was confirmed by fiberoptic endoscopic and/or videofluoroscopic evaluation of swallowing. In addition, a healthy control group of 132 participants were recruited. Structural validity was determined using exploratory and confirmatory factor analyses and internal consistency by calculating Cronbach's alpha coefficients. Hypothesis testing was evaluated using Mann-Whitney U-tests, linear regression analysis and correlations analysis. Diagnostic performance and receiver operating characteristic curves analysis were calculated. Factor analyses indicated that the DHI is a unidimensional measure. The DHI has good internal consistency with some indication of item redundancy, weak to moderate structural validity and strong hypothesis testing for construct validity. The DHI shows high diagnostic performance as part of criterion validity. These findings support that the DHI is an appropriate choice as a patient self-report measure to evaluate FHS and HR-QoL in dysphagia. Ongoing validation to assess the measure for possible item redundancy and to examine the dimensionality of the DHI using item response theory is recommended.

Keywords: Classical test theory; DHI; Diagnostic performance; Psychometrics; Reliability; Validity.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
ROC curve of the DHI Total score
Fig. 2
Fig. 2
a Data distribution for the DHI Total score for the patient group (no floor and ceiling effects). b Data distribution for the DHI Total score for the control group
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Speyer R. Oropharyngeal dysphagia: screening and assessment. Otolaryngol Clin North Am. 2013;46(6):989–1008. doi: 10.1016/j.otc.2013.08.004. - DOI - PubMed
    1. Baijens LWJ, et al. ESSD-EUGMS white paper: oropharyngeal dysphagia as a geriatric syndrome. Clin Interv Aging. 2016;11:1403–1428. doi: 10.2147/CIA.S107750. - DOI - PMC - PubMed
    1. Timmerman AA, et al. Psychometric characteristics of health-related quality-of-life questionnaires in oropharyngeal dysphagia. Dysphagia. 2014;29(2):183–198. doi: 10.1007/s00455-013-9511-8. - DOI - PubMed
    1. Ferrans CE, et al. Conceptual model of health-related quality of life. J Nurs Scholarsh. 2005;37(4):336–342. doi: 10.1111/j.1547-5069.2005.00058.x. - DOI - PubMed
    1. Mokkink LB, et al. The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. J Clin Epidemiol. 2010;63(7):737–745. doi: 10.1016/j.jclinepi.2010.02.006. - DOI - PubMed

LinkOut - more resources