PDF(Pubmed)
Abstract：
Background/Objectives: The Dysphagia Handicap Index (DHI) is commonly used in oropharyngeal dysphagia (OD) research as a self-report measure of functional health status and health-related quality of life. The DHI was developed and validated using classic test theory. The aim of this study was to use item response theory (Rasch analysis) to evaluate the psychometric properties of the DHI. Methods: Prospective, consecutive patient data were collected at dysphagia or otorhinolaryngology clinics. The sample included 256 adults (53.1% male; mean age 65.2) at risk of OD. The measure\'s response scale, person and item fit characteristics, differential item functioning, and dimensionality were evaluated. Results: The rating scale was ordered but showed a potential gap in the rating category labels for the overall measure. The overall person (0.91) and item (0.97) reliability was excellent. The overall measure reliably separated persons into at least three distinct groups (person separation index = 3.23) based on swallowing abilities, but the subscales showed inadequate separation. All infit mean squares were in the acceptable range except for the underfitting for item 22 (F). More misfitting was evident in the Z-Standard statistics. Differential item functioning results indicated good performance at an item level for the overall measure; however, contrary to expectation, an OD diagnosis presented only with marginal DIF. The dimensionality of the DHI showed two dimensions in contrast to the three dimensions suggested by the original authors. Conclusions: The DHI failed to reproduce the original three subscales. Caution is needed using the DHI subscales; only the DHI total score should be used. A redevelopment of the DHI is needed; however, given the complexities involved in addressing these issues, the development of a new measure that ensures good content validity may be preferred.
摘要：
背景/目标：吞咽困难障碍指数（DHI）通常用于口咽吞咽困难（OD）研究，作为功能健康状况和健康相关生活质量的自我报告指标。DHI是使用经典测试理论开发和验证的。这项研究的目的是使用项目反应理论（Rasch分析）来评估DHI的心理测量特性。方法：前瞻性，在吞咽困难或耳鼻喉科诊所收集连续患者数据.样本包括256名处于OD风险的成年人(53.1%为男性;平均年龄65.2岁)。措施的响应量表，人和物品适合的特征，差分项目功能，并对维度进行了评估。结果：订购了评定量表，但在总体测量的评级类别标签中显示出潜在的差距。总体人(0.91)和项目(0.97)可靠性优异。根据吞咽能力，总体措施可靠地将人分为至少三个不同的组（人分离指数=3.23）。但分量表显示分离不充分。所有注入均方均在可接受的范围内,除了项目22(F)的欠拟合。更多的错误拟合在Z-标准统计中是明显的。差异项目功能结果表明，在整体测量的项目级别上表现良好；然而，与预期相反，OD诊断仅表现为边缘DIF。与原始作者建议的三个维度相比，DHI的维度显示出两个维度。结论：DHI未能重现原始的三个分量表。使用DHI分量表需要注意；仅使用DHI总分。需要重新开发DHI；然而，考虑到解决这些问题的复杂性，开发一种确保良好内容有效性的新措施可能是首选。
