Translation, Cross-Cultural Adaptation, and Validation of the Polish Version of the Dizziness Handicap Inventory

Published:August 07, 2022DOI:


      • The article presents validation and adaptation of the Dizziness Handicap Inventory to the Polish language.
      • The Dizziness Handicap Inventory required statistical analysis and adaptation to the Polish language to be fully implemented in the healthcare system.
      • It is a self-report questionnaire validated in 12 countries and still is successfully used to measure the perceived handicap related to the vestibular organ.
      • The questionnaire helps to understand perceived difficulties in emotional, physical, and functional scales that are not measured by other tests and supports doctors’ decisions in the rehabilitative process.



      The Dizziness Handicap Inventory (DHI) questionnaire is used to assess the severity of vertigo. In clinical practice, it is a good indicator for understanding the patient’s feelings and can be used as a quantitative measure for monitoring ongoing treatment and rehabilitation. This study involved the translation, cultural adaptation, and validation of the Polish DHI questionnaire (DHI-POL).


      We recruited 127 subjects (mean age 55.1 years) who experienced vertigo, dizziness, and imbalance resulting from a disturbance to their vestibular system that had lasted longer than 1 month and 56 subjects (mean age 51.8 years) without any vestibular symptoms. All subjects performed a posturography Sensory Organization Test and completed the questionnaire twice.


      Cronbach’s alpha for the overall DHI-POL was α = 0.93. The questions were divided into 3 subgroups (functional [F], emotional [E], and physical [P]) for which the internal consistency was as follows: DHI-F, α = 0.84; DHI-E, α = 0.85; and DHI-P, α = 0.81. Reproducibility, as measured by interclass correlation coefficient for the overall DHI-POL, was 0.91. For each interclass correlation coefficient subgroup, the results were as follows: DHI-F, 0.90; DHI-E, 0.93; and DHI-P, 0.83.


      DHI-POL has a high consistency and repeatability; therefore, it is a fully functional questionnaire that meets all the validation criteria and is a tool ready for use on Polish patients with vertigo.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Value in Health Regional Issues
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Weidt S.
        • Bruehl A.B.
        • Straumann D.
        • Hegemann S.C.
        • Krautstrunk G.
        • Rufer M.
        Health-related quality of life and emotional distress in patients with dizziness: a cross-sectional approach to disentangle their relationship.
        BMC Health Serv Res. 2014; 14: 317
        • Mendel B.
        • Bergenius J.
        • Langius-Eklöf A.
        Dizziness: a common, troublesome symptom but often treatable.
        J Vestib Res. 2010; 20: 391-398
        • Neuhauser H.K.
        • Radtke A.
        • von Brevern M.
        • Lezius F.
        • Feldmann M.
        • Lempert T.
        Burden of dizziness and vertigo in the community [published correction appears in Arch Intern Med. 2009;169(1):89].
        Arch Intern Med. 2008; 168: 2118-2124
        • Neuhauser H.K.
        • von Brevern M.
        • Radtke A.
        • et al.
        Epidemiology of vestibular vertigo: a neurotologic survey of the general population [published correction appears in Neurology. 2006;67(8):1528].
        Neurology. 2005; 65: 898-904
        • Humphriss R.
        • Hall A.J.
        Dizziness in 10 year old children: an epidemiological study.
        Int J Pediatr Otorhinolaryngol. 2011; 75: 395-400
        • Niemensivu R.
        • Pyykkö I.
        • Wiener-Vacher S.R.
        • Kentala E.
        Vertigo and balance problems in children--an epidemiologic study in Finland.
        Int J Pediatr Otorhinolaryngol. 2006; 70: 259-265
        • Piker E.G.
        • Jacobson G.P.
        • Newman C.W.
        Assessing dizziness-related quality of life.
        in: Jacobson G.P. Shepard N.T. Barin K. Burkard R.F. Janky K. McCaslin D.L. Balance Function Assessment and Management. 3rd ed. Plurar Publishing, San Diego, CA2021: 143-165
        • Black N.
        • Varaganum M.
        • Hutchings A.
        Relationship between patient reported experience (PREMs) and patient reported outcomes (PROMs) in elective surgery.
        BMJ Qual Saf. 2014; 23: 534-542
        • Snyder C.F.
        • Jensen R.E.
        • Segal J.B.
        • Wu A.W.
        Patient-reported outcomes (PROs): putting the patient perspective in patient-centered outcomes research.
        Med Care. 2013; 51: S73-S79
        • Ratajczak A.
        • Sobczyk K.
        • Budnicki D.
        • Gos E.
        • Skarżyński P.H.
        Przegląd wybranych kwestionariuszy stosowanych do oceny zawrotów głowy i zaburzeń równowagi.
        Now Audiofonol. 2020; 8: 60-71
        • Wojtczak R.
        • Narożny W.
        • Kuczkowski J.
        • Siebert J.
        Epidemiology of dizziness in northern Poland – the first Polish neurootologic survey of the general population.
        Ann Agric Environ Med. 2017; 24: 502-506
      1. International classification of functioning, disability and health (ICF). World Health Organization.
        • Jacobson G.P.
        • Newman C.W.
        The development of the Dizziness Handicap Inventory.
        Arch Otolaryngol Head Neck Surg. 1990; 116: 424-427
        • Wild D.
        • Grove A.
        • Martin M.
        • et al.
        Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: report of the ISPOR Task Force for Translation and Cultural Adaptation.
        Value Health. 2005; 8: 94-104
        • Beaton D.E.
        • Bombardier C.
        • Guillemin F.
        • Ferraz M.B.
        Guidelines for the process of cross-cultural adaptation of self-report measures.
        Spine (Phila Pa 1976). 2000; 25: 3186-3191
        • Hall D.A.
        • Zaragoza Domingo S.
        • Hamdache L.Z.
        • et al.
        A good practice guide for translating and adapting hearing-related questionnaires for different languages and cultures.
        Int J Audiol. 2018; 57: 161-175
        • Thorndike R.M.
        Book Review : psychometric theory (3rd ed).
        Appl Psychol Meas. 1995; 19: 303-305
        • Cohen J.
        Statistical Power Analysis for the Behavioral Science.
        2nd ed. Routledge, Hillsdale, NJ1988
        • Nunnally J.C.
        • Bernstein I.H.
        Psychometric Theory. 3rd ed. McGraw-Hill, New York1994
        • Terwee C.B.
        • Bot S.D.M.
        • de Boer M.R.
        • et al.
        Quality criteria were proposed for measurement properties of health status questionnaires.
        J Clin Epidemiol. 2007; 60: 34-42
        • Bland J.M.
        • Altman D.G.
        Statistical methods for assessing agreement between two methods of clinical measurement.
        Lancet. 1986; 1: 307-310
        • Vereeck L.
        • Truijen S.
        • Wuyts F.
        • Van de Heyning P.H.
        Test-retest reliability of the Dutch version of the Dizziness Handicap Inventory.
        B-ENT. 2006; 2: 75-80
        • Kurre A.
        • van Gool C.J.A.W.
        • Bastiaenen C.H.G.
        • Gloor-Juzi T.
        • Straumann D.
        • de Bruin E.D.
        Translation, cross-cultural adaptation and reliability of the German version of the dizziness handicap inventory.
        Otol Neurotol. 2009; 30: 359-367
        • Georgieva-Zhostova S.
        • Kolev O.I.
        • Stambolieva K.
        Translation, cross-cultural adaptation and validation of the Bulgarian version of the Dizziness Handicap Inventory.
        Qual Life Res. 2014; 23: 2103-2107
        • Nikitas C.
        • Kikidis D.
        • Katsinis S.
        • Kyrodimos E.
        • Bibas A.
        Translation and validation of the dizziness handicap inventory in Greek language.
        Int J Audiol. 2017; 56: 936-941
        • Colnaghi S.
        • Rezzani C.
        • Gnesi M.
        • et al.
        Validation of the Italian version of the dizziness handicap inventory, the situational vertigo questionnaire, and the activity-specific balance confidence scale for peripheral and central vestibular symptoms.
        Front Neurol. 2017; 8: 528
        • Valančius D.
        • Ulytė A.
        • Masiliūnas R.
        • et al.
        Validation and factor analysis of the Lithuanian version of the dizziness handicap inventory.
        J Int Adv Otol. 2019; 15: 447-453
        • da Glória Canto de Sousa M.
        • Cruz O.
        • Santos A.N.
        • Ganança C.
        • Almeida L.
        • de Sena E.P.
        Brazilian adaptation of the dizziness handicap inventory for the pediatric population: reliability of the results.
        Audiol, Commun Res. 2015; 20: 327-335
        • Jacobson G.P.
        • Calder J.H.
        A screening version of the Dizziness Handicap Inventory (DHI-S).
        Am J Otol. 1998; 19: 804-808
        • Perez N.
        • Garmendia I.
        • García-Granero M.
        • Martin E.
        • García-Tapia R.
        Factor analysis and correlation between Dizziness Handicap Inventory and dizziness characteristics and impact on quality of life scales.
        Acta Otolaryngol Suppl. 2001; 545: 145-154
        • de Vet H.C.W.
        • Terwee C.B.
        • Mokkink L.B.
        • Knol D.L.
        Measurement in Medicine: A Practical Guide.
        Cambridge University Press, Cambridge, United Kingdom2011
        • Brzeziński J.
        Methodology of Psychological Research. 5th ed.
        PWN Publishing, Warsaw2019
        • Caldara B.
        • Asenzo A.I.
        • Brusotti Paglia G.
        • et al.
        [Cross-cultural adaptation and validation of the Dizziness Handicap Inventory: Argentine version].
        Acta Otorrinolaringol Esp. 2012; 63: 106-114
        • Szostek-Rogula S.
        • Zamysłowska-Szmytke E.
        Walidacja polskiej wersji kwestionariusza Dizziness Handicap Inventory.
        Otorynolaryngologia. 2018; 17: 105-111
        • Szostek-Rogula S.
        • Zamysłowska-Szmytke E.
        Validation of the Polish version of the Dizziness Handicap Inventory.
        Med Pr. 2019; 70: 529-534
        • Harkness J.A.
        • Vijver FJR van de
        • Johnson T.P.
        Questionnaire design in comparative research, 2003 research. In: Cross-Cultural Survey Methods.
        Wiley, New York, NY2003: 19-34