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The Dysphagia Handicap Index: Development and Validation


Quality-of-life indicators for dysphagia provide invaluable information to the treating clinician regarding the success or failure of swallowing therapy. The purpose of this study was to develop a clinically efficient, statistically robust patient-reported outcomes tool that measures the handicapping effect of dysphagia on emotional, functional, and physical aspects of individual’s lives. 60 statements describing the handicapping effect of dysphagia were collected from patient reports and divided into subscales of physical, emotional, and functional problems. The statements were presented to 77 individuals with dysphagia. Respondents replied never, sometimes, or always to each statement and rated their self-perceived dysphagia severity on a 7-point equal-appearing interval scale. Cronbach’s α was performed to assess the internal consistency validation of the items within the questionnaire. The final questionnaire was reduced to 25 items and administered to 214 individuals with dysphagia and 74 controls. Test–retest was performed on 63 individuals with dysphagia. Cronbach’s α for the initial and final versions was strong at r = 0.96 and r = 0.94, respectively. Significant differences occurred between the dysphagia and control groups. Test–retest reliability was strong. We present a new, easy-to-complete, statistically robust, patient-reported outcomes measure for assessing the handicapping effect of dysphagia.

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The authors gratefully acknowledge the staff of the Division of Speech-Language Sciences and Disorders, Department of Neurology, Henry Ford Hospitals and Health Network for their assistance in data collection for this study.

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Correspondence to Alice K. Silbergleit.

Appendix: Dysphagia Handicap Index (DHI)

Appendix: Dysphagia Handicap Index (DHI)

Please place a check in the box that describes your swallowing difficulty.






1P. I cough when I drink liquids.


2P. I cough when I eat solid food.


3P. My mouth is dry.


4P. I need to drink fluids to wash food down.


5P. I’ve lost weight because of my swallowing problem.


1F. I avoid some foods because of my swallowing problem.


2F. I have changed the way I swallow to make it easier to eat.


1E. I’m embarrassed to eat in public.


3F. It takes me longer to eat a meal than it used to.


4F. I eat smaller meals more often due to my swallowing problem.


6P. I have to swallow again before food will go down.


2E. I feel depressed because I can’t eat what I want.


3E. I don’t enjoy eating as much as I used to.


5F. I don’t socialize as much due to my swallowing problem.


6F. I avoid eating because of my swallowing problem.


7F. I eat less because of my swallowing problem.


4E. I am nervous because of my swallowing problem.


5E. I feel handicapped because of my swallowing problem.


6E. I get angry at myself because of my swallowing problem.


7P. I choke when I take my medication.


7E. I’m afraid that I’ll choke and stop breathing because of my swallowing problem.


8F. I must eat another way (e.g., feeding tube) because of my swallowing problem.


9F. I’ve changed my diet due to my swallowing problem.


8P. I feel a strangling sensation when I swallow.


9P. I cough up food after I swallow.











Moderate Problem


Severe Problem

  1. Please circle the number that matches the severity of your swallowing difficulty (1 = no difficulty at all; 4 = somewhat of a problem; 7 = the worse problem you could have)

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Silbergleit, A.K., Schultz, L., Jacobson, B.H. et al. The Dysphagia Handicap Index: Development and Validation. Dysphagia 27, 46–52 (2012).

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