, Volume 34, Issue 1, pp 63–72 | Cite as

Translation and Validation of the Dysphagia Handicap Index in Hebrew-Speaking Patients

  • Yael Shapira-GalitzEmail author
  • Michael Drendel
  • Ruth Yousovich-Ulriech
  • Liat Shtreiffler-Moskovich
  • Michael Wolf
  • Yonatan Lahav
Original Article


The Dysphagia Handicap Index (DHI) is a 25-item questionnaire assessing the physical, functional, and emotional aspects of dysphagia patients’ quality of life (QoL). The study goal was to translate and validate the Hebrew-DHI. 148 patients undergoing fiberoptic endoscopic examination of swallowing (FEES) in two specialized dysphagia clinics between February and August 2017 filled the Hebrew-DHI and self-reported their dysphagia severity on a scale of 1–7. 21 patients refilled the DHI during a 2-week period following their first visit. FEES were scored for residue (1 point per consistency), penetration and aspiration (1 point for penetration, 2 points for aspiration, per consistency). 51 healthy volunteers also filled the DHI. Internal consistency and test–retest reproducibility were used for reliability testing. Validity was established by comparing DHI scores of dysphagia patients and healthy controls. Concurrent validity was established by correlating the DHI score with the FEES score. Internal consistency of the Hebrew-DHI was high (Cronbach’s alpha = 0.96), as was the test–retest reproducibility (Spearman’s correlation coefficient = 0.82, p < 0.001). The Hebrew-DHI’s total score, and its three subscales (physical/functional/emotional) were significantly higher in dysphagia patients compared to those in healthy controls (median 38 pts, IQR 18–56 for dysphagia patients compared to 0, IQR 0–2 for healthy controls, p < 0.0001). A strong correlation was observed between the DHI score and the self-reported dysphagia severity measure (Spearman’s correlation coefficient = 0.88, p < 0.0001). A moderate correlation was found between the DHI score and the FEES score (Pearson’s correlation coefficient = 0.245, p = 0.003). The Hebrew-DHI is a reliable and valid questionnaire assessing dysphagia patients’ QoL.


Deglutition Deglutition disorders Dysphagia Handicap Index Patient-reported outcome measure Quality of life Fiber optic endoscopic evaluation of swallowing Dysphagia Questionnaire Translation Hebrew 


Compliance with Ethical Standards

Conflict of interest

The authors have no conflict of interest to declare.

Ethical Approval

All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

All participants signed an informed consent form.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.The Department of Otolaryngology Head and Neck Surgery, Kaplan Medical CenterAffiliated with the Hebrew University of JerusalemRehovotIsrael
  2. 2.The Department of Otololaryngology Head and Neck Surgery, Sheba Medical CenterAffiliated with the Tel Aviv UniversityTel HaShomerIsrael

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