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Cross-Cultural Adaptation and Validation of the European Portuguese Dysphagia Handicap Index


The Dysphagia Handicap Index (DHI) is a valid Health-related Quality of Life (HRQoL) 25-item questionnaire assessing the physical, functional, and emotional aspects of patients with oropharyngeal dysphagia (OD), of heterogeneous etiologies. The purpose of this study is to translate and validate the European Portuguese-DHI (EP-DHI). This is a prospective study that was carried out at Centro Hospitalar Universitário do Porto (CHUPorto). The generated EP-DHI was administered to 132 patients with OD and 112 healthy control subjects. 132 patients undergoing fiberoptic endoscopic examination of swallowing (FEES). 15 patients were contacted by phone, 2 or 3 weeks later after the first interview to repeat the questionnaire. The validity of concurrent criteria was evaluated by comparing the results of the EP-DHI score with the score attributed to the pathological findings found in FEES and, consequently, Functional Oral Intake Scale (FOIS). The internal consistency of EP-DHI was successful: Cronbach’s alpha coefficient for total EP-DHI was 0.874. The test–retest reliability for the total and the three EP-DHI subscales obtained a Pearson's correlation coefficient ranged from 0.990 to 0.712. This study demonstrates that EP-DHI is a valid tool for self-assessment of the handicapping effect of dysphagia on physical, functional, and emotional aspects of patient’s quality of life, among an European Portuguese sample.

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Correspondence to Isabel Silva-Carvalho.

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All procedures performed in study were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by ethics committee.

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Final version of the EP-DHI.

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Silva-Carvalho, I., Martins, A., Casanova, M.J. et al. Cross-Cultural Adaptation and Validation of the European Portuguese Dysphagia Handicap Index. Dysphagia 38, 1072–1079 (2023).

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