Skip to main content
SpringerLink
Log in

Clinical Usefulness of the Korean Version of the Dysphagia Handicap Index: Reliability, Validity, and Role as a Screening Test

  • Original Article
  • Published:
Dysphagia Aims and scope Submit manuscript

Abstract

This study aimed to measure the validity and reliability of the Korean version of the Dysphagia Handicap Index (K-DHI) and evaluate its diagnostic efficacy for predicting aspiration. We enrolled 104 patients with dysphagia symptoms (D group) and 88 controls (ND group). Among controls, there were 43 patients without dysphagia symptoms (ND patient group). All subjects completed the K-DHI survey. The D and ND group patients underwent the Gugging Swallowing Screen (GUSS) and videofluoroscopic swallowing study (VFSS). Two weeks later, the D group completed the second session of the K-DHI survey. The internal consistency of the K-DHI was good to excellent (Cronbach’s α: 0.79–0.95). The test–retest reliability of the K-DHI survey was also high (interclass correlation coefficient = 0.88). There were moderate correlations between the K-DHI and GUSS (r = − 0.65, p < 0.001) as well as findings of VFSS–videofluoroscopic dysphagia scale (r = 0.55, p < 0.001) and American Speech-Language-Hearing Association National Outcome Measurement System swallowing scale (r = − 0.55, p < 0.001). For predicting aspiration, the K-DHI cutoff value was 11 (sensitivity, 0.82; specificity, 0.72; positive predictive value, 0.34; and negative predictive value, 0.96). K-DHI ≥ 11 [odds ratio (OR), 6.43; 95% Confidence Interval (CI) (1.87–22.16); p = 0.003] and GUSS ≤ 15 [OR 4.73; 95% CI (1.59–14.07); p = 0.005] were independent risk factors for aspiration on VFSS. The K-DHI is a reliable and valid self-reporting instrument for evaluating patient’s quality of life associated with dysphagia among the Korean language population. It is also useful for the screening of aspiration.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bisch EM, Logemann JA, Rademaker AW, Kahrilas PJ, Lazarus CL. Pharyngeal effects of bolus volume, viscosity, and temperature in patients with dysphagia resulting from neurologic impairment and in normal subjects. J Speech Hear Res. 1994;37(5):1041–59. https://doi.org/10.1044/jshr.3705.1041.

    Article  CAS  PubMed  Google Scholar 

  2. Sura L, Madhavan A, Carnaby G, Crary MA. Dysphagia in the elderly: management and nutritional considerations. Clin Interv Aging. 2012;7:287–98. https://doi.org/10.2147/CIA.S23404.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Perry SE, Miles A, Fink JN, Huckabee ML. The dysphagia in stroke protocol reduces aspiration pneumonia in patients with dysphagia following acute stroke: a clinical audit. Transl Stroke Res. 2019;10(1):36–43. https://doi.org/10.1007/s12975-018-0625-z.

    Article  PubMed  Google Scholar 

  4. Gustafsson B, Tibbling L. Dysphagia, an unrecognized handicap. Dysphagia. 1991;6(4):193–9. https://doi.org/10.1007/BF02493525.

    Article  CAS  PubMed  Google Scholar 

  5. Triggs J, Pandolfino J. Recent advances in dysphagia management. F1000Research. 2019. https://doi.org/10.12688/f1000research.18900.1.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Tomita S, Oeda T, Umemura A, Kohsaka M, Park K, Yamamoto K, Sugiyama H, Sawada H. Video-fluoroscopic swallowing study scale for predicting aspiration pneumonia in Parkinson’s disease. PLoS ONE. 2018;13(6):e0197608. https://doi.org/10.1371/journal.pone.0197608.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. O’Horo JC, Rogus-Pulia N, Garcia-Arguello L, Robbins J, Safdar N. Bedside diagnosis of dysphagia: a systematic review. J Hosp Med. 2015;10(4):256–65. https://doi.org/10.1002/jhm.2313.

    Article  PubMed  Google Scholar 

  8. Silbergleit AK, Schultz L, Jacobson BH, Beardsley T, Johnson AF. The Dysphagia handicap index: development and validation. Dysphagia. 2012;27(1):46–52. https://doi.org/10.1007/s00455-011-9336-2.

    Article  PubMed  Google Scholar 

  9. Oda C, Yamamoto T, Fukumoto Y, Nakayama K, Sato M, Murata M, Kobayashi Y. Validation of the Japanese translation of the Dysphagia Handicap Index. Patient Prefer Adherence. 2017;11:193–8. https://doi.org/10.2147/PPA.S126052.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Farahat M, Malki KH, Mesallam TA, Bukhari M, Alharethy S. Development of the Arabic Version of Dysphagia Handicap Index (DHI). Dysphagia. 2014;29(4):459–67. https://doi.org/10.1007/s00455-014-9528-7.

    Article  PubMed  Google Scholar 

  11. Barzegar-Bafrooei E, Bakhtiary J, Khatoonabadi AR, Fatehi F, Maroufizadeh S, Fathali M. Validation of the Persian version of the dysphagia handicap index in patients with neurological disorders. Iran J Neurol. 2016;15(3):128–32.

    PubMed  PubMed Central  Google Scholar 

  12. Shapira-Galitz Y, Drendel M, Yousovich-Ulriech R, Shtreiffler-Moskovich L, Wolf M, Lahav Y. Translation and validation of the Dysphagia Handicap Index in Hebrew-speaking patients. Dysphagia. 2019;34(1):63–72. https://doi.org/10.1007/s00455-018-9914-7.

    Article  PubMed  Google Scholar 

  13. Kim GH, Choi SH, Lee KJ, Choi CH. Dysphagia Handicap Index and swallowing characteristics based on laryngeal functions in Korean elderly. Phonet Speech Sci. 2014;6(3):3–12. https://doi.org/10.13064/KSSS.2014.6.3.003.

    Article  Google Scholar 

  14. Kim HK, Kim HH, Choi SH, Kim DY. Analysis of Dysphagia Handicap Index in stroke patients and associated factors. Commun Sci Disord. 2019;24(1):220–33. https://doi.org/10.12963/csd.18539.

    Article  Google Scholar 

  15. Trapl M, Enderle P, Nowotny M, Teuschl Y, Matz K, Dachenhausen A, Brainin M. Dysphagia bedside screening for acute-stroke patients: the Gugging Swallowing Screen. Stroke. 2007;38(11):2948–52. https://doi.org/10.1161/STROKEAHA.107.483933.

    Article  PubMed  Google Scholar 

  16. Kim J, Oh BM, Kim JY, Lee GJ, Lee SA, Han TR. Validation of the videofluoroscopic dysphagia scale in various etiologies. Dysphagia. 2014;29(4):438–43. https://doi.org/10.1007/s00455-014-9524-y.

    Article  PubMed  Google Scholar 

  17. Dungan S, Gregorio D, Abrahams T, Harrison B, Abrahams J, Brocato D, Davis C, Espana E, Garcia R, Smith S, Taylor B, Higgins T, Daley L, Carnaby G. Comparative validity of the American Speech-Language-Hearing Association’s National Outcomes Measurement System, Functional Oral Intake Scale, and G-Codes to Mann Assessment of Swallowing Ability Scores for Dysphagia. Am J Speech Lang Pathol. 2019;28(2):424–9. https://doi.org/10.1044/2018_AJSLP-18-0072.

    Article  PubMed  Google Scholar 

  18. Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11(2):93–8. https://doi.org/10.1007/BF00417897.

    Article  CAS  PubMed  Google Scholar 

  19. Park KD, Kim TH, Lee SH. The Gugging swallowing screen in dysphagia screening for patients with stroke: a systematic review. Int J Nurs Stud. 2020;107:103588. https://doi.org/10.1016/j.ijnurstu.2020.103588.

    Article  PubMed  Google Scholar 

  20. Palmer JL, Metheny NA. Preventing aspiration in older adults with dysphagia. Am J Nurs. 2008;108(2):40–8. https://doi.org/10.1097/01.NAJ.0000308961.99857.33.

    Article  PubMed  Google Scholar 

  21. Christmas C, Rogus-Pulia N. Swallowing disorders in the older population. J Am Geriatr Soc. 2019;67(12):2643–9. https://doi.org/10.1111/jgs.16137.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Eyal H. Evaluation and treatment of swallowing disorders (dysphagia)–the American model as an opportunity for improving patient care and cost containment in Israel’s healthcare system. Harefuah. 1997;132(11):775–8.

    CAS  PubMed  Google Scholar 

  23. Pikus L, Levine MS, Yang YX, Rubesin SE, Katzka DA, Laufer I, Gefter WB. Videofluoroscopic studies of swallowing dysfunction and the relative risk of pneumonia. Am J Roentgenol. 2003;180(6):1613–6. https://doi.org/10.2214/ajr.180.6.1801613.

    Article  Google Scholar 

  24. Reynolds J, Carroll S, Sturdivant C. Fiberoptic endoscopic evaluation of swallowing: a multidisciplinary alternative for assessment of infants with dysphagia in the neonatal intensive care unit. Adv Neonatal Care. 2016;16(1):37–43. https://doi.org/10.1097/ANC.0000000000000245.

    Article  PubMed  Google Scholar 

  25. Palli C, Fandler S, Doppelhofer K, Niederkorn K, Enzinger C, Vetta C, Trampusch E, Schmidt R, Fazekas F, Gattringer T. Early Dysphagia screening by trained nurses reduces pneumonia rate in stroke patients: a clinical intervention study. Stroke. 2017;48(9):2583–5. https://doi.org/10.1161/STROKEAHA.117.018157.

    Article  PubMed  Google Scholar 

  26. Mandrekar JN. Receiver operating characteristic curve in diagnostic test assessment. J Thorac Oncol. 2010;5(9):1315–6. https://doi.org/10.1097/JTO.0b013e3181ec173d.

    Article  Google Scholar 

  27. Teuschl Y, Trapl M, Ratajczak P, Matz K, Dachenhausen A, Brainin M. Systematic dysphagia screening and dietary modifications to reduce stroke-associated pneumonia rates in a stroke-unit. PLoS ONE. 2018;13(2):e0192142. https://doi.org/10.1371/journal.pone.0192142.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Speyer R, Heijnen BJ, Baijens LW, Vrijenhoef FH, Otters EF, Roodenburg N, Bogaardt HC. Quality of life in oncological patients with oropharyngeal dysphagia: validity and reliability of the Dutch version of the MD Anderson Dysphagia Inventory and the Deglutition Handicap Index. Dysphagia. 2011;26(4):407–14. https://doi.org/10.1007/s00455-011-9327-3.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors are grateful to SH Hwang for her aid and dedication to this project.

Author information

Author notes

  1. Tae Yeon Kim and Dougho Park have been equally contributed to this manuscript.

Authors and Affiliations

  1. Speech-Language Therapy Department of Rehabilitation Center, Pohang Stroke and Spine Hospital, Pohang, Republic of Korea

    Tae Yeon Kim

  2. Department of Rehabilitation Medicine, Pohang Stroke and Spine Hospital, 352, Huimang-daero, Pohang, 37659, Republic of Korea

    Dougho Park, Sang-Eok Lee & Byung Hee Kim

  3. Occupational Therapy Department of Rehabilitation Center, Pohang Stroke and Spine Hospital, Pohang, Republic of Korea

    Seok Il Son

  4. Department of Audiology and Speech-Language Pathology, Catholic University of Daegu, 13-13, Hayang-ro, Hayang-eup, Gyeongsan, 38430, Republic of Korea

    Seong Hee Choi

Authors
  1. Tae Yeon Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dougho Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sang-Eok Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Byung Hee Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Seok Il Son
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Seong Hee Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Sang-Eok Lee or Seong Hee Choi.

Ethics declarations

Conflict of Interest

Authors have no conflicts of interest to declare that they are relevant to the content of this article.

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.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 30 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, T.Y., Park, D., Lee, SE. et al. Clinical Usefulness of the Korean Version of the Dysphagia Handicap Index: Reliability, Validity, and Role as a Screening Test. Dysphagia 37, 183–191 (2022). https://doi.org/10.1007/s00455-021-10262-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00455-021-10262-y

Keywords

Search

Navigation