Translation, cross-cultural adaptation and validation of the Bulgarian version of the Dizziness Handicap Inventory

Abstract

The aim of the present study was the translation, cross-cultural adaptation and validation of the Dizziness Handicap Inventory in Bulgarian language (DHI-BG). Ninety-seven vestibular patients (19 men and 78 women, mean age 45.08±13.85years) took part in the investigation. All participants were asked to fill in the DHI-BG. Internal consistency was estimated using Cronbach's alpha and item-total correlation, reproducibility by calculating Bland-Altman's limits of agreement and intraclass correlation coefficients (ICCs). Associations were estimated by Spearman's correlation coefficients. The Cronbach's alpha for the total score, functional, physical and emotional subscales of DHI-BG were 0.88, 0.75, 0.72 and 0.81. The floor and ceiling effects of the DHI-BG total scale were evaluated with respect to the limits of agreement which were ±9.4-14.53 points. Intraclass correlation coefficients (ICCs) for all scale and subscales were higher than the recommended value of 0.75 and determined good test-retest reliability. The range of items correlation for DHI-BG was from 0.27 (item 12) to 0.72 (item 3). No significant differences were observed in the Cronbach's alpha coefficients between the DHI-BG and the original version, the German and Italian versions of the questionnaire. The most significant difference was observed in comparison with the German version of DHI. Construct validity presented a moderate correlation between Romberg coefficients and DHI-BG scores and strong correlation between all scores of DHI and the self-perceived disability. The results suggest that DHI-BG scores show a good discriminative validity between groups with different levels of self-assessed disability. The Bulgarian version of the DHI is a reliable and valid tool in assessing the impact of dizziness on the quality of life in Bulgarian vestibular patients.