Form Structure: Dizziness Handicap Inventory (DHI)
This form structure is an organized set of data definitions for a form that has not been copyrighted
Title:
Dizziness Handicap Inventory (DHI)
Short Name:
DHI
Description:
Dizziness Handicap Inventory (DHI) is a 25-item self-assessment scale designed to quantify the functional, emotional, and physical effects of dizziness and unsteadiness. The patient is asked to answer each question as it pertains to dizziness or unsteadiness problems, specifically considering their condition during the last month. Questions are designed to incorporate functional (F), physical (P), and emotional (E) impacts on disability. Scores greater than 10 points should be referred to balance specialists for further evaluation.
References: Jacobson GP, Newman CW, The development of the Dizziness Handicap Inventory. Arch Otolaryngol Head Neck Surg. 1990 Apr;116(4):424-7. https://www.ncbi.nlm.nih.gov/pubmed/2317323
.
Disease:
Traumatic Brain Injury
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2016-03-31
Version:
1.2
Date Created:
2016-01-05
Owner:
Number of Data Elements:
42
eForms:
N
Logically grouped data elements with defined frequency at which they repeat.
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | GUID | Global Unique ID which uniquely identifies a subject | GUID | Required | CDE |
| 2 | Subject identifier number | An identification number assigned to the participant/subject within a given protocol or a study. | SubjectIDNum | Recommended | CDE |
| 3 | Age in years | Value for participant's subject age recorded in years. | AgeYrs | Recommended | CDE |
| 4 | Vital status | Status of participant/subject as alive or dead | VitStatus | Recommended | CDE |
| 5 | Visit date | Actual interview or visit date | VisitDate | Recommended | CDE |
| 6 | Site name | The name of the site for the study | SiteName | Recommended | CDE |
| 7 | Days since baseline | The number of days since baseline | DaysSinceBaseline | Recommended | CDE |
| 8 | Case control indicator | Indicator of whether subject is in the case or control arm of the study. | CaseContrlInd | Recommended | CDE |
| 9 | General notes text | General notes | GeneralNotesTxt | Recommended | CDE |
Additional Element Groups
Listed below are your additional element groups.
Form Administration (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Data source | Source of the data provided on the case report form | DataSource | Recommended | CDE |
| 2 | Data source other text | The free-text field related to Data source specifying other text. Source of the data provided on the case report form | DataSourceOTH | Recommended | CDE |
| 3 | Context type | The context to which the questions were answered | ContextType | Recommended | CDE |
| 4 | Context type other text | The free-text related to ContextType specifying other text | ContextTypeOTH | Recommended | CDE |
DHI (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Dizziness Handicap Inventory (DHI) - Looking Up Increase Problem Scale | Scale to rate the frequency the subject thinks looking up increases their problem, as a part of the Dizziness Handicap Inventory | DHILookUpIncrProbScl | Recommended | CDE |
| 2 | Dizziness Handicap Inventory (DHI) - Feel Frustrated Scale | Scale to rate the frequency the subject thinks they feel frustrated because of their problem, as a part of the Dizziness Handicap Inventory | DHIFeelFrustratedScl | Recommended | CDE |
| 3 | Dizziness Handicap Inventory (DHI) - Restrict Travel Scale | Scale to rate the frequency the subject thinks they restrict travel for business or recreation because of their problem, as a part of the Dizziness Handicap Inventory | DHIRestrictTravelScl | Recommended | CDE |
| 4 | Dizziness Handicap Inventory (DHI) - Walking Down Aisle of Supermarket Scale | Scale to rate the frequency the subject thinks walking down the aisle of a supermarket increases their problems, as a part of the Dizziness Handicap Inventory | DHIWalkDownAisleSupermarketScl | Recommended | CDE |
| 5 | Dizziness Handicap Inventory (DHI) - Difficulty Getting Out Of Bed Scale | Scale to rate the frequency the subject thinks they have difficulty getting out of bed because of their problem, as a part of the Dizziness Handicap Inventory | DHIDiffGettingOutOfBedScl | Recommended | CDE |
| 6 | Dizziness Handicap Inventory (DHI) - Restrict Participation In Social Activities Scale | Scale to rate the frequency the subject thinks they significantly restrict their participation in social activities because of their problem, as a part of the Dizziness Handicap Inventory | DHIRestrictSocialActivitiesScl | Recommended | CDE |
| 7 | Dizziness Handicap Inventory (DHI) - Difficulty Reading Scale | Scale to rate the frequency the subject thinks they have difficulty reading because of their problem, as a part of the Dizziness Handicap Inventory | DHIDifficultyReadingScl | Recommended | CDE |
| 8 | Dizziness Handicap Inventory (DHI) - Ambitious Activity Increase Problem Scale | Scale to rate the frequency the subject thinks performing more ambitious activities such as sports or dancing increases their problem, as a part of the Dizziness Handicap Inventory | DHIAmbitiousActIncrProbScl | Recommended | CDE |
| 9 | Dizziness Handicap Inventory (DHI) - Afraid To Leave Home Without Someone To Accompany Scale | Scale to rate the frequency the subject thinks they are afraid to leave home without having someone accompany them because of their problem, as a part of the Dizziness Handicap Inventory | DHIAfrdLeaveHomeWOAccompanyScl | Recommended | CDE |
| 10 | Dizziness Handicap Inventory (DHI) - Embarrassed In Front Of Others Scale | Scale to rate the frequency the subject thinks they are embarrassed in front of others because of their problem, as a part of the Dizziness Handicap Inventory | DHIEmbarrassedInFrontOfOthScl | Recommended | CDE |
| 11 | Dizziness Handicap Inventory (DHI) - Quick Movements Of Head Increase Problem Scale | Scale to rate the frequency the subject thinks quick movements of their head increase their problem, as a part of the Dizziness Handicap Inventory | DHIQuickMoveOfHeadIncrProbScl | Recommended | CDE |
| 12 | Dizziness Handicap Inventory (DHI) - Avoid Heights Scale | Scale to rate the frequency the subject avoids heights because of their problem, as a part of the Dizziness Handicap Inventory | DHIAvoidHeightsScl | Recommended | CDE |
| 13 | Dizziness Handicap Inventory (DHI) - Turning Over In Bed Increase Problem Scale | Scale to rate the frequency the subject thinks turning over in bed increases their problem, as a part of the Dizziness Handicap Inventory | DHITurningOverInBedIncrProbScl | Recommended | CDE |
| 14 | Dizziness Handicap Inventory (DHI) - Difficulty Doing Strenuous Work Scale | Scale to rate the frequency the subject thinks it is difficult to do strenuous homework or yard work, as a part of the Dizziness Handicap Inventory | DHIDifficultStrenuousWorkScl | Recommended | CDE |
| 15 | Dizziness Handicap Inventory (DHI) - Afraid People Think You Are Intoxicated Scale | Scale to rate the frequency the subject is afraid people may think they are intoxicated because of their problem, as a part of the Dizziness Handicap Inventory | DHIAfraidPplThinkIntoxScl | Recommended | CDE |
| 16 | Dizziness Handicap Inventory (DHI) - Difficult To Walk By Yourself Scale | Scale to rate the frequency the subject thinks it is difficult to go for a walk by themselves because of their problem, as a part of the Dizziness Handicap Inventory | DHIDiffWalkingByYourselfScl | Recommended | CDE |
| 17 | Dizziness Handicap Inventory (DHI) - Walking Down Sidewalk Increases Problem Scale | Scale to rate the frequency the subject thinks walking down a sidewalk increases their problem, as a part of the Dizziness Handicap Inventory | DHIWalkDnSidewalkIncrProbscl | Recommended | CDE |
| 18 | Dizziness Handicap Inventory (DHI) - Difficult To Concentrate Scale | Scale to rate the frequency the subject thinks it is difficult to concentrate because of their problem, as a part of the Dizziness Handicap Inventory | DHIDiffToConcentrateScl | Recommended | CDE |
| 19 | Dizziness Handicap Inventory (DHI) - Difficult To Walk In House In The Dark Scale | Scale to rate the frequency the subject thinks it is difficult to walk around in their house in the dark because of their problem, as a part of the Dizziness Handicap Inventory | DHIDiffToWalkInHouseInDarkScl | Recommended | CDE |
| 20 | Dizziness Handicap Inventory (DHI) - Afraid To Stay Home Alone Scale | Scale to rate the frequency the subject is afraid to stay home alone because of their problem, as a part of the Dizziness Handicap Inventory | DHIAfraidToStayHomeAloneScl | Recommended | CDE |
| 21 | Dizziness Handicap Inventory (DHI) - Feel Handicapped Scale | Scale to rate the frequency the subject feels handicapped because of their problem, as a part of the Dizziness Handicap Inventory | DHIFeelHandicappedScl | Recommended | CDE |
| 22 | Dizziness Handicap Inventory (DHI) - Stress on Relationships Scale | Scale to rate the frequency the subject thinks their problem has placed stress on their relationships with members of their family or friends, as a part of the Dizziness Handicap Inventory | DHIStressOnRelationshipsScl | Recommended | CDE |
| 23 | Dizziness Handicap Inventory (DHI) - Depressed Scale | Scale to rate the frequency the subject feels depressed because of their problem, as a part of the Dizziness Handicap Inventory | DHIDepressedScl | Recommended | CDE |
| 24 | Dizziness Handicap Inventory (DHI) - Problem Interferes With Responsibilities Scale | Scale to rate the frequency the subject thinks their problem interferes with their job or household responsibilities, as a part of the Dizziness Handicap Inventory | DHIProbIntrfrWRspnsbltsScl | Recommended | CDE |
| 25 | Dizziness Handicap Inventory (DHI) - Bending Over Increases Problem Scale | Scale to rate the frequency the subject thinks bending over increases their problem, as a part of the Dizziness Handicap Inventory | DHIBendOverIncrProbScl | Recommended | CDE |
Scoring (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Dizziness Handicap Inventory (DHI) - Emotional Score | Quantifies the emotional impact on disability domain score for the subject, as part of the Dizziness Handicap Inventory | DHIEmotionalScr | Recommended | CDE |
| 2 | Dizziness Handicap Inventory (DHI) - Physical Score | Quantifies the physical impact on disability domain score for the subject, as part of the Dizziness Handicap Inventory | DHIPhysicalScr | Recommended | CDE |
| 3 | Dizziness Handicap Inventory (DHI) - Functional Score | Quantifies the functional impact on disability domain score for the subject, as part of the Dizziness Handicap Inventory | DHIFunctionalScr | Recommended | CDE |
| 4 | Dizziness Handicap Inventory (DHI) - Total Score | Quantifies the total emotional, functional, and physical impacts on disability score for the subject, as part of the Dizziness Handicap Inventory | DHITotalScr | Recommended | CDE |
Keywords
