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Form Structure: Dizziness Handicap Inventory (DHI)

This form structure is an organized set of data definitions for a form that has not been copyrighted
Resource:
FITBIR
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.

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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
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