an investigation of the factor structure of the persian version of the dysphagia handicap index

Background: oropharyngeal dysphagia harms all aspects of a person’s life, including behaviors, activities, and social situations. quality of life is a multidimensional concept. the dysphagia handicap index (dhi) is a patientreported outcomes tool that evaluates the different dimensions of quality of life in three physical, emotional, and functional factors in englishspeaking countries. the validity of the persian version of the dysphagia handicap index (dhi) has been evaluated in a study, but the reliability and factor analysis of the persian version has not been investigated in any study. objectives: this study aimed to investigate the factor structure analysis and reliability of the persian version of the dysphagia handicap index (pdhi). methods: in this crosssectional study, 100 patients with oropharyngeal dysphagia (mean age 55.69 ± 15.04, 53 women) completed the dysphagia handicap index (dhi). the severity of dysphagia was defined as follows: 1 for no dysphagia (normal), 2 and 3 for mild, 4, and 5 for moderate and 6 and 7for severe. construct validity was examined by confirmatory factor analysis (cfa). cronbach’s alpha and intraclass correlation coefficient (icc) were performed to evaluate the internal consistency and testretest reliability of the pdhi, respectively. results: the results of cfa provided support for a secondorder threefactor model of pdhi (χ^2 = 484.61, df = 273, (p = 0.0001), χ^2/df = 1.77; cfi = 0.901; rmsea = 0.088 and srmr = 0.010). the cronbach’s alpha for physical, functional, and emotional subscales and total score were 0.751, 0.836, 0.773, and 0.900, respectively. the testretest reliability of the pdhi for the total score and subscales was high (icc: 0.952 0.988). furthermore, a significant relationship was found between the pdhi total score and selfreported severity of dysphagia (p = 0.0001), while there were no relationships between pdhi total score and age (p = 0.223), sex (p = 0.936), level of education (p = 0.113), disease duration (p = 0.126). conclusions: the pdhi is a reliable and valid instrument for assessing the disabling effects of swallowing disorders on the one’s quality of life in iranian patients with oropharyngeal dysphagia due to a variety of diseases. also, the cfa findings provide support for the treefactor structure of the pdhi and the use of the subscales as distinct variables.