Open Access Highly Accessed Research article

Exploratory factor analysis of the Dizziness Handicap Inventory (German version)

Annette Kurre1*, Caroline HG Bastiaenen2, Christel JAW van Gool2, Thomas Gloor-Juzi1, Eling D de Bruin3 and Dominik Straumann4

Author Affiliations

1 Department of Rheumatology and Institute of Physical Medicine, University Hospital Zurich, Switzerland

2 Maastricht University, school CAPHRI, Department of Epidemiology and Faculty of Health Medicine and Life Sciences, the Netherlands

3 Institute of Human Movement Sciences and Sport, ETH, Zurich, Switzerland

4 Interdisciplinary Center for Vertigo & Balance Disorders, Departments of ENT, Neurology & Psychiatry, University Hospital Zurich, Switzerland

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BMC Ear, Nose and Throat Disorders 2010, 10:3  doi:10.1186/1472-6815-10-3

Published: 15 March 2010



The Dizziness Handicap Inventory (DHI) is a validated, self-report questionnaire which is widely used as an outcome measure. Previous studies supported the multidimensionality of the DHI, but not the original subscale structure. The objectives of this survey were to explore the dimensions of the Dizziness Handicap Inventory - German version, and to investigate the associations of the retained factors with items assessing functional disability and the Hospital Anxiety and Depression Scale (HADS). Secondly we aimed to explore the retained factors according to the International Classification of Functioning, Disability and Health (ICF).


Patients were recruited from a tertiary centre for vertigo, dizziness or balance disorders. They filled in two questionnaires: (1) The DHI assesses precipitating physical factors associated with dizziness/unsteadiness and functional/emotional consequences of symptoms. (2) The HADS assesses non-somatic symptoms of anxiety and depression. In addition, patients answered the third question of the University of California Los Angeles-Dizziness Questionnaire which covers the impact of dizziness and unsteadiness on everyday activities. Principal component analysis (PCA) was performed to explore the dimensions of the DHI. Associations were estimated by Spearman correlation coefficients.


One hundred ninety-four patients with dizziness or unsteadiness associated with a vestibular disorder, mean age (standard deviation) of 50.6 (13.6) years, participated. Based on eigenvalues greater one respectively the scree plot we analysed diverse factor solutions. The 3-factor solution seems to be reliable, clinically relevant and can partly be explained with the ICF. It explains 49.2% of the variance. Factor 1 comprises the effect of dizziness and unsteadiness on emotion and participation, factor 2 informs about specific activities or effort provoking dizziness and unsteadiness, and factor 3 focuses on self-perceived walking ability in relation to contextual factors. The first factor correlates moderately with disability and the HADS (values ≥0.6). The second factor is comparable with the original physical subscale of the DHI and factors retained in previous studies.


The results of the present survey can not support the original subscale structure of the DHI. Therefore only the total scale should be used. We discuss a possible restructuring of the DHI.