| ObjectiveIn this study,we refer to the Dizziness Handicap Inventory(DHI)in English and analysis the different Chinese versions,in order to development Dizziness Handicap Inventory-China Mainland(DHI-CM)revised version through the standardized tabulation and inspection procedures.Then,we determine the applicability of the scale by analysis it's using in the emergency dizziness / vertigo patients,and ultimately provide an objective and effective clinical efficacy evaluation scale.for clinical and scientific research.Methods1.We make Chinese translation and back-translation according to the DHI scale English original version,and analyze the pros and cons in different DHI Chinese versions content which found in domestic literature,and finally development Dizziness Handicap Inventory-China Mainland(DHI-CM)initial version.2.The initial version of the DHI-CM scale was analyzed in 50 emergency patients with dizziness,and the understanding of each item of the scale in the course of the procedure was analyzed,also and the reliability and validity.The DHI-CM final version was development accordding to all aspects of the analysis results.3.DHI-CM scale final version was carry out for application and test analysis in Guangdong Province TCM hospital Fangcun Emergency Department and Zhuhai combinational hospital of Chinese and western medicine emergency dizziness patients from June 2006 to December 2016.The research diseases include Cervical source dizziness,vertebrobasilar insufficiency,benign paroxysmal positional vertigo,and other benign dizziness called dizziness and vertigo(ICD-10 encoding R42.X00).The test procedure included the initial measurement and retesting of the scale,choose appropriate patient for the initial scale,and followed retest.made by 100 patients selected for 1 week later The reliability,validity,age-related and the application of different syndromes and syndromes were analyzed.Results1.Development and clinical analysis of the initial version DHI-CM scale: compared with different DHI Chinese versions,and revise ietm E10,finally development the initial version DHI-CM scale.Fifty patients with emergency dizziness were included in the analysis.Physical dimension,Emotional dimension,Functional dimension and internal consistency coefficient of Cronbach a were 0.589,0.753,0.862 and 0.908 respectively.According to the factor analysis,each item factor load is> 0.4,but some is low.The consistency results of Physical and Emotional dimension.suggest that the scale need for further revision.2.According to the results of DHI-CM scale reliability and validity analysis,the items E15,P17 were revised to improve the clarity of the scale refer to the degree of understanding of each item in the course of practical application.And the final development of DHI-CM scale was development.3.The DHI scale was used for analysis 318 emergency patients with dizziness,in which 100 patients were retested after 1 week.Reliability analysis: the initial measurement of the consistency coefficient Cronbach a of the scale for first test in the three physic,emotion,function dimensions and the total score were 0.853,0.863,0.915,0.951,and in re-test table corresponding to the three dimensions and total score Cronbach a values were 0.854,0.872,0.918,0.988 respectively.For the four kinds of diseases,such as cervical vertigo,VBI,BPPV and "dizziness and vertigo".the results showed that in the first and second test,every disease's Cronbach a coefficient in total score were above 0.90.The Cronbach a coefficient of the physical dimension in the patients with cervical vertigo was 0.795 and 0.730,respectively in two tests,and the reliability index of the other dimensions were above.0.8;The body dimension reliability index of the VBI patients was measured in two tests,and the Cronbach a coefficient was respectively 0.784,0.63,the other dimensions' s a coefficient was above 0.8;BPPV patients in addition to the physical dimension of the reliability factor of 0.791,the remaining dimensions of the first and second test reliability coefficient was above 0.8;In the initial and re-test measurement,the reliability coefficient of all dimensions in "dizziness and vertigo" patients was above 0.85.The DHI-CM total scale Cronbach a coefficient of every type of TCM syndrome is more than 0.92.The coefficients in the physical dimension of phlegm-dampness syndrome in re-test was below 0.8(0.742).The other TCM syndromes and dimensions are estimated to be above 0.8 in two tests,the total is above 0.9.We measured test-retest reliability coefficient through correlation analysis between the scale's total score and every dimension in two tests.The rank-sum test z the total score and the physical,emotion,function dimension were 0.152?0.153?0.168?0.156(P>0.05),correlation analysis r values were 0.802,0.269,0.213,0.259(P<0.05).Validity analysis: For content validity,through the expert review and clinical application analysis by research group members,we found DHI-CM final version's every item is logical and reasonable,the content is cleart,and could achieve the desired tabulation purposes.In structural validity,the correlation analysis r between the total scale and the subscale scores such as physical dimension-total scale,emotional dimension-total scale,functional dimension-total scale,physical-functional dimension,emotional-functional dimension,emotional-physical dimension,were 0.901,0.900,091,0.868,0.818 and 0.668.The correlation analysis r between 25 items and three sub-dimension scores which include physical dimension(7 entries),emotional dimension(9 entries)and functional dimensions(9 entries)were 0.730,0.681,0.772,respectively.It is obvious that the correlation between 25 items and their respective sub-dimensions is higher than t with other sub-dimensions.We obtain 4 common factors by using factor maximum twiddle analysis method,and the total contribution rate of the four common factors was 63.548%.Combined with the load factor and classification of each item,suggesting that the common factor 1 represents functional characteristics,the common factor 2,4 represents emotional characteristics,the common factor 3 represents physical characteristics.And it display that the scale has a good structural feature distribution.4.Age and DHI-CM scale correlation analysis: age and F6,F7,E10,E15,E18,F24 were negative correlation,in addition to E15(P = 0.013)has statistical significance,the other five have no statistically significant.E2,E9,F16,F19,E20,E21,E22 and age have statistical significance,and it is a positive correlation.There was also a statistically significant correlation between age and emotional dimensions(P = 0.001)and total score(P = 0.049).Conclusion1.The DHI-CM scale developed by two times revision has good reliability in the total table and every dimensions for different disease and TCM syndromes in the initial and retest.2.The scale is logical and its content is clear.It has good content validity.The correlation between the sub-dimensions and the total scale showed that there was a positive correlation between the three sub-dimensions,and the correlation between physical dimension and functional dimension was the strongest,suggesting that the scale had a good degree of polymerization.The correlation factor r between every item and its dimension of the scale is higher than it and the other sub-dimensions,suggesting that the dimensions of the scale are interrelated and differentiated.Through the factor analysis,the four factors extracted can reflect the representative significance of the three dimensions of the scale.The correlation analysis and factor analysis showed that the scale had good structural validity.3.The correlation analysis between age and scale showed that the emotional factor was significantly correlated with the age of the patients and had an effect on the general table,which was consistent with the social reality.Also it suggested that the age factor was need to pay attention to in the development and application of the scale.4.Based on the analysis of emergency application above,DHI-CM scale has a good reliability and validity,suitable for emergency efficacy evaluation of patients with dizziness. |
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