Diagnostic Study of Indonesian Version of Dysphagia Handicap Index in Oropharyngeal Dysphagia Patient
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Published:
Dec 24, 2025
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Keywords: diagnostic, dysphagia, dysphagia handicap index, DHI, Indonesia version
Main Article Content
Abstract
Introduction: Dysphagia significantly affects patients’ quality of life, and its early detection is crucial. The Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is limited to referral hospitals. Accordingly, the Indonesian version of the Dysphagia Handicap Index (DHI-INA) was investigated as a potential screening instrument for identifying dysphagia among patients in community-based settings with restricted access to advanced diagnostic modalities.
Methods: A cross-sectional study was conducted involving patients with oropharyngeal dysphagia. Each participant completed the DHI-INA questionnaire, and FEES was conducted to assess swallowing function using the Penetration-Aspiration Scale (PAS). Data were analyzed using ROC curve analysis to determine the Area Under the Curve (AUC), sensitivity, specificity, and optimal cut-off values.
Results: A total of 100 patients were enrolled in the study, with a mean age of 52.62 ± 9.61 years; with 58% male and 42% female. The primary etiologies included neurological disorders, head and neck pathologies, reflux disease, and other medical conditions. The optimal DHI-INA cut-off score of 21 yielded a sensitivity of 90.24% and specificity of 84.74%, with an AUC of 86.30%, indicating good diagnostic accuracy. A significant correlation was found between DHI-INA domain scores and PAS results (p < 0.001).
Conclusion: The DHI-INA demonstrated strong diagnostic performance and a significant correlation with FEES outcomes. It represents a valid and practical screening instrument for identifying patients at risk of penetration or aspiration, particularly in community settings with limited access to advanced swallowing diagnostics.
Methods: A cross-sectional study was conducted involving patients with oropharyngeal dysphagia. Each participant completed the DHI-INA questionnaire, and FEES was conducted to assess swallowing function using the Penetration-Aspiration Scale (PAS). Data were analyzed using ROC curve analysis to determine the Area Under the Curve (AUC), sensitivity, specificity, and optimal cut-off values.
Results: A total of 100 patients were enrolled in the study, with a mean age of 52.62 ± 9.61 years; with 58% male and 42% female. The primary etiologies included neurological disorders, head and neck pathologies, reflux disease, and other medical conditions. The optimal DHI-INA cut-off score of 21 yielded a sensitivity of 90.24% and specificity of 84.74%, with an AUC of 86.30%, indicating good diagnostic accuracy. A significant correlation was found between DHI-INA domain scores and PAS results (p < 0.001).
Conclusion: The DHI-INA demonstrated strong diagnostic performance and a significant correlation with FEES outcomes. It represents a valid and practical screening instrument for identifying patients at risk of penetration or aspiration, particularly in community settings with limited access to advanced swallowing diagnostics.
Article Details
How to Cite
Rusfanisa, Ira Mistivani, Rachmawati, E. Z. K., & Dewi Friska. (2025). Diagnostic Study of Indonesian Version of Dysphagia Handicap Index in Oropharyngeal Dysphagia Patient. Indonesian Journal of Physical Medicine and Rehabilitation, 14(2), 196 - 202. https://doi.org/10.36803/indojpmr.v14i2.520
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Original Article
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References
1. Ninfa A, Crispiatico V, Pizzorni N, Bassi M, Casazza G, Schindler A, et al. The care needs of persons with oropharyngeal dysphagia and their informal caregivers: A scoping review. PLoS One. 2021;16:1–20. A
2.Kertscher B, Speyer R, Fong E, Georgiou AM, Smith M. Prevalence of oropharyngeal dysphagia in the netherlands: a telephone survey. Dysphagia. 2015;30(2):114–20.
3.Bahareh Bakhshaie P. Dysphagia - Pathophysiology of swallowing dysfunction, symptoms, diagnosis and treatment. J Otolaryngol Rhinol. 2019;5(3):1–4.
4. Mccullough GH, Martino R. Manual of diagnostic and therapeutic techniques for disorders of deglutition. New York: Springer. 2013. p. 11-30.
5. Yang L, Zhang Z, Gao H, Wu Y, Wei H, Kong J, et al. Cultural adaptation and validation of questionnaires for evaluation of health-related quality of life with dysphagia in different countries: a systematic review. Dysphagia. 2022;37(4):812–23.
6. Silbergleit AK, Schultz L, Jacobson BH, Beardsley T, Johnson AF. The dysphagia handicap index: development and validation. Dysphagia. 2012;27(1):46–52.
7. Kim TY, Park D, Lee SE, Kim BH, Son S Il, Choi SH. Clinical usefulness of the korean version of the dysphagia handicap index: reliability, validity, and role as a screening test. Dysphagia. 2022;37(1):183–91.
8. Oda C, Yamamoto T, Fukumoto Y, Nakayama K, Sato M, Murata M, et al. Validation of the Japanese translation of the Dysphagia Handicap index. 2017;11:193–8.
9. Farahat M, Malki KH, Mesallam TA, Bukhari M, Alharethy S. Development of the arabic version of dysphagia handicap index (DHI). Dysphagia. 2014;29(4):459–67.
10.Asadollahpour F, Baghban K, Asadi M. Validity and reliability of the persian version of the dysphagia handicap index (DHI). Iran J Otorhinolaryngol. 2015;27.
11. Krishnamurthy R, Balasubramanium RK. Translation and validation of kannada version of the dysphagia handicap index. Am J Speech-Language Pathol. 2020;29(1):255–62.
12. Ramadhany M, Mistivani I, Zulka E, Friska D, Nusdwinuringtyas N. Uji validitas dan reliabilitas dysphagia handicap index versi bahasa indonesia sebagai alat ukur kualitas hidup pasien disfagia (thesis). Jakarta: Universitas Indonesia; 2021.
13. Speyer R, Sandbekkbråten A, Rosseland I, Moore JL. Dysphagia care and management in rehabilitation: a national survey. J Clin Med. 2022;11(19).
14. Karunaratne TB, Clavé P, Ortega O. Complications of oropharyngeal dysphagia in older individuals and patients with neurological disorders: insights from Mataró hospital, Catalonia, Spain. Front Neurol . 2024;15:1–9.
15. Stojanovi? M, Apostolovi? M, Stojanovi? D, Miloševi? Z, Toplaovi? A, Lakuši? VM, et al. Understanding sensitivity, specificity and predictive values. Vojnosanit Pregl. 2014;71(11):1062–5.
16. Çorbac?o?lu ?K, Aksel G. Receiver operating characteristic curve analysis in diagnostic accuracy studies: a guide to interpreting the area under the curve value. Turkish J Emerg Med. 2023;23(4):195–8.
17. Beidelschies M, Cella D, Katzan I, D’Adamo CR. Patient-reported outcomes and the patient-reported outcome measurement information system of functional medicine care and research. Phys Med Rehabil Clin N Am. 2022;33(3):679–97.
18. Terwee CB, Prinsen CAC, Chiarotto A, Westerman MJ, Patrick DL, Alonso J, et al. Cosmin methodology for evaluating the content validity of patient-reported outcome measures: a Delphi study. Qual Life Res. 2018;27(5):1159–70.
2.Kertscher B, Speyer R, Fong E, Georgiou AM, Smith M. Prevalence of oropharyngeal dysphagia in the netherlands: a telephone survey. Dysphagia. 2015;30(2):114–20.
3.Bahareh Bakhshaie P. Dysphagia - Pathophysiology of swallowing dysfunction, symptoms, diagnosis and treatment. J Otolaryngol Rhinol. 2019;5(3):1–4.
4. Mccullough GH, Martino R. Manual of diagnostic and therapeutic techniques for disorders of deglutition. New York: Springer. 2013. p. 11-30.
5. Yang L, Zhang Z, Gao H, Wu Y, Wei H, Kong J, et al. Cultural adaptation and validation of questionnaires for evaluation of health-related quality of life with dysphagia in different countries: a systematic review. Dysphagia. 2022;37(4):812–23.
6. Silbergleit AK, Schultz L, Jacobson BH, Beardsley T, Johnson AF. The dysphagia handicap index: development and validation. Dysphagia. 2012;27(1):46–52.
7. Kim TY, Park D, Lee SE, Kim BH, Son S Il, Choi SH. Clinical usefulness of the korean version of the dysphagia handicap index: reliability, validity, and role as a screening test. Dysphagia. 2022;37(1):183–91.
8. Oda C, Yamamoto T, Fukumoto Y, Nakayama K, Sato M, Murata M, et al. Validation of the Japanese translation of the Dysphagia Handicap index. 2017;11:193–8.
9. Farahat M, Malki KH, Mesallam TA, Bukhari M, Alharethy S. Development of the arabic version of dysphagia handicap index (DHI). Dysphagia. 2014;29(4):459–67.
10.Asadollahpour F, Baghban K, Asadi M. Validity and reliability of the persian version of the dysphagia handicap index (DHI). Iran J Otorhinolaryngol. 2015;27.
11. Krishnamurthy R, Balasubramanium RK. Translation and validation of kannada version of the dysphagia handicap index. Am J Speech-Language Pathol. 2020;29(1):255–62.
12. Ramadhany M, Mistivani I, Zulka E, Friska D, Nusdwinuringtyas N. Uji validitas dan reliabilitas dysphagia handicap index versi bahasa indonesia sebagai alat ukur kualitas hidup pasien disfagia (thesis). Jakarta: Universitas Indonesia; 2021.
13. Speyer R, Sandbekkbråten A, Rosseland I, Moore JL. Dysphagia care and management in rehabilitation: a national survey. J Clin Med. 2022;11(19).
14. Karunaratne TB, Clavé P, Ortega O. Complications of oropharyngeal dysphagia in older individuals and patients with neurological disorders: insights from Mataró hospital, Catalonia, Spain. Front Neurol . 2024;15:1–9.
15. Stojanovi? M, Apostolovi? M, Stojanovi? D, Miloševi? Z, Toplaovi? A, Lakuši? VM, et al. Understanding sensitivity, specificity and predictive values. Vojnosanit Pregl. 2014;71(11):1062–5.
16. Çorbac?o?lu ?K, Aksel G. Receiver operating characteristic curve analysis in diagnostic accuracy studies: a guide to interpreting the area under the curve value. Turkish J Emerg Med. 2023;23(4):195–8.
17. Beidelschies M, Cella D, Katzan I, D’Adamo CR. Patient-reported outcomes and the patient-reported outcome measurement information system of functional medicine care and research. Phys Med Rehabil Clin N Am. 2022;33(3):679–97.
18. Terwee CB, Prinsen CAC, Chiarotto A, Westerman MJ, Patrick DL, Alonso J, et al. Cosmin methodology for evaluating the content validity of patient-reported outcome measures: a Delphi study. Qual Life Res. 2018;27(5):1159–70.