Rasch Analysis of the Clinimetric Properties of the Korean Dizziness Handicap Inventory in Patients with Parkinson Disease

Lee, Da Young; Yang, Hui Jun; Yang, Dong Seok; Choi, Jin Hyuk; Park, Byoung Soo; Park, Ji Yun

Abstract

OBJECTIVES
The Korean Dizziness Handicap Inventory (KDHI), which includes 25 patient-reported items, has been used to assess self-reported dizziness in Korean patients with Parkinson disease (PD). Nevertheless, few studies have examined the KDHI based on item-response theory within this population. The aim of our study was to address the feasibility and clinimetric properties of the KDHI instrument using polytomous Rasch measurement analysis.
METHODS
The unidimensionality, scale targeting, separation reliability, item difficulty (severity), and response category utility of the KDHI were statistically assessed based on the Andrich rating scale model. The utilities of the orderedresponse categories of the 3-point Likert scale were analyzed with reference to the probability curves of the response categories. The separation reliability of the KDHI was assessed based on person separation reliability (PSR), which is used to measure the capacity to discriminate among groups of patients with different levels of balance deficits.
RESULTS
Principal component analyses of residuals revealed that the KDHI had unidimensionality. The KHDI had satisfactory PSR and there were no disordered thresholds in the 3-point rating scale. However, the KDHI showed several issues for inappropriate scale targeting and misfit items (items 1 and 2) for Rasch model.
CONCLUSIONS
The KDHI provide unidimensional measures of imbalance symptoms in patients with PD with adequate separation reliability. There was no statistical evidence of disorder in polytomous rating scales. The Rasch analysis results suggest that the KDHI is a reliable scale for measuring the imbalance symptoms in PD patients, and identified parts for possible amendments in order to further improve the linear metric scale.