Dizziness Handicap Inventory (DHI)Dizziness Handicap Inventory Patient Name First Last Date MM slash DD slash YYYY InstructionsThe purpose of this scale is to identify difficulties that you may be experiencing because of your dizziness or unsteadiness. Please answer "always", "no", or "sometimes" to each question. ANSWER EACH QUESTION AS IT PERTAINS TO YOUR DIZZINESS OR UNSTEADINESS ONLY.1. Does looking up increase your problem? (P) Always No Sometimes2. Because of your problem, do you feel frustrated ? (E) Always No Sometimes3. Because of your problem, do you restrict your travel for business or recreation? (F) Always No Sometimes4. Does walking down the aisle of a supermarket increase your problem? (P) Always No Sometimes5. Because of your problem, do you have difficulty getting into or out of bed? (F) Always No Sometimes6. Does you problem significantly restrict your participation in social activities such as going out to dinner, the movies, dancing, or parties? (F) Always No Sometimes7. Because of your problem, do you have difficulty reading? (F) Always No Sometimes8. Does performing more ambitious activities such as sports or dancing or household chores such as sweeping or putting dishes away increase your problem? (P) Always No Sometimes9. Because of you problem, are you afraid to leave you home without having someone accompany you? (E) Always No Sometimes10. Because of your problem, are you embarrassed in front of others? (E) Always No Sometimes11. Do quick movements of your head increase your problem? (P) Always No Sometimes12. Because of you problem, do you avoid heights? (F) Always No Sometimes13. Does turning over in you bed increase your problem? (P) Always No Sometimes14. Because of you problem, is it difficult for you to do strenuous housework or yard work? (F) Always No Sometimes15. Because of you problem, are you afraid people may think you are intoxicated? (E) Always No Sometimes16. Because of you problem, is it difficult for you to walk by yourself? (F) Always No Sometimes17. Does walking down a sidewalk increase your problem? (P) Always No Sometimes18. Because of you problem, is it difficult for you to concentrate? (E) Always No Sometimes19. Because of your problem, is it difficult for you to walk around your house in the dark? (F) Always No Sometimes20. Because of your problem, are you afraid to stay at home alone? (E) Always No Sometimes21. Because of your problem, do you feel handicapped? (E) Always No Sometimes22. Has you problem placed stress on you relationships with members of you family or friends? (E) Always No Sometimes23. Because of you problem, are you depressed? (E) Always No Sometimes24. Does your problem interfere with your job or household responsibilities? (F) Always No Sometimes25. Does bending over increase your problem? (P) Always No SometimesTotal DHI Score100-70 = severe perception of having a handicap 69-40 = moderate perception of handicap 39-0 = low perception of handicapΔ
