Dizziness Handicap Inventory

Dizziness Handicap Inventory

    Instructions

    The purpose of this questionnaire is to identify difficulties that you may be experiencing because of your dizziness or unsteadiness. Please check "No" or "Sometimes" or "Yes" to each question.

    Answer each question as it pertains to your dizziness problem.

    P1

    Does looking up increase your problem?

    NoSometimesYes

    E2

    Because of the problem, do you feel frustrated?

    NoSometimesYes

    F3

    Because of the problem, do you restrict your travel for business or recreation?

    NoSometimesYes

    P4

    Does walking down the aisle of the supermarket increase your problem?

    NoSometimesYes

    F5

    Because of the problem, do you have difficulty getting into or out of bed?

    NoSometimesYes

    F6

    Does your problem significantly restrict your participation in social activites such as going out to dinner, the movies, dancing or to parties?

    NoSometimesYes

    F7

    Because of the problem, do you have difficulty reading?

    NoSometimesYes

    P8

    Does performing more ambitious activities like sports or dancing or household chores such as sweeping or putting away dishes increase your problem?

    NoSometimesYes

    E9

    Because of the problem, are you afraid to leave home without someone to accompany you?

    NoSometimesYes

    E10

    Because of the problem, are you embarrassed in front of other people?

    NoSometimesYes

    P11

    Do quick movements of your head increase your problem?

    NoSometimesYes

    F12

    Because of the problem, do you avoid heights?

    NoSometimesYes

    P13

    Does turning over in bed increase your problem?

    NoSometimesYes

    F14

    Because of your problem, is it difficult for you to do strenuous housework or yard work?

    NoSometimesYes

    E15

    Because of your problem, are you afraid people may think you are intoxicated?

    NoSometimesYes

    F16

    Because of your problem, is it difficult for you to walk by yourself?

    NoSometimesYes

    P17

    Does walking down a sidewalk increase the problem?

    NoSometimesYes

    E18

    Because of your problem, is it difficult for you to concentrate?

    NoSometimesYes

    F19

    Because of your problem, is it difficult for you to walk around the house in the dark?

    NoSometimesYes

    E20

    Because of your problem, are you afraid to stay at home alone?

    NoSometimesYes

    E21

    Because of your problem, do you feel handicapped?

    NoSometimesYes

    E22

    Has your problem placed stress on your relationship with members of your family or friends?

    NoSometimesYes

    E23

    Because of your problem, are your depressed?

    NoSometimesYes

    F24

    Does your problem intefere with your job or household responsibilities?

    NoSometimesYes

    P25

    Does bending over increase the problem?

    NoSometimesYes

    First Name*

    Cellphone

    Surname*

    Telephone

    Email*