Evidências de validades do questionário autorreferido para rastreamento de disfagia orofaríngea em idosos - RaDI
In older adults, feeding may be compromised as a result of a swallowing disorder during the passage of food through the oral and pharyngeal region called oropharyngeal dysphagia (OD). This health condition interferes with the maintenance of their nutritional and hydration status, with the possibi...
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| Formato: | doctoralThesis |
| Idioma: | por |
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| Endereço do item: | https://repositorio.ufrn.br/jspui/handle/123456789/25636 |
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| Resumo: | In older adults, feeding may be compromised as a result of a swallowing disorder during the
passage of food through the oral and pharyngeal region called oropharyngeal dysphagia (OD).
This health condition interferes with the maintenance of their nutritional and hydration status,
with the possibility of respiratory complications. Recognized as a geriatric syndrome by two
important European Communities, OD affects the autonomy and independence of older adults
in carrying out their daily life activities and contributes to functional decline. The objective of
this study was to develop and validate a self-reported questionnaire screening for
oropharyngeal dysphagia in older people (RaDI). The methodology of this non-randomized,
cross-sectional validation study was performed by the Standards for Educational and
Psychological Testing, which describe the process of obtaining evidence based on test
content, response processes, internal structure, with other variables (convergent validity,
discriminant, criterion, and generalization). The data were collected from March 2013 to
October 2017, in Natal city of the Rio Grande do Norte state, included older adults, aged 60
and older, of both sexes, and excluded those with functional difficulties to understand simple
orders, with hearing loss, even they used individual sound-amplifier apparatus, no oral
feeding, history of head and neck cancer and were undergoing to tracheostomy. In the first
two stages of validation, four researchers involved in the issues of swallowing and aging,
three speech pathologists and a sanitary dentist participated in a panel of experts to evaluate
the analyzes of 32 judges on the first version of RaDI with 17 items. After its reformulation,
the questionnaire was applied to the target population in 40 older people. Adjusted to 14
questions, the instrument were applied in 211 elders to perform the confirmatory factor
analysis, by lower chi-square value (2), even if it is significant, normed chi-square, root of
the mean square error of approximation (RMSEA), weighted root mean square residual
(WRMR), comparative fit index (CFI) e Tucker Lewis index (TLI). After some adjustments in
the model, the evaluation of its convergent validity (n = 393) and discriminant (n = 110)
considered the analysis of the Spearman coefficient . The reliability of the test-retest in 75
older subjects, was achieved by intraclass correlation coeficient (ICC), weighted Kappa,
standard error of measurement (SEM) and the smallest real difference (SRD), and the internal
consistency by Cronbach's alpha with the 95% of confidence interval. Results: RaDI was
adjusted in its internal structure to nine questions model 2 = 45,81, p < 0,05, 2/gl =1,76,
RMSEA = 0,06, WRMR = 0,72, CFI = 0,97 e TLI = 0,96), with good reliability (ICC = 0,83, IC 0,74-0,89, p <0,001; SEM =02,13; SRD = 5,90) and high internal consistency ( = 0,90)
and excellent discriminant ( = -0,06; p = 0,6) but moderate convergent validity = 0,43;
p<0,001). Conclusions: RaDI produced valid and reliable responses to identify the
oropharyngeal dysphagia symptoms in community-dwelling older people. |
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