Evidências de validade de um instrumento de rastreamento para disfagia orofaríngea no acidente vascular encefálico
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2023-03-02
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Universidade Estadual Paulista (Unesp)
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Introdução: A disfagia orofaríngea é uma condição frequente na população com Acidente Vascular Encefálico (AVE), sendo preditor independente de mal prognóstico e, desta forma, o rastreamento realizado por meio de protocolos válidos e confiáveis é primordial para minimizar as possíveis complicações. Objetivo: Obter evidências de validade de um instrumento de rastreamento para disfagia orofaríngea no AVE (RADAVE). Método: A metodologia da pesquisa deste estudo de validação, transversal, seguiu as premissas dos Standards for Educational and Psychological Testing. A coleta da pesquisa, realizada de junho de 2020 a dezembro de 2021, incluiu pacientes adultos com diagnóstico confirmado de AVE. Na etapa de validação de evidência baseada na estrutura interna o instrumento foi administrado em 174 pacientes para realização da análise fatorial confirmatória sendo realizado alguns ajustes no modelo. Para a confiabilidade, dois enfermeiros aplicaram o RADAVE no intervalo de até duas horas em 20 pacientes da amostra e utilizou-se Coeficiente de Correlação Intraclasse (ICC) e a consistência interna por meio do alfa de Cronbach com intervalo de confiança de 95%. Optou-se por realizar a validade de critério com análise da acurácia sendo que os resultados do RADAVE foram analisados em relação ao desfecho disfagia e aspiração laringotraqueal por meio da videofluoroscopia da deglutição (VFD) ou avaliação clínica. Foram analisados os indicadores sensibilidade, especificidade, valor preditivo positivo (VPP) e valor preditivo negativo (VPN), razão de verossimilhança positiva (RV+) e verossimilhança negativa (RV-). Resultados: O RADAVE foi ajustado em sua estrutura interna no modelo de 13 questões, com boa confiabilidade (ICC = 0,88; IC: 0,85-0,90) e moderada consistência interna ( = 0,79). O valor para a área abaixo da curva ROC foi de 0,941 (IC 95%:0,99-0,89) acima do ponto de corte 2 para identificação da disfagia e 0,719 (IC 95%: 0,835- 0,604) acima do ponto de corte 4 para aspiração laringotraqueal. O RADAVE apresentou bons parâmetros de sensibilidade, 0,99, e especificidade 0,91 para disfagia, VPP:0,96%, VPN: 0,98%, RV+:12,74, RV-:0,04 e para aspiração laringotraqueal 0,80, 0,80,0,67%, 0,89%, 2,42 e 0,37 respectivamente. Conclusão: O RADAVE produziu respostas válidas e confiáveis para identificar risco de disfagia orofaríngea e aspiração laringotraqueal em pacientes com AVE.
Introduction: Oropharyngeal dysphagia is a frequent condition in the population with stroke, being an independent predictor of poor prognosis and, therefore, tracking this condition is essential to minimize possible complications. It is important that tracking is performed using valid and reliable protocols. Objective: Obtain evidence of validity of a screening tool for oropharyngeal dysphagia in stroke (RADAVE).This study aimed to validate a screening instrument for oropharyngeal dysphagia in stroke (RADAVE) with evidence of validity based on the internal structure, based on the relationship with other variables (criterion validity) and to evaluate the reliability. Method: The research methodology of this cross-sectional validation study followed the premises of the Standards for Educational and Psychological Testing. The survey collection, carried out from June 2020 to December 2021, included adult patients with a confirmed diagnosis of stroke. In the validation stage of evidence based on the internal structure, the instrument was administered to 174 patients to perform the confirmatory factor analysis, with some adjustments being made to the model. For reliability, two nurses applied RADAVE within a 2-hour interval to 20 patients in the sample. Intraclass correlation coefficient (ICC) and internal consistency were used using Cronbach's alpha with a confidence interval of 95%. We chose to perform criterion validity with analysis of accuracy, and the RADAVE results were analyzed in relation to the outcome dysphagia and laryngotracheal aspiration through videofluoroscopy of swallowing (VFD) or clinical evaluation. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio and negative likelihood ratio were analyzed. Results: RADAVE was adjusted in its internal structure in the 13-question model, with good reliability (ICC = 0.88; CI: 0.85-0.90) and moderate internal consistency ( = 0.79). The value for the area under the ROC curve was 0.941 (CI 95%: 0.99-0.89) above the cutoff point 2 for dysphagia identification and 0.719 (CI 95%: 0.835-0.604) above the cutoff point cut 4 for laryngotracheal aspiration. The screening showed good parameters of sensitivity 0.99 and specificity 0.91 for dysphagia, PPV:0.96%, NPV: 0.98%, positive likelihood ratio:12,74, negative likelihood ratio:0,004 and for laryngotracheal aspiration 0.80, 0.80, 0.67%, 0.89%, 2,42 and 0,37 respectively. Conclusion: RADAVE produced valid and reliable responses to identify risk of oropharyngeal dysphagia and laryngotracheal aspiration in stroke patients.
Introduction: Oropharyngeal dysphagia is a frequent condition in the population with stroke, being an independent predictor of poor prognosis and, therefore, tracking this condition is essential to minimize possible complications. It is important that tracking is performed using valid and reliable protocols. Objective: Obtain evidence of validity of a screening tool for oropharyngeal dysphagia in stroke (RADAVE).This study aimed to validate a screening instrument for oropharyngeal dysphagia in stroke (RADAVE) with evidence of validity based on the internal structure, based on the relationship with other variables (criterion validity) and to evaluate the reliability. Method: The research methodology of this cross-sectional validation study followed the premises of the Standards for Educational and Psychological Testing. The survey collection, carried out from June 2020 to December 2021, included adult patients with a confirmed diagnosis of stroke. In the validation stage of evidence based on the internal structure, the instrument was administered to 174 patients to perform the confirmatory factor analysis, with some adjustments being made to the model. For reliability, two nurses applied RADAVE within a 2-hour interval to 20 patients in the sample. Intraclass correlation coefficient (ICC) and internal consistency were used using Cronbach's alpha with a confidence interval of 95%. We chose to perform criterion validity with analysis of accuracy, and the RADAVE results were analyzed in relation to the outcome dysphagia and laryngotracheal aspiration through videofluoroscopy of swallowing (VFD) or clinical evaluation. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio and negative likelihood ratio were analyzed. Results: RADAVE was adjusted in its internal structure in the 13-question model, with good reliability (ICC = 0.88; CI: 0.85-0.90) and moderate internal consistency ( = 0.79). The value for the area under the ROC curve was 0.941 (CI 95%: 0.99-0.89) above the cutoff point 2 for dysphagia identification and 0.719 (CI 95%: 0.835-0.604) above the cutoff point cut 4 for laryngotracheal aspiration. The screening showed good parameters of sensitivity 0.99 and specificity 0.91 for dysphagia, PPV:0.96%, NPV: 0.98%, positive likelihood ratio:12,74, negative likelihood ratio:0,004 and for laryngotracheal aspiration 0.80, 0.80, 0.67%, 0.89%, 2,42 and 0,37 respectively. Conclusion: RADAVE produced valid and reliable responses to identify risk of oropharyngeal dysphagia and laryngotracheal aspiration in stroke patients.
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Palavras-chave
Deglutição, Transtornos de deglutição, Acidente vascular encefálico, Estudos de validação, Programas de rastreamento, Deglutition, Deglutition disorders, Stroke, Validation study, Mass screening
Como citar
GRITTI, Tatiana Magalhães de Almeida. Evidências de validade de um instrumento de rastreamento para disfagia orofaríngea no acidente vascular encefálico. Universidade Estadual Paulista (Unesp), 2023.