Escore Finlandês de Risco de Diabetes - FINDRISC: tradução e adaptação transcultural, estudo de prevalência e aplicações
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Data
2019-02-25
Autores
Barim, Estela Maria
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Universidade Estadual Paulista (Unesp)
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BARIM, E.M. Escore Finlandês de Risco de Diabetes - FINDRISC: tradução e adaptação transcultural, estudo de prevalência e aplicações. 2019. 132f. Tese (Doutorado) – Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, 2019. O diabetes mellitus tipo 2 (DM2) é um problema de saúde pública a nível mundial. Existem evidências que mudanças no estilo de vida podem prevenir ou retardar o desenvolvimento de DM2 em indivíduos com risco elevado de desenvolver a doença. O Escore Finlandês de Risco de Diabetes - FINDRISC é um instrumento de rastreamento não invasivo desenvolvido com o objetivo de predizer o desenvolvimento de DM2 no futuro e vem sendo usado em diferentes países. Com o decorrer do tempo o FINDRISC também passou a ser utilizado para predizer e/ou rastrear diferentes afecções. Os objetivos desta tese foram (i) traduzir e adaptar transculturalmente a versão original do FINDRISC para o português brasileiro e avaliar a sua confiabilidade; (ii) estratificar os usuários de um centro de atenção primária quanto ao risco de desenvolver DM2 utilizando o FINDRISC e investigar os fatores associados com risco alto e muito alto; e (iii) mapear as aplicações do FINDRISC através da realização de uma revisão integrativa da literatura. Três manuscritos compuseram essa tese. O primeiro manuscrito descreveu o processo de tradução e adaptação transcultural da versão original do FINDRISC para o português do Brasil de acordo com as recomendações desenvolvidas pela força tarefa da International Society for Pharmacoeconomics and Outcomes Research – ISPOR. Uma vez desenvolvida a versão final em português brasileiro (FINDRISC-BR), realizou-se a avaliação da confiabilidade do instrumento com 83 indivíduos atendidos em um centro de saúde escola (CSE) no interior do estado de São Paulo. Cada participante foi entrevistado em duas ocasiões com intervalo médio de 14 dias. A avaliação da confiabilidade foi realizada por meio da análise do nível de concordância entre as respostas do teste-reteste do FINDRISC-BR, utilizando-se o coeficiente kappa de Cohen. Os passos das diretrizes da ISPOR foram seguidos consecutivamente sem grandes problemas. O FINDRISC-BR mostrou concordância quase perfeita entre as medidas do teste-reteste, com exceção de dois itens: atividade física (coeficiente kappa de Cohen: 0,78; IC95% 0,64-0,94) e consumo de frutas, verduras e legumes (coeficiente kappa de Cohen: 0,63; IC95% 0,41-0,84). No segundo manuscrito avaliou-se a frequência dos estratos de risco para DM2 por meio do FINDRISC. Realizou-se um estudo de corte transversal, com uma amostra aleatória de usuários não diabéticos maiores de 18 anos do mesmo CSE entre junho e julho de 2018. Regressão logística foi usada para investigar os fatores associados ao FINDRISC elevado (FINDRISC ≥15 pontos). Observou-se que 69 (34,5%) dos indivíduos rastreados, apresentaram um escore de risco alto e muito alto. Na análise multivariada, as variáveis que apresentaram associação estatisticamente significativa com FINDRISC elevado foram o nível de escolaridade (OR=3,21; IC95% 1,52–6,77) e história pessoal de hipercolesterolemia (OR=2,47; IC95% 1,27–4,81). O terceiro manuscrito mapeou as aplicações do FINDRISC, por meio de uma revisão integrativa da literatura. A revisão incluiu estudos primários que utilizaram o questionário FINDRISC original e avaliaram diferentes desfechos por meio de exames laboratoriais ou outros meios. Foi realizada uma extensa busca em múltiplas bases de dados para identificar pesquisas publicadas na língua inglesa, espanhola e portuguesa. Não foram estabelecidos limites quanto à data das publicações. A extração dos dados foi realizada por um único revisor utilizando um instrumento padronizado para a coleta. Os resultados da revisão são apresentados de forma narrativa e apoiada por quadros. Trinta e quatro publicações foram incluídas. Após a leitura crítica dos artigos selecionados foram elencadas três categorias para a análise temática, quanto ao tipo de rastreamento/predição de afecções: 1. DM2; 2. Pré-diabetes e 3. Outras afecções. Em conclusão, o FINDRISC foi traduzido e adaptado transculturalmente para o português brasileiro seguindo procedimentos padronizados. O FINDRISC-BR está disponível para o uso como ferramenta de rastreamento em diferentes cenários. A frequência de escores alto e muito alto do FINDRISC encontrada neste estudo foi elevada e as variáveis associadas foram baixo nível de escolaridade e história pessoal de hipercolesterolemia. Em suma, o FINDRISC é uma ferramenta de rastreamento não invasiva, simples e fácil de ser aplicada. A sua utilização na atenção primária à saúde poderia contribuir no direcionamento de ações para mudanças no estilo de vida especialmente para alguns grupos específicos. E por fim a revisão integrativa da literatura permitiu mapear o uso do FINDRISC como ferramenta de rastreamento/predição para DM2, pré-diabetes e outras afecções. A análise dos dados nos evidenciou o amplo uso desta ferramenta em diferentes grupos populacionais no mundo e em diferentes contextos.
BARIM, E.M. Finnish Diabetes Risk Score - FINDRISC: translation and cross-cultural adaptation, cross-sectional study and clinical uses. 2019. 132 pages (PhD Thesis) - São Paulo State University - UNESP, Medical School, Botucatu, 2019. Type 2 diabetes mellitus (T2DM) is a public health problem worldwide. There is evidence that lifestyle changes can prevent or delay the onset of T2DM for individuals at high risk for T2DM. The Finnish Diabetes Risk Score - FINDRISC is a non-invasive screening tool initially developed to predict the risk of developing T2DM in adults and it has been used in different countries. Over time, FINDRISC has also been used to predict and detect different conditions. The aims of this thesis were (i) to describe the process of translation and cross-cultural adaptation of the original version of FINDRISC into Brazilian Portuguese and to assess its reliability; (ii) to stratify users of a primary care center according to their risk of developing T2DM using the FINDRISC questionnaire and investigate factors associated with high and very high-risk score (FINDRISC≥15 points); and (iii) to map the applications of the FINDRISC questionnaire by performing an integrative literature review. The first manuscript described the process of translation and cross-cultural adaptation of the original version of the FINDRISC questionnaire into Brazilian Portuguese in accordance with the recommendations developed by the International Society for Pharmacoeconomics and Outcomes Research - ISPOR. Once the final version was developed into Brazilian Portuguese (FINDRISC-BR), we assessed its reliability by analyzing the level of agreement between the test-retest responses using the Cohen's kappa coefficient. The steps of ISPOR guidelines were consecutively followed without major problems. FINDRISC-BR showed almost perfect agreement between test-retest measures, except for two items: physical activity (Cohen's kappa: 0.78; 95%CI, 0.64-0.94) and consumption of fruits and vegetables (Cohen's kappa: 0.63; 95%CI, 0.41-0.84). In the second manuscript the frequency of strata of risk for T2DM was assessed using the FINDRISC questionnaire. A cross-sectional study was carried out with a random sample of nondiabetic users aged 18 years or more from the same primary health center between June and July 2018. Logistic regression was used to assess factors associated with elevated FINDRISC. We observed that 69 (34.5%) of the individuals screened had a high/very high-risk score. In the multivariable analysis, variables that showed a statistically significant association with elevated scores were low educational level (OR=3.21; 95%CI 1.52–6.77) and personal history of hypercholesterolemia (OR=2.47; 95%CI 1.27-4.81). The third manuscript examined and mapped the different applications of the FINDRISC questionnaire through an integrative literature review. The review included primary studies that used the original FINDRISC questionnaire and assessed different outcomes based on laboratory tests or other means. An extensive search of multiple databases was undertaken to identify published research in English, Spanish and Portuguese with no date of publication restriction. Data extraction was undertaken by a single reviewer using a standardized tool. The results of the review are presented in a narrative form and supported by tables. Thirty-four publications were included. After the critical reading of the selected articles, three categories were listed for thematic analysis, regarding the type of screening/prediction of conditions: 1. T2DM, 2. Pre-diabetes and, 3. Other conditions. In conclusion, FINDRISC was translated into Brazilian Portuguese and culturally adapted following standardized procedures. FINDRISC-BR has thus become available for use and has potential as a screening tool in different Brazilian settings and applications. The prevalence of scores high/very high-risk of developing T2DM in the future is high in users of a primary health care center in a medium-sized municipality in the state of São Paulo, Brazil. Variables associated with high/very high-risk were level of education and personal history of hypercholesterolemia. FINDRISC is a simple and easy-to-apply and non-invasive tool and its use in primary health care could contribute in directing actions to promote healthy lifestyles for some specific groups.
BARIM, E.M. Finnish Diabetes Risk Score - FINDRISC: translation and cross-cultural adaptation, cross-sectional study and clinical uses. 2019. 132 pages (PhD Thesis) - São Paulo State University - UNESP, Medical School, Botucatu, 2019. Type 2 diabetes mellitus (T2DM) is a public health problem worldwide. There is evidence that lifestyle changes can prevent or delay the onset of T2DM for individuals at high risk for T2DM. The Finnish Diabetes Risk Score - FINDRISC is a non-invasive screening tool initially developed to predict the risk of developing T2DM in adults and it has been used in different countries. Over time, FINDRISC has also been used to predict and detect different conditions. The aims of this thesis were (i) to describe the process of translation and cross-cultural adaptation of the original version of FINDRISC into Brazilian Portuguese and to assess its reliability; (ii) to stratify users of a primary care center according to their risk of developing T2DM using the FINDRISC questionnaire and investigate factors associated with high and very high-risk score (FINDRISC≥15 points); and (iii) to map the applications of the FINDRISC questionnaire by performing an integrative literature review. The first manuscript described the process of translation and cross-cultural adaptation of the original version of the FINDRISC questionnaire into Brazilian Portuguese in accordance with the recommendations developed by the International Society for Pharmacoeconomics and Outcomes Research - ISPOR. Once the final version was developed into Brazilian Portuguese (FINDRISC-BR), we assessed its reliability by analyzing the level of agreement between the test-retest responses using the Cohen's kappa coefficient. The steps of ISPOR guidelines were consecutively followed without major problems. FINDRISC-BR showed almost perfect agreement between test-retest measures, except for two items: physical activity (Cohen's kappa: 0.78; 95%CI, 0.64-0.94) and consumption of fruits and vegetables (Cohen's kappa: 0.63; 95%CI, 0.41-0.84). In the second manuscript the frequency of strata of risk for T2DM was assessed using the FINDRISC questionnaire. A cross-sectional study was carried out with a random sample of nondiabetic users aged 18 years or more from the same primary health center between June and July 2018. Logistic regression was used to assess factors associated with elevated FINDRISC. We observed that 69 (34.5%) of the individuals screened had a high/very high-risk score. In the multivariable analysis, variables that showed a statistically significant association with elevated scores were low educational level (OR=3.21; 95%CI 1.52–6.77) and personal history of hypercholesterolemia (OR=2.47; 95%CI 1.27-4.81). The third manuscript examined and mapped the different applications of the FINDRISC questionnaire through an integrative literature review. The review included primary studies that used the original FINDRISC questionnaire and assessed different outcomes based on laboratory tests or other means. An extensive search of multiple databases was undertaken to identify published research in English, Spanish and Portuguese with no date of publication restriction. Data extraction was undertaken by a single reviewer using a standardized tool. The results of the review are presented in a narrative form and supported by tables. Thirty-four publications were included. After the critical reading of the selected articles, three categories were listed for thematic analysis, regarding the type of screening/prediction of conditions: 1. T2DM, 2. Pre-diabetes and, 3. Other conditions. In conclusion, FINDRISC was translated into Brazilian Portuguese and culturally adapted following standardized procedures. FINDRISC-BR has thus become available for use and has potential as a screening tool in different Brazilian settings and applications. The prevalence of scores high/very high-risk of developing T2DM in the future is high in users of a primary health care center in a medium-sized municipality in the state of São Paulo, Brazil. Variables associated with high/very high-risk were level of education and personal history of hypercholesterolemia. FINDRISC is a simple and easy-to-apply and non-invasive tool and its use in primary health care could contribute in directing actions to promote healthy lifestyles for some specific groups.
Descrição
Palavras-chave
Diabetes Mellitus, Rastreamento, Tradução, Adaptação transcultural, Confiabilidade dos dados, Atenção Primária à Saúde, Findrisc, Screening, Translation, Cross-cultural adaptation, Data reliability, Primary Health Care