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- ItemAcesso aberto (Open Access)Cross-cultural adaptation and validation of the Michigan Hand Outcomes Questionnaire (MHQ) for Brazil: validation study(Associação Paulista de Medicina - APM, 2014-12-01) Meireles, Sandra Mara [UNIFESP]; Natour, Jamil [UNIFESP]; Batista, Daniel Alberton; Lopes, Mayara; Skare, Thelma Larocca; Universidade Federal de São Paulo (UNIFESP); Hospital Universitário Evangélico de CuritibaCONTEXT AND OBJECTIVE:Rheumatoid arthritis is a chronic systemic disease that causes joint damage. A variety of methods have been used to evaluate the general health status of these patients but few have specifically evaluated the hands. The objective of this study was to translate, perform cultural adaptation and assess the validity of the Michigan Hand Outcomes Questionnaire for Brazil.DESIGN AND SETTING:Validation study conducted at a university hospital in Curitiba, Brazil.METHODS:Firstly, the questionnaire was translated into Brazilian Portuguese and back-translated into English. The Portuguese version was tested on 30 patients with rheumatoid arthritis and proved to be understandable and culturally adapted. After that, 30 patients with rheumatoid arthritis were evaluated three times. On the first occasion, two evaluators applied the questionnaire to check inter-rater reproducibility. After 15 days, one of the evaluators reassessed the patients to verify intra rater reproducibility. To check the construct validity at the first assessment, one of the evaluators also applied other similar instruments.RESULTS:There were strong inter and intra rater correlations in all the domains of the Michigan Hand Outcomes Questionnaire. Cronbach's alpha was higher than 0.90 for all the domains of the questionnaire, thus indicating excellent internal validity. Almost all domains of the questionnaire presented moderate or strong correlation with other instruments, thereby showing good construct validity.CONCLUSION:The Brazilian Portuguese version of the Michigan Hand Outcomes Questionnaire was translated and culturally adapted successfully, and it showed excellent internal consistency, reproducibility and construct validity.
- ItemAcesso aberto (Open Access)The IDEAL classification system: a new method for classifying fractures of the distal extremity of the radiudescription and reproducibility(Associação Paulista de Medicina - APM, 2013-01-01) Belloti, Joao Carlos [UNIFESP]; Santos, João Baptista Gomes dos [UNIFESP]; Moraes, Vinícius Ynoe de [UNIFESP]; Wink, Felipe Vitiello; Tamaoki, Marcel Jun Sugawara [UNIFESP]; Faloppa, Flávio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)CONTEXT AND OBJECTIVE There is no consensus concerning which classification for distal radius fractures is best and the existing methods present poor reproducibility. This study aimed to describe and assess the reproducibility of the new IDEAL classification, and to compare it with widely used systems. DESIGN AND SETTING Reproducibility study, Hand Surgery Section, Universidade Federal de São Paulo. METHODS The IDEAL classification and its evidence-based rationale are presented. Sixty radiographs (posteroanterior and lateral) from patients with distal radius fractures were classified by six examiners: a hand surgery specialist, a hand surgery resident, an orthopedic generalist, an orthopedic resident and two medical students. Each of them independently assessed the radiographs at three different times. We compared the intra and interobserver concordance of the IDEAL, AO, Frykman and Fernandez classifications using Cohen's kappa (κ) (for two observers) and Fleiss's κ (for more than two observers). RESULTS The concordance was high for the IDEAL classification (κ = 0.771) and moderate for Frykman (κ = 0.556), Fernandez (κ = 0.671) and AO (κ = 0.650). The interobserver agreement was moderate for the IDEAL classification (κ = 0.595), but unsatisfactory for Frykman (κ = 0.344), Fernandez (κ = 0.496) and AO (κ = 0.343). CONCLUSION The reproducibility of the IDEAL classification was better than that of the other systems analyzed, thus making the IDEAL system suitable for application. Complementary studies will confirm whether this classification system makes adequate predictions for therapy and prognosis.
- ItemAcesso aberto (Open Access)INTEROBSERVER RELIABILITY IN ULTRASOUND ASSESSMENT OF RHEUMATOID WRIST JOINTS(Medfarma-edicoes Medicas, Lda, 2011-07-01) Luz, Karine Rodrigues da [UNIFESP]; Furtado, Rita Nely Vilar [UNIFESP]; Mitraud, Sonia de Aguiar Vilela [UNIFESP]; Porglhof, Jorge [UNIFESP]; Nunes, Conceição [UNIFESP]; Fernandes, Artur da Rocha Correa [UNIFESP]; Natour, Jamil [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: To evaluate interobserver reliability in the ultrasound assessment of synovitis in the radiocarpal (RC), midcarpal (MC) and ulnocarpal (UC) joints in RA.Methods: Ultrasound examinations of 295 rheumatoid wrist joints were performed over a three month period. The RC, MC and UC joints were examined using dorsal longitudinal ultrasound scans. Synovial thickening was assessed by quantitative measurement and a previously established semi-quantitative scoring system (Grades 0 to 3). Interobserver reliability was determined by the comparing the findings of two radiologists who were unaware of each other findings.Results:The intraclass correlation coefficient (ICC) between examiners for the quantitative measurement of synovitis in the RC, MC and UC recesses were 0.508, 0.346 and 0.240 (p<0.001), respectively. Weighted kappa values using the semi-quantitative scoring system were 0.308, 0.312 and 0.153 for the RC, MC and UC joints, respectively.Conclusion: Interobserver reliability of the ultrasound assessment in rheumatoid wrists proved good for the quantitative measurement of synovitis in the RC joint, but poor agreement was found for the MC and UC joints. Using the semi-quantitative scoring system, interobserver agreement was poor for all three joints (RC, MC and UC).