COMMUNITY SCREENING FOR RHEUMATIC DISORDER - CROSS-CULTURAL ADAPTATION AND SCREENING CHARACTERISTICS OF THE COPCORD CORE QUESTIONNAIRE IN BRAZIL, CHILE, AND MEXICO
K. Bennett et al., COMMUNITY SCREENING FOR RHEUMATIC DISORDER - CROSS-CULTURAL ADAPTATION AND SCREENING CHARACTERISTICS OF THE COPCORD CORE QUESTIONNAIRE IN BRAZIL, CHILE, AND MEXICO, Journal of rheumatology, 24(1), 1997, pp. 160-168
Objective. (1) To adapt the Community Oriented Programme for the Contr
ol of Rheumatic Disease (COPCORD) Core Questionnaire (CCQ) for use as
a rheumatic disease screening instrument in Spanish and Portuguese com
munities in Brazil, Chile, and Mexico, including translation and back
translation, and assessment of cross cultural equivalence and reliabil
ity. (2) To determine the screening characteristics of thr CCQ, specif
ically the sensitivity and specificity of Spanish and Portuguese versi
ons for detecting cases of rheumatic disorder compared with a full cli
nical examination by a rheumatologist. (3) To determine the number of
clinical examinations that could be avoided in population studies by a
pplying the CCQ followed by a clinical examination in positive CCQ scr
eenees. Methods. Translation and assessment of cross cultural equivale
nce were conducted by practising rheumatologists in Brazil, Chile, and
Mexico using standardized methods. Back translation was done by an in
dependent rheumatologist (Brazil), a radiologist (Chile), and a genera
l physician (Mexico). Interviewer agreement was assessed in all sites
in a convenience sample. Sensitivity and specificity were assessed by
independently administering the CCQ and a full clinical examination to
a sample of 200 persons aged 15 years or older, randomly selected fro
m communities in Sao Paulo, Brazil (n = 200), Temuco, Chile (n = 200),
and Mexico City, Mexico (n = 200). Results. (1) Cross cultural equiva
lence and back translation of the modified questionnaire were satisfac
tory. interviewer agreement was acceptable. (2) In groups From Brazil,
Chile, and Mexico, respectively, the overall prevalence of rheumatic
disease based on clinical examination was 33.3, 45.1, and 46.3%. The s
ensitivity and specificity of 2 definitions of a positive CCQ screenin
g for thr presence of rheumatic disorder were: Definition 1 (no trauma
, present pain, tenderness, swelling or stiffness in bones, joints or
muscles): sensitivity, 91.8, 96.0, 84.0; specificity, 70.0, 35.5, 61.0
; Definition 2 (Definition 1 plus pain intensity greater than or equal
to 4 on 11 point category rating scale): sensitivity, 66.2, 86.3, 42.
7; specificity, 82.3, 41.9, 80.0. (3) In groups from Brazil, Chile, an
d Mexico, respectively, positive screening by Definition 1 followed by
a clinical examination avoids 499, 213, and 403 clinical examination
per 1000 respondents screened and yields an overall prevalence of rheu
matic disorder of 30, 43, and 40%. The addition of pain intensity (Def
inition 2) increased the total number of examinations avoided, but red
uced the prevalence estimate compared to Definition 1 (22.0, 39.0, and
20.0%). Conclusion. The CCQ appears promising as a screening tool to
detect rheumatic disorder in Spanish and Portuguese speaking communiti
es in a developing country. The findings suggest that the CCQ followed
by a full clinical examination in positive respondents can provide an
acceptable estimate of prevalence of rheumatic disorder. The total nu
mber of clinical examinations that must be administered in population
based prevalence surveys can be reduced by using the CCQ, while mainta
ining satisfactory accuracy. Our findings need to be confirmed in furt
her applications of the CCQ.