COMMUNITY SCREENING FOR RHEUMATIC DISORDER - CROSS-CULTURAL ADAPTATION AND SCREENING CHARACTERISTICS OF THE COPCORD CORE QUESTIONNAIRE IN BRAZIL, CHILE, AND MEXICO

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.