RESUMO
Introduction: The purpose of this study is to evaluate the applicability of a self-administered questionnaire in the screening of psychomotor development (PD) in a primary care setting (PC). For that purpose, the degree of concordance between the Ages and Stages Questionnaire (ASQ) and a Psychomotor Development Evaluation Scale (Escala de Evaluación del Desarrollo Psicomotor-EEDP) currently utilized in PC was tested. In addition, perceptions and value judgment by professionals who participated in the study were explored. Methodology: This semi-quantitative study was performed between November 2008 and December 2009 in two PC centers of the Metropolitan Area of Chile on full-term newborns of the well-baby clinic. At age 8 and 18 months, parents or primary caretakers were asked to fill out the ASQ, and a PC professional completed the EEDP. Correlation and concordance between both tests was measured. Interviews and mini-focus groups were con-ducted with the participating professionals. Results: Three hundred and thirty newborns were recruited in the study. PD deficits were found on 8.79 percent of patients through the use of EEDP and in 12.73 percent through the use of ASQ (p = 0,05). Correlation between both evaluations was acceptable (r 0,5) as was concordance in deficit detection (kappa 0.576). The qualitative analysis showed appreciation of ASQ as a measuring tool as well as promoting awareness of PD. Staff of the PC settings utilized various strategies to overcome deficiencies of a self-administered test in populations of higher socio-educational and cultural risk. Conclusions: ASQ picked up significantly more PM deficits than EEDP, while correlation and concordance indices between both tests were adequate. Considering the subjective advantages expressed by staff in favor of ASQ, it is proposed that those PC centers that wish to implement the ASQ do so by progressively incorporating parents and caretakers into the observation of their children's development.
Introducción: El propósito del estudio fue evaluar la aplicabilidad de un cuestionario de autoreporte para el screening del desarrollo psicomotor (DSM) en atención primaria de salud (APS). Para ello se analizó el grado de acuerdo entre el cuestionario Ages and Stages (ASQ) y la Escala de Evaluación del Desarrollo Psicomotor (EEDP), que es el método empleado de rutina en APS. Además, se exploraron las percepciones y valoraciones comparativas de profesionales que participaron en la aplicación de dichos test. Metodología: Estudio cuanti-cualitativo, realizado entre noviembre 2008 y diciembre 2009. En 2 centros de Salud de la Región Metropolitana de Chile se reclutó lactantes nacidos de término, que acudieron a control sano. A los 8 y 18 meses se les solicitó a los padres o cuidadores principales completar el ASQ y un profesional de APS aplicó el EEDP. Se midió la correlación y concordancia entre ambos test. Se aplicaron entrevistas individuales y mini focus groups a los profesionales participantes en las evaluaciones. Resultados: Fueron reclutados 330 lactantes. La frecuencia de déficit del DSM fue 8,79 por ciento en EEDP y 12,73 por ciento en ASQ (p0,05). Hubo correlación entre ambas evaluaciones (r 0,5) y la concordancia en la pesquisa de déficit de DSM fue buena (kappa 0.576). En el análisis cualitativo destacó la valoración positiva del ASQ, tanto como instrumento de medición, como guía para promover el DSM. Para suplir las debilidades del ASQ, relacionadas con la modalidad de autoreporte, en grupos de mayor riesgo socio cultural o educacional, los centros de salud adoptaron diferentes estrategias. Conclusiones: El ASQ pesquisó significativamente más déficits del DSM que el EEDP, mientras que la correlación y concordancia entre ambas pruebas fueron adecuadas. Considerando las ventajas comparativas del ASQ en opinión de los profesionales, se propone que los centros de APS que deseen implementar ASQ, tomen una estrategia progresiva basada en la integración de ...
Assuntos
Humanos , Masculino , Adulto , Feminino , Recém-Nascido , Atenção Primária à Saúde , Inquéritos e Questionários , Cuidadores , Desenvolvimento Infantil/classificação , Deficiências do Desenvolvimento/diagnóstico , Triagem Neonatal/instrumentação , Chile , Desempenho Psicomotor/classificação , Estudos Transversais , Relações Pais-Filho , Triagem Neonatal/métodos , Valor Preditivo dos TestesRESUMO
OBJECTIVES: To explore the performance of the Physical Functioning (PF) subscale of the Child Health Questionnaire (CHQ) in children with cerebral palsy (CP). STUDY DESIGN: Parents of 177 children and adolescents (age 3 to 18 years) with CP completed the CHQ -Parent Form 50. Severity of CP was assessed using the 5-level Gross Motor Function Classification System (GMFCS), in which higher levels reflect more severe impairment. RESULTS: PF scores were negatively correlated with GMFCS classification (R = -0.62) and were distributed bimodally in subjects with severe motor impairment. For GMFCS classifications IV and V (n = 59), PF scores were very low (means, 9 to 28; medians, 0 to 8); however, 12% of these subjects had excellent PF scores (> 88) despite being nonambulatory. CONCLUSIONS: Although the CHQ PF subscale correlated well with the GMFCS, the CHQ questions on physical functioning resulted in unexpected responses in approximately 1 in 8 subjects with severe CP. These unanticipated responses to the PF subscale questions may be due to ambiguity in the questions (which do not differentiate between health problems and disability) or to alternative parental interpretation of physical functioning. Confusion in differentiating health status and functional status may make the CHQ less useful in children with significant disabilities.
Assuntos
Paralisia Cerebral/classificação , Avaliação da Deficiência , Crianças com Deficiência/classificação , Desempenho Psicomotor/classificação , Inquéritos e Questionários , Paralisia Cerebral/diagnóstico , Criança , Pré-Escolar , Feminino , Indicadores Básicos de Saúde , Humanos , Masculino , Transtornos das Habilidades Motoras/classificação , Caminhada/classificaçãoRESUMO
Pregunta de investigación: ¿cuál es la sensibilidad especificidad y valores predictivos del test: " la prueba de desarrollo del Dr. Muñoz (en adelante: Prueba de Desarrollo), tomando como prueba de referencia la "Escala abreviada de desarroolo" del Dr. Nelson Ortiz) (prueba de referencia). Objetivo: Determinar la sensibilidad, esecificidad, valores predictivos y valor global del test de la prueba de desarrollo. Diseño: test de diagnósitco. Lugar: En los barrios marginaes de la ciudad de La Paz (12 barrios), Cochabamba (12 barrios) y S. Cruz (15 barrios), el cálculo del tamaño muestral fue de 112 niños por ciudad, por tanto, se incluyeron a 389 niñod menores de 5 años. Análisi propuesto: Pruebas para el testo de diagnóstico. Resultados: La prueba de desarrollo dio la sensibilidad, especificidad y valores predictivos más bajos de lo esperado. Conclusiones: La prueba de desarrollo del Dr. Muñoz no es adecuado para el diagnostico de retraso psicomot.