Fadiga na doença de Parkinson: validação brasileira da escala modificada de impacto da fadiga

LOPES, Josiane; ARAÚJO, Hayslenne Andressa Gonçalves de Oliveira; SMAILI, Suhaila Mahmoud

doi:10.1590/0004-282X20200033

Acessibilidade / Reportar erro

Brasil

Arquivos de Neuro-Psiquiatria

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Articles • Arq. Neuro-Psiquiatr. 78 (08) • Ago 2020 • https://doi.org/10.1590/0004-282X20200033 copiar

Fadiga na doença de Parkinson: validação brasileira da escala modificada de impacto da fadiga

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Introdução:

Os instrumentos que mensuram o impacto da fadiga nos aspectos físicos, cognitivos e psicossociais ainda não foram validados na população brasileira com doença de Parkinson (DP). O objetivo deste estudo foi adaptar culturalmente e avaliar as propriedades psicométricas da versão brasileira da escala modificada de impacto da fadiga (MFIS-PD/BR).

Métodos:

Setenta indivíduos com DP foram recrutados. A adaptação do MFIS-PD foi realizada pela metodologia de tradução e retrotradução. Na análise psicométrica foi realizada a administração de questionário socioclínico, Miniexame do estado mental (Mini-Mental State Examination - MMSE), Escala Unificada de Avaliação da DP (Unified Parkinson’s Disease Rating Scale - UPDRS Parte I-IV), escala de incapacidade Hoehn-Yahr (HY), escala hospitalar de ansiedade e depressão (Hospital Anxiety and Depression Scale - HADS), escala de depressão geriátrica (Geriatric Depression Scale - GDS), escala de gravidade da fadiga (Fatigue Severity Scale - FSS), escala de fadiga de Parkinson (Parkinson Fatigue Scale - PFS-16) e a MFIS-PD/BR com reteste após 7 dias.

Resultados:

A fase de adaptação manteve os mesmos itens do MFIS-PD original. O coeficiente alfa de Cronbach para o MFIS-PD/BR foi de 0,878 quando todos os itens das respostas foram pontuados. Os coeficientes de correlação intraclasse teste-reteste foram superiores a 0,80 (p<0,01) para o escore MFIS-PD/BR, que foi moderadamente correlacionado com o escore HADS, GDS, MDS-UPDRS, total e aspectos não-motores da vida diária, FSS e PFS-16. Foi revelado o ponto de corte do MFIS-PD/BR>29 pontos para indicar indivíduos fatigados com acurácia de 0,835 (p<0,001).

Conclusões:

O MFIS-PD/BR é válido e reprodutível para a avaliação do sintoma de fadiga em indivíduos brasileiros com DP.

Palavras-chave:
Doença de Parkinson; Fadiga; Estudos de Validação; Psicometria

Variable	Adaptation sample (n=20)	Validation sample (n=70)
Demographics
Age, years	63.80±6.47	68.40±10.21
Education, years	8 (4.25-11)	8 (4-12.75)
Sex (male: female)	13: 7	45: 25
Clinical features
Disease duration, months	51 (31-92.75)	56.50 (27.25-96.25)
MMSE	27.50 (25.25-28.75)	26 (25-28)
HADS anxiety	5.85±2.99	6.76±3.77
HADS depression	6.30±3.18	6.73±3.16
HADS total score	12.15±5.20	13.50±5.83
GDS total score	3.5 (2-6.75)	4 (2-7)
HY, stage	2 (2-2.5)	2 (2-2.5)
HY, stage: 1/1.5/2/2.5/3/4/5 (n)	0/ 3/ 7/ 6/ 4/ 0/ 0	5/ 6/ 32/ 12/ 15/ 0/ 0
MDS-UPDRS - part I score	16.25±11.24	13.95±9.11
MDS-UPDRS - part II score	16.35±8.29	15.31±7.73
MDS-UPDRS - part III score	33.10±10.46	36.85±14.57
MDS-UPDRS - part IV score	5.20±5.47	4.75±5.03
MDS-UPDRS total score	70.90±27.90	70.87±28.56
LEDD (mg/ day)	519 (312.50-850)	500 (300-856.25)
Fatigue measures
FSS total score	4.26±1.39	3.70±1.39
PFS-16 total score	3.20±0.83	3.03±0.80
MFIS-PD total score	31.05±19.91	30.25±17.81

Variable	Fatigued (n=32)	Non-fatigued (n=38)	p-value
Demographics
Age, years	68.20±9.53	68.52±10.72	0.90
Education, years	9 (4-14.5)	8 (4-11)	0.52
Sex (male: female)	21 (65.6%): 11 (34.3%)	24 (63.1%): 14 (36.8%)	0.68
Clinical features
Disease duration, months	63 (48 - 89.75)	51 (17.75-111)	0.21
MMSE	26 (23.25-27.75)	26.50 (25-28.75)	0.24
HADS anxiety	8.20±3.30	5.90±3.80	0.01
HADS depression	8.62± 2.84	5.60 ±2.81	0.00
HADS total score	16.83±4.77	11.50±5.53	0.00
GDS total score	5.5 (3.25-9)	3.5 (2-6)	0.01
HY, stage	2.37±0.64	2.03±0.52	0.02
MDS-UPDRS - part I score	20.75± 8.69	9.87±6.63	0.00
MDS-UPDRS - part II score	18.87±8.14	13.17±6.71	0.00
MDS-UPDRS - part III score	39.37±15.53	35.35±13.95	0.28
MDS-UPDRS - part IV score	6.91±5.80	3.45±4.05	0.00
MDS-UPDRS total score	85.91±29.68	61.85±23.98	0.00
LEDD (mg/ day)	500 (300-737.50)	487.50 (300-893.75)	0.81
Fatigue measures
FSS total score	4.75±1.17	3.06±1.10	0.00
PFS-16 total score	3.84±0.45	2.55±0.52	0.00
MFIS-PD total score	42.87±17.55	22.67±13.19	0.00

MFIS/PD-BR - Item	Mean (SD)	CITC	α
1. I have been clumsy and uncoordinated.	0.90 (0.95)	0.401	0.851
2. I have had to pace myself in my physical activities.	2.18 (1.61)	0.056	0.855
3. I have been less motivated to do anything that requires physical effort.	1.37 (1.32)	0.675	0.848
4. I have trouble maintaining physical effort for long periods.	1.45 (1.33)	0.683	0.848
5. My muscles have felt weak	1.93 (1.52)	0.544	0.849
6. I have been physically uncomfortable.	1.71 (1.37)	0.570	0.849
7. I have been less able to complete tasks that require physical effort.	1.71 (1.30)	0.693	0.848
8. I have limited my physical activities.	1.60 (1.51)	0.735	0.846
9. I have needed to rest more often or for longer periods.	1.71 (1.53)	0.622	0.848
10. I have been less alert	1.18 (1.18)	0.680	0.848
11. I have had difficulty paying attention for long periods of time.	1.25 (1.33)	0.700	0.848
12. I have been unable to think clearly.	1.15 (1.23)	0.622	0.849
13. I have been forgetful.	1.64 (1.37)	0.503	0.849
14. I have had difficulty making decisions	0.90 (1.19)	0.566	0.849
15. I have been less motivated to do anything that requires thinking	1.29 (1.32)	0.747	0.847
16. I have had trouble finishing tasks that require thinking.	1.14 (1.46)	0.738	0.847
17. I have had difficulty organizing my thoughts when doing things at home or at work.	1.09 (1.34)	0.805	0.847
18. My thinking has been slowed down.	1.65 (1.43)	0.675	0.847
19. I have had trouble concentrating.	0.98 (1.09)	0.668	0.849
20. I have been less motivated to participate in social activities.	1.59 (1.43)	0.647	0.848
21. I have been limited in my ability to do things away from home.	1.71 (1.65)	0.629	0.847

MFIS/PD-BR (subscale)	ICC	[95% CI]	SEM	Bland-Altman
MFIS/PD-BR (subscale)	ICC	[95% CI]	SEM	d	95%CI of d	SD of d	95%LC
MFIS (Physical)
Intra-observer	0.88	0.81 - 0.93	2.84	-0.18	-1.39 -1.01	0.75	-11.69 - 11.32
Interobserver	0.86	0.77 - 0.91	5.52	-1.31	-2.66 - 0.03	0.05	-14.22 - 11.59
MFIS (Cognitive)
Intra-observer	0.96	0.93 - 0.97	1.96	-0.57	-1.51 - 0.35	0.22	-9.50 - 8.34
Interobserver	0.92	0.87 - 0.95	5.60	-1.32	-2.68 - 0.03	0.05	-14.32 - 11.66
MFIS (Psychosocial)
Intra-observer	0.89	0.84 - 0.93	1.12	0.15	-0.50 - 0.8	0.63	-6.14 - 6.45
Interobserver	0.84	0.75 - 0.90	2.06	-0.15	-0.65 - 0.34	0.53	-4.95 - 4.64
MFIS (Total)
Intra-observer	0.93	0.88 - 0.95	8.84	-0.60	-2.80 -1.58	0.58	-21.56 - 20.34
Interobserver	0.92	0.88 - 0.95	9.93	-2.79	-5.15 - (-0.44)	0.02	-25.31 - 19.72

Variable	MFIS-PD/BR	p- value
Variable	Correlation	p- value
Demographics
Age, years	0.10⁺	0.43
Education, years	-0.03⁺⁺	0.78
Sex (male; female)	-0.14⁺	0.24
Clinical features
Disease duration, months	0.06⁺⁺	0.60
MMSE	-0.33⁺⁺	0.00
HADS anxiety	0.26⁺	0.03
HADS depression	0.64	0.00
HADS total score	0.52	0.00
GDS total score	0.56⁺	0.00
HY, stage	0.32⁺	0.01
MDS-UPDRS - part I score	0.64⁺	0.00
MDS-UPDRS - part II score	0.33⁺	0.00
MDS-UPDRS - part III score	0.29⁺	0.01
MDS-UPDRS - part IV score	0.36⁺	0.00
MDS-UPDRS total score	0.51⁺	0.00
LEDD (mg/ day)	0.00⁺⁺	0.99
Fatigue measures
FSS total score	0.56⁺	0.00
PFS-16 total score	0.71⁺	0.00

Academia Brasileira de Neurologia - ABNEURO R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices Torre Norte, 04101-000 São Paulo SP Brazil, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revista.arquivos@abneuro.org

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence: Josiane Lopes; E-mail: josianelopes@yahoo.com.br