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Temporomandibular disorders among Brazilian adolescents: reliability and validity of a screening questionnaire.

Franco-Micheloni AL, Fernandes G, Gonçalves DA, Camparis CM - J Appl Oral Sci (2014 Jul-Aug)

Bottom Line: Both versions demonstrated excellent specificity (about 90%), but higher sensitivity for detecting painful TMD (78.2%).Better reproducibility was obtained for the short version (k=0.840).The Portuguese version of AAOP questions showed both good reliability and validity for the screening of TMD among adolescents, especially painful TMD, according to RDC/TMD.

View Article: PubMed Central - PubMed

Affiliation: Department of Dental Materials and Prosthodontics, Araraquara Dental School, Univ. Estadual Paulista, Araraquara, SP, Brazil.

ABSTRACT

Unlabelled: Temporomandibular disorders (TMD) screeners assume significant item overlap with the screening questionnaire proposed by the American Academy of Orofacial Pain (AAOP).

Objective: To test the reliability and validity of the Portuguese version of AAOP questions for TMD screening among adolescents.

Material and methods: Diagnoses from Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I were used as reference standard. Reliability was evaluated by internal consistency (KR-20) and inter-item correlation. Validity was tested by sensitivity, specificity, predictive values, accuracy and receiver operating characteristic (ROC) curves, the relationship between the true-positive rate (sensitivity) and the false-positive rate (specificity). Test-retest reliability of AAOP questions and intra-examiner reproducibility of RDC/TMD Axis I were tested with kappa statistics.

Results: The sample consisted of 1307 Brazilian adolescents (56.8% girls; n=742), with mean age of 12.72 years (12.69 F/12.75 M). According to RDC/TMD, 397 [30.4% (32.7% F/27.3% M)] of adolescents presented TMD, of which 330 [25.2% (27.6% F/22.2% M)] were painful TMD. Because of low consistency, items #8 and #10 of the AAOP questionnaire were excluded. Remaining items (of the long questionnaire version) showed good consistency and validity for three positive responses or more. After logistic regression, items #4, #6, #7 and #9 also showed satisfactory consistency and validity for two or more positive responses (short questionnaire version). Both versions demonstrated excellent specificity (about 90%), but higher sensitivity for detecting painful TMD (78.2%). Better reproducibility was obtained for the short version (k=0.840).

Conclusions: The Portuguese version of AAOP questions showed both good reliability and validity for the screening of TMD among adolescents, especially painful TMD, according to RDC/TMD.

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Related in: MedlinePlus

Receiver operating characteristic (ROC) curves for the diagnosis of overalltemporomandibular disorders (TMD) and painful TMD with the eight-item and thefour-item questionnaires, compared with the reference standard [ResearchDiagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I]. (A) ROCcurve for diagnosing overall TMD with the eight-item questionnaire; (B) ROCcurve for diagnosing painful TMD with the eight-item questionnaire; (C) ROCcurve for diagnosing overall TMD with the four-item questionnaire; and (D) ROCcurve for diagnosing painful TMD with the four item questionnaire
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f01: Receiver operating characteristic (ROC) curves for the diagnosis of overalltemporomandibular disorders (TMD) and painful TMD with the eight-item and thefour-item questionnaires, compared with the reference standard [ResearchDiagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I]. (A) ROCcurve for diagnosing overall TMD with the eight-item questionnaire; (B) ROCcurve for diagnosing painful TMD with the eight-item questionnaire; (C) ROCcurve for diagnosing overall TMD with the four-item questionnaire; and (D) ROCcurve for diagnosing painful TMD with the four item questionnaire

Mentions: Using the reliable scales, the validity of the eight-item and the four-itemquestionnaires was tested considering the results obtained with the referencestandard. Similar good results were obtained by using both short and long versions.As can be observed in Table 4, the bestthresholds for detecting overall TMD and painful TMD were in more than two positiveanswers (>2) for the eight-item questionnaire, and in more than one positiveanswers (>1) for the four-item version, since they provided the best balancebetween sensitivity and specificity in ROC curve analysis. For both versions,excellent specificity was demonstrated (about 90%); however, the questions showedbetter ability in correctly detecting individuals with painful TMD in comparison withoverall TMD. Moreover, the best accuracy values were obtained at the same cut-offvalues, i.e., at the same number of positive responses (Table 4). Referred ROC curves are presented in Figure 1.


Temporomandibular disorders among Brazilian adolescents: reliability and validity of a screening questionnaire.

Franco-Micheloni AL, Fernandes G, Gonçalves DA, Camparis CM - J Appl Oral Sci (2014 Jul-Aug)

Receiver operating characteristic (ROC) curves for the diagnosis of overalltemporomandibular disorders (TMD) and painful TMD with the eight-item and thefour-item questionnaires, compared with the reference standard [ResearchDiagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I]. (A) ROCcurve for diagnosing overall TMD with the eight-item questionnaire; (B) ROCcurve for diagnosing painful TMD with the eight-item questionnaire; (C) ROCcurve for diagnosing overall TMD with the four-item questionnaire; and (D) ROCcurve for diagnosing painful TMD with the four item questionnaire
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4126828&req=5

f01: Receiver operating characteristic (ROC) curves for the diagnosis of overalltemporomandibular disorders (TMD) and painful TMD with the eight-item and thefour-item questionnaires, compared with the reference standard [ResearchDiagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I]. (A) ROCcurve for diagnosing overall TMD with the eight-item questionnaire; (B) ROCcurve for diagnosing painful TMD with the eight-item questionnaire; (C) ROCcurve for diagnosing overall TMD with the four-item questionnaire; and (D) ROCcurve for diagnosing painful TMD with the four item questionnaire
Mentions: Using the reliable scales, the validity of the eight-item and the four-itemquestionnaires was tested considering the results obtained with the referencestandard. Similar good results were obtained by using both short and long versions.As can be observed in Table 4, the bestthresholds for detecting overall TMD and painful TMD were in more than two positiveanswers (>2) for the eight-item questionnaire, and in more than one positiveanswers (>1) for the four-item version, since they provided the best balancebetween sensitivity and specificity in ROC curve analysis. For both versions,excellent specificity was demonstrated (about 90%); however, the questions showedbetter ability in correctly detecting individuals with painful TMD in comparison withoverall TMD. Moreover, the best accuracy values were obtained at the same cut-offvalues, i.e., at the same number of positive responses (Table 4). Referred ROC curves are presented in Figure 1.

Bottom Line: Both versions demonstrated excellent specificity (about 90%), but higher sensitivity for detecting painful TMD (78.2%).Better reproducibility was obtained for the short version (k=0.840).The Portuguese version of AAOP questions showed both good reliability and validity for the screening of TMD among adolescents, especially painful TMD, according to RDC/TMD.

View Article: PubMed Central - PubMed

Affiliation: Department of Dental Materials and Prosthodontics, Araraquara Dental School, Univ. Estadual Paulista, Araraquara, SP, Brazil.

ABSTRACT

Unlabelled: Temporomandibular disorders (TMD) screeners assume significant item overlap with the screening questionnaire proposed by the American Academy of Orofacial Pain (AAOP).

Objective: To test the reliability and validity of the Portuguese version of AAOP questions for TMD screening among adolescents.

Material and methods: Diagnoses from Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I were used as reference standard. Reliability was evaluated by internal consistency (KR-20) and inter-item correlation. Validity was tested by sensitivity, specificity, predictive values, accuracy and receiver operating characteristic (ROC) curves, the relationship between the true-positive rate (sensitivity) and the false-positive rate (specificity). Test-retest reliability of AAOP questions and intra-examiner reproducibility of RDC/TMD Axis I were tested with kappa statistics.

Results: The sample consisted of 1307 Brazilian adolescents (56.8% girls; n=742), with mean age of 12.72 years (12.69 F/12.75 M). According to RDC/TMD, 397 [30.4% (32.7% F/27.3% M)] of adolescents presented TMD, of which 330 [25.2% (27.6% F/22.2% M)] were painful TMD. Because of low consistency, items #8 and #10 of the AAOP questionnaire were excluded. Remaining items (of the long questionnaire version) showed good consistency and validity for three positive responses or more. After logistic regression, items #4, #6, #7 and #9 also showed satisfactory consistency and validity for two or more positive responses (short questionnaire version). Both versions demonstrated excellent specificity (about 90%), but higher sensitivity for detecting painful TMD (78.2%). Better reproducibility was obtained for the short version (k=0.840).

Conclusions: The Portuguese version of AAOP questions showed both good reliability and validity for the screening of TMD among adolescents, especially painful TMD, according to RDC/TMD.

Show MeSH
Related in: MedlinePlus