Bressan Lucia Aparecida, Vale Francisco de Assis Carvalho, Speciali José Geraldo
Terapeuta Ocupacional Doutora em Neurociências - Programa de Pós-Graduação em Neurologia. Departamento de Neurologia, Psiquiatria e Psicologia Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP-USP) Ribeirão Preto SP, Brasil.
Doutor em Neurologia, Coordenador do Grupo de Neurologia Comportamental do HCFMRP-USP. Departamento de Neurologia, Psiquiatria e Psicologia Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP-USP) Ribeirão Preto SP, Brasil.
Dement Neuropsychol. 2007 Jul-Sep;1(3):288-295. doi: 10.1590/S1980-57642008DN10300011.
The functionality concept is very important, as the diagnosis of dementia presupposes the existence of functional impairment. Instruments assessing functional performance present some limitations. In most cases, the assessment is based on the caregiver's report. Some studies in international literature have evaluated this issue and concluded that a difference exists between the caregiver's report and direct patient assessment. American and European caregivers tend to underestimate the patient's functional limitations. However, this issue has hitherto not been investigated in our context.
To compare the caregiver's information with direct assessment of the patient's performance based on the same functional assessment questionnaire.
Seventy-two patients and caregivers were attended by the Occupational Therapy service of the Behavioral Neurology Outpatient Clinic between 1999 and 2001, 25 of whom fulfilled the inclusion criteria: having a confirmed diagnosis of dementia according to the DSM-IV; having attended three or more return appointments, and where the caregiver belonged to the patient's family nucleus. The remaining subjects were excluded because of non-adherence to treatment or refusal to participate in the study. The Functional Activities Questionnaire by Pfeffer et al., 1982 was applied to patients in a laboratory simulation, while another evaluator interviewed the respective caregivers. The data were analyzed based on the weighted Kappa coefficient, and Wilcoxon test.
There were significative differences between caregiver's answers and direct observation of the patient's performance. The information provided by the caregivers proved unreliable since caregivers underestimated the patient's functional capacity.
功能概念非常重要，因为痴呆症的诊断以功能损害的存在为前提。评估功能表现的工具存在一些局限性。在大多数情况下，评估基于照顾者的报告。国际文献中的一些研究评估了这个问题，并得出结论，照顾者的报告与对患者的直接评估之间存在差异。美国和欧洲的照顾者往往低估患者的功能限制。然而，在我们的背景下，这个问题迄今尚未得到研究。
基于相同的功能评估问卷，比较照顾者提供的信息与对患者表现的直接评估。
1999年至2001年间，行为神经病学门诊的职业治疗服务接待了72名患者和照顾者，其中25名符合纳入标准：根据《精神疾病诊断与统计手册》第四版确诊为痴呆症；参加了三次或更多次复诊预约，且照顾者属于患者的核心家庭成员。其余受试者因不坚持治疗或拒绝参与研究而被排除。1982年Pfeffer等人编制的功能活动问卷在实验室模拟中应用于患者，同时另一名评估者对相应的照顾者进行访谈。数据基于加权卡帕系数和威尔科克森检验进行分析。
照顾者的回答与对患者表现的直接观察之间存在显著差异。照顾者提供的信息被证明不可靠，因为照顾者低估了患者的功能能力。
