Bennett K, Cardiel M H, Ferraz M B, Riedemann P, Goldsmith C H, Tugwell P
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
J Rheumatol. 1997 Jan;24(1):160-8.
(1) To adapt the Community Oriented Programme for the Control of Rheumatic Disease (COPCORD) Core Questionnaire (CCQ) for use as a rheumatic disease screening instrument in Spanish and Portuguese communities in Brazil, Chile, and Mexico, including translation and back translation, and assessment of cross cultural equivalence and reliability. (2) To determine the screening characteristics of the CCQ, specifically the sensitivity and specificity of Spanish and Portuguese versions for detecting cases of rheumatic disorder compared with a full clinical examination by a rheumatologist. (3) To determine the number of clinical examinations that could be avoided in population studies by applying the CCQ followed by a clinical examination in positive CCQ screenees.
Translation and assessment of cross cultural equivalence were conducted by practising rheumatologists in Brazil, Chile, and Mexico using standardized methods. Back translation was done by an independent rheumatologist (Brazil), a radiologist (Chile), and a general 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 from communities in Sao Paulo, Brazil (n = 200), Temuco, Chile (n = 200), and Mexico City, Mexico (n = 200).
(1) Cross cultural equivalence and back translation of the modified questionnaire were satisfactory. 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 sensitivity and specificity of 2 definitions of a positive CCQ screening for the 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 > or = 4 and 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, and 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 rheumatic disorder of 30, 43, and 40%. The addition of pain intensity (Definition 2) increased the total number of examinations avoided, but reduced the prevalence estimate compared to Definition 1 (22.0, 39.0, and 20.0%).
The CCQ appears promising as a screening tool to detect rheumatic disorder in Spanish and Portuguese speaking communities 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 number of clinical examinations that must be administered in population based prevalence surveys can be reduced by using the CCQ, while maintaining satisfactory accuracy. Our findings need to be confirmed in further applications of the CCQ.
（1）对社区导向的风湿性疾病控制项目核心问卷（COPCORD Core Questionnaire，CCQ）进行改编，使其适用于巴西、智利和墨西哥讲西班牙语及葡萄牙语的社区，作为风湿性疾病筛查工具，包括翻译、回译以及跨文化等效性和信度评估。（2）确定CCQ的筛查特征，特别是与风湿科医生进行全面临床检查相比，西班牙语和葡萄牙语版本检测风湿性疾病病例的敏感性和特异性。（3）确定在人群研究中，通过应用CCQ然后对CCQ筛查阳性者进行临床检查，可避免的临床检查数量。
巴西、智利和墨西哥的执业风湿科医生采用标准化方法进行翻译和跨文化等效性评估。由一名独立的风湿科医生（巴西）、一名放射科医生（智利）和一名全科医生（墨西哥）进行回译。在所有地点对便利样本进行访员一致性评估。通过对从巴西圣保罗社区（n = 200）、智利特木科（n = 200）和墨西哥城（n = 200）随机选取的200名15岁及以上人员独立进行CCQ和全面临床检查，评估敏感性和特异性。
（1）修改后问卷的跨文化等效性和回译令人满意。访员一致性可接受。（2）在巴西、智利和墨西哥的人群中，基于临床检查的风湿性疾病总体患病率分别为33.3%、45.1%和46.3%。CCQ筛查阳性用于判断风湿性疾病存在的2种定义的敏感性和特异性为：定义1（无创伤，骨骼、关节或肌肉存在疼痛、压痛、肿胀或僵硬）：敏感性分别为91.8%、96.0%、84.0%；特异性分别为70.0%、35.5%、61.0%；定义2（定义1加上疼痛强度≥4且采用11点类别评定量表）：敏感性分别为66.2%、86.3%、42.7%；特异性分别为82.3%、41.9%、80.0%。（3）在巴西、智利和墨西哥的人群中，按定义1筛查阳性后进行临床检查，每1000名接受筛查的受访者可分别避免499次、213次和403次临床检查，风湿性疾病总体患病率分别为30%、43%和
