Construção e validação de instrumento para avaliação da prática de automedicação realizada por pacientes com desordens temporomandibulares

Abstract

The term temporomandibular disorders (TMD) refers to a set of clinical problems involving pain and/or dysfunction that can affect the stomatognathic system, representing a major cause of chronic pain in the orofacial region. Many patients with constant complaints associated with such disorders consider self-medication the fastest and most convenient way to ease their pain, and do not seek help from a professional. Currently there is no specific instrument found in the literature to assess the practice of self-medication in patients with TMD, thus the objective of this study was to construct and validate a questionnaire for this purpose. The first step in constructing the instrument was the qualitative phase, in which a comprehensive review of the literature on the subjects involved in the study, semi-structured interviews with TMD patients, and focus group dynamics were carried out in order to generate items for constructing the instrument. The generated material was then carefully read and evaluated in order to begin construction of the instrument. The first version of the questionnaire was developed, with questions based on five-point Likert scale response options. The first version of the instrument resulted in 62 questions divided into four dimensions: TMD / orofacial pain, medications used, opinions / attitudes regarding self-medication, care / treatment of TMD. Aftervalidation performed by a committee of experts, some items were excluded and others created, and their order was amended as well, to facilitate reading by the researcher, but without allowing similar responses due to the sequence of very similar questions. The pre-test version had 48 questions, and although none of the questions presented a misunderstanding rate greater than 20%, seven questions were excluded for being considered repetitive, and with little difference in the explanatory power compared to the other questions, after initial assessment of the data. The version for validation, with 41 items, was administered to a sample of 110 patients diagnosed with TMD according to the criteria of the RDC/TMD (1992). According to factor analysis, 7 questions with loadings below 0.30 were taken out, with the final version consisting of 34 questions. The analysis of internal consistency and temporal stability resulted in values of 0.844 for Cronbach's alpha coefficient and 0.810 for the Kappa coefficient, respectively, indicating that the questionnaire presents reliability and reproducibility, having satisfactory properties for its proposed objective. As to the ultimate goal of classifying patients according to the degree / intensity of self-medication, a classification was proposed that allowed discrimination into three distinct groups regarding self-medication exposure: mild (34-81 points), moderate (82-103 points), severe (104-170 points), based on the total for the self-medication raw score. Highest prevalence (46.4%) was observed for moderate cases of self-medication. In summary, it is hoped that the resulting instrument will contribute to the development of further studies assessing the self-medication associated with TMD. From further discussion of the subject in the literature, it will be possible to disseminate more information, clarifying important issues associated with the practice under study, aiming mainly at its reduction.