Os instrumentos do Washington Group on Disability Statistics está se tornando cada vez mais utilizando mundialmente, revelando suas potencialidades, tais como possibilidade de medidas de comparação internacional, facilidade de aplicação e compreensão.
Entretanto, observou-se nesta revisão que o ponto de corte e outras divergências metodologias inviabilizam a estimativa de taxas comparáveis sendo necessário uma padronização de medida. Apesar do WG ter recomendado ponto de corte, os estudos que disponibilizaram medidas de acurácia evidenciaram que, quando considerado o ponto de corte “muita dificuldade”, há um subestimativa de indivíduos que possuem dificuldades moderada/severa de audição. Porém quando considerado o ponto de corte “alguma dificuldade” observa-se uma boa sensibilidade para a identificação de pessoas com dificuldades auditivas consideradas leves.
Os pontos positivos e as vantagens na utilização da WG possibilitaram também a disseminação do instrumento para pesquisas nos diferentes campos da incapacidade e não apenas para estimativa de prevalência.
Apesar de questionário funcional auto referido da WG não ser capaz de identificar todos os usuários com dificuldade auditivas funcionais, a utilização deste como subsídio para elaboração de políticas públicas de inclusão e assistência à pessoas com deficiência auditiva, principalmente em regiões mais vulneráveis, onde a escassez de recursos físicos e humanos impossibilitam o diagnóstico clínico, permite a estimativa de prevalência de dificuldade auditiva eficiente contribuindo para diminuição da desigualdade na participação social.
Portanto, para que seja atendido o objetivo principal da ferramenta recomenda- se que os estudos que se propõem a utilizar o WG possibilitem os valores de prevalência e medida de acurácia para cada ponto de corte de dificuldade considerado de forma a possibilitar tanto o monitoramento, ou seja estudos longitudinais sobre a incapacidade.
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APÊNDICE
Apêndice A - Estratégias de buscas nas bases de dados científicas
Quadro 3 - Estratégia de busca utilizada de acordo com a base de dados
PUBMED/MEDLINE SCOPUS SCIENCE DIRECT WEB OF SCIENCE BVS
Search ((("washington group") OR ((("short set" OR "extended set")) AND question))) AND ((((("washington group") OR ((("short set" OR "extended set")) AND question)) OR ((("washington
questionnaire") OR module disability) OR "do you have difficulty"))) AND (((((((((domain) OR function) OR disability) OR impairment) OR disorder) OR "health survey"[MeSH Terms]) OR hearing) OR "hearing loss") OR difficulty)) ( ( TITLE-ABS-KEY ( "washington group" ) ) OR ( ( ( TITLE-ABS- KEY ( "short set" ) OR TITLE-ABS- KEY ( "extended
set" ) ) ) AND ( TITLE-ABS- KEY ( question ) ) ) OR ( ( TITLE- ABS-KEY ( "washington
question" ) OR TITLE-ABS-
KEY ( "washington module disability" ) OR TITLE-ABS-KEY ( {do
you have
difficulty} ) ) ) ) AND ( ( TITLE-ABS- KEY ( function ) OR TITLE-ABS- KEY ( domain ) OR TITLE-ABS- KEY ( disability ) OR TITLE-ABS- KEY ( impairment ) OR TITLE-ABS- KEY ( disorder ) OR TITLE-ABS- KEY ( "health survey" ) OR TITLE- ABS-KEY ( hearing ) OR TITLE-ABS- KEY ( "hearing loss" ) OR TITLE- ABS-KEY ( difficulty ) )
((("washington group W/2 disability") or ("washington group")) OR ((({short set?}) or ({extended set?})) AND ({question?}))) AND (((hearing) OR ("hearing loss") OR (difficulty)) AND ((function) OR (domain) OR (disability) OR (impairment) OR (disorder)))
Tópico: (function) OR Tópico: ( domain) OR Tópico: (difficulty) OR Tópico: (hearing) OR Tópic o: ("hearing
loss") OR Tópico: ("health survey") OR Tópico: (impairme nt) OR Tópico: (disorder*) OR Tópico: (disability)AND Tópico: ("Washington question*") OR Tópico: ("do
you have
difficulty") OR Tópico: ("washi ngton module") OR ("short set" OR "extended set") OR ("Washington group")
(tw:("washington group" OR "short set" OR "extended set")) AND (tw:((tw:(domain)) OR (tw:(function)) OR (tw:(disability)) OR (tw:(impairment)) OR (tw:(disorder)) OR (mh:("health survey")) OR (tw:(hearing)) OR (tw:("hearing loss")) OR (tw:(difficulty))))
Apêndice B - Formulário de Extração
Quadro 4 - Formulário de Extração utilizado na etapa de seleção dos estudos
Objetivo do Estudo: País:
Qual a ferramenta da WG utilizada?
WG Short Set of Question WG Extended Set of Question
Ano da aplicação do questionário: Tipo de Estudo:
Área Territorial aplicada (abrangência)
País Estado Cidade Bairro
Amostra populacional inespecífica
Metodologia para seleção populacional (Recrutamento):
Prevalência de Incapacidade Geral:
Prevalência de Incapacidade Auditiva identificada:
Qual a variável de comparação?
Educação Envelhecimento Análise socioeconômica Doenças
Outra ferramenta (questionário) Outro:
O estudo se propôs a validar o instrumento?
Sim Não
Medidas de Acurácia:
Considerações do estudo sobre a utilização do WG: Vantagens: Operacionais Interpretação Desvantagens Operacionais Interpretação
ANEXOS
Anexo A - The Washington Group Short Set of Questions On Disability
The next questions ask about difficulties you may have doing certain activities because of a HEALTH PROBLEM.
1. Do you have difficulty seeing, even if wearing glasses?
a.No - no difficulty b.Yes – some difficulty c. Yes – a lot of difficulty d. Cannot do at all
2. Do you have difficulty hearing, even if using a hearing aid? a. No- no difficulty
b. Yes – some difficulty c. Yes – a lot of difficulty d. Cannot do at all
3. Do you have difficulty walking or climbing steps?
a. No- no difficulty b. Yes – some difficulty c. Yes – a lot of difficulty d. Cannot do at all
4. Do you have difficulty remembering or concentrating?
a. No – no difficulty b. Yes – some difficulty c. Yes – a lot of difficulty d. Cannot do at all
5. Do you have difficulty (with self-care such as) washing all over or dressing? a. No – no difficulty
b. Yes – some difficulty c. Yes – a lot of difficulty d. Cannot do at all
6. Using your usual (customary) language, do you have difficulty communicating, for example
understanding or being understood? a. No – no difficulty
b. Yes – some difficulty c. Yes – a lot of difficulty d. Cannot do a
Anexo B - Washington Group/Budapest Initiative/UNESCAP Question Development
Figura 7 – Quadro de desenvolvimento do Extended Set of Question – Washington
Group/Budapest Iniciatie/ UNESCAP
SEVERITY is captured in response categories: no difficulty; some difficulty; a lot of difficulty; cannot do it at all NOTES:
1 Measurement is WITHOUT the use of assistive devices or other help with the exception of VISION glasses/lenses) and HEARING (hearing aids). These are both measured WITH the use of assistive devices and thus do NOT represent true measures of Capacity. Extended Set multiplequestions are capturedunder Performance (Row 4).
2 Micro environment - technical and personal assistance that follows the person wherever they go (e.g. wheelchair, eye glasses, personal attendant). ICF Environment Chapter 1 & 3
3 Meso environment - the environment beyond the person (e.g. transportation infrastructure, accessibility, service provision at local level, attitudes of others). ICF Environment Chapters 2 & 4
4 Meso environmental questions may also be non-domain specific.
5 Macro environment - that which affects a whole country, such as policies and legislation, general societal attitudes and practices. ICF Environment Chapter 5
6 Macro-environmental questions are NOT domain specific.
7 Pain and Fatigue are not obvious functional domains (nor are they included in the ICF) however they are included here as domains that impact functioning
a) tested and rejected one question for children / one question for adults b) available for special populations
c) No mention of functioning with/without assistive devices d) Upper body short set question is the ADL short set question
ADL (Activities of Daily Living): e.g. walking inside the home, standing from a chair, getting into and out of bed, eating, and dressing
IADL (Instrumental Activities of Daily Living): e.g. doing chores around the house, preparing meals, and managing money
Getting along with people: involves interpersonal interactions and relationships (socializing and interacting with others) and includes dealing with family, friends, persons in authority Major Life Activities include: working inside or outside the home to earn an income and support the family or going to school and achieving educational goals
Participation in Society: includes joining in community/family gatherings, religious/civic activities and leisure/sports events
Anexo C - Washington Group - Extended Question Set On Functioning
A Survey Module for Measuring Health State (Version 19 January 2011) (Proposal endorsed by the Joint UNECE/WHO/Eurostat Task Force on Measuring Health State, at the joint Washington Group / Budapest Initiative Task Force Meeting, 3-5 November 2010, Luxembourg)
Preamble to the BI-M2:
Interviewer read: “Now I am going to ask you some [further] questions about [your/his/her] general mental and physical health. These questions deal with [your/his/her] ability to do different daily activities, as well as with how [you have/he has/she has] been feeling. [Although some of these questions may seem similar to ones you have already answered, it is important that we ask them all.]”
NOTE: The BI-M2 is a subset of the WG ES-F. BI-M2 questions are indicated with an
asterisk (*) in the question set that follows.
NOTE: All questions include the following response categories: 7. Refused
9. Don’tknow
(RECORTE PARA AUDIÇÃO)
HEARING
HEAR_1* [Do/Does] [you/he/she] use a hearing aid? 1. Yes 2. No
HEAR_2* [Do/Does] [you/he/she] have difficulty hearing, [If HEAR_1 = 1: even when using a hearing aid(s)]? Would you say... [Read response categories]
1. No difficulty 2. Some difficulty 3.A lot of difficulty
4. Cannot do at all / Unable to do
[Note: This item is Question 2 in the WG Short Set.]
OPTIONAL Hearing questions (HEAR_4 and HEAR_5 are NOT considered optional