Adaptação transcultural e testes das propriedades de medida do Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) para o português do Brasil

Abstract

Background: Temporomandibular dysfunction is a condition that involves the temporomandibular joint, the masticatory muscles and/or other structures. The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) is currently considered the gold standard for TMD assessment, and it was recently translated into Brazilian Portuguese. Objectives: To carry out the cross-cultural adaptation and the measurement properties tests of the Brazilian Portuguese version of the DC/TMD. Materials and Methods: The cross-cultural adaptation process was carried out through a pre-test and a bilingual phase, as recommended in the “Guidelines for Translation and Cultural Equivalency of Instruments”, a document that describes the translation, adaptation and validation process of the DC/TMD. To test the measurement properties, 117 Brazilians with TMD were included and underwent an assessment day. They answered all the DC/TMD instruments, the Research Diagnostic Criteria for Temporomandibular Disorders Axis II, Craniofacial Pain and Disability Inventory, Mandibular Function Impairment Questionnaire, Numerical Pain Rating Scale and Symptom Checklist-90-Revised. In this sample, structural validity, construct validity – hypothesis testing, internal consistency, criterion validity and measurement errors were tested. The reliability was tested among 51 and 59 participants in this sample. Results: Adequate criterion validity and reliability were found for the Brazilian Portuguese version of the TMD Pain Screening. Adequate reliability was found for the diagnoses of painful TMDs and disc displacement with reduction, as well as for the Axis II orofacial-related instruments: Pain Drawing, Graded Chronic Pain Scale version 2 (GCPS v.2), Jaw Functional Limitation Scale (JFLS) and the Oral Behavior Checklist (OBC). Internal consistency was also adequate for these Axis II instruments (α > 0.77), except for the functional activities domain of the OBC-12 (α = 0.48). Construct validity was good (75% of hypotheses confirmed), except for the OBC total score. Regarding structural validity parameters, the GCPS v.2 presented adequate Goodness of Fit Index (GFI) for the solution with two domains. JFLS and OBC presented insufficient GFI for the solutions with three and two domains, respectively. Conclusion: The Brazilian Portuguese version of the DC/TMD Axis I is valid and reliable to screen painful TMD, and reliable to diagnose myalgia, myofascial pain with referral, arthralgia, headache attributed to TMD and disc displacement with reduction. The Axis II instruments Pain Drawing and GCPS v.2 are valid and reliable for use in Brazil; however more studies are needed to find a more appropriate structure for JFLS and OBC in a Brazilian sample.