Estágio de prontidão em pacientes com disfonia: nova perspectiva com base na teoria de resposta ao item na escala URICA-V

Abstract

The stage of readiness in relation to treatment implies the best condition for adherence to a therapeutic proposal. The URICA-V scale is used in the self-assessment of the readiness stage in patients with dysphonia and uses the Classic Test Theory (CTT) as a model for its calculation, which has some limitations. The Item Response Theory (IRT) can be used to search for evidence of validity of the URICA-V scale, as it considers each item individually, without prioritizing the total scores to characterize the studied attribute. Objective: Obtain evidence of validity of the URICA-V scale and estimate the psychometric properties of its items from the IRT, in order to assess the stage of readiness of patients with dysphonia in a different way. Method: 658 subjects were evaluated, who were allocated into two groups - with dysphonia (GCD) and vocally healthy (GVS), of both sexes and above 18 years old. To build a digital database, personal and professional information and patients' responses were typed on the URICA-V scale. Subsequently, exploratory factor analysis (AFE) was performed; confirmatory factor analysis (AFC); application of the item response theory (IRT) using the Samejima model and analysis of the ROC curve, to obtain the cutoff point of the URICA-V scale. Results: It was observed that the factors pre-established in the original version of the URICA-V scale were not maintained for the Brazilian population, as demonstrated by AFE and AFC and reliability analysis. Thus, two factors were adopted and the factor loads item by item were observed, which were considered adequate and showed good internal consistency. In addition, it was possible to observe the items with higher values of difficulty (b) and discrimination (a), which contributed to the calculation of the theta of each subject. Then, an analysis of the ROC curve was performed, which allowed the establishment of a cut-off value for the instrument, being: -0.236. Conclusion: After analyzing the psychometric measures on the URICA-V scale, there was a need for adaptations in its structure, such as considering two factors and excluding some items. In addition, a new cut-off point for the structure was obtained from the IRT to measure the stage of readiness with greater reliability and differentiate individuals with and without dysphonia.