Validez y reproducibilidad del cuestionario perfil de síntomas autonómicos

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dc.contributor.advisorOrozco Vargas, Luis Carlos
dc.contributor.authorNino Mantilla, María Eugenia
dc.date.accessioned2024-03-03T16:15:16Z
dc.date.available2006
dc.date.available2024-03-03T16:15:16Z
dc.date.created2006
dc.date.issued2006
dc.description.abstractLa neuropatía autonómica cardiovascular (NAC). Se caracteriza por el deterioro de las fibras nerviosas autonómicas pequeñas que inervan el corazón y los vasos sanguíneos. La diabetes mellitus es la enfermedad que con mayor frecuencia la produce, se estima que su presencia aumenta dos veces más el riesgo de isquemia miocárdica silenciosa y labilidad intraoperatoria. Adicionalmente, del 27 al 56% de los pacientes con este diagnóstico mueren en los siguientes 5-10 años. El perfil de síntomas autonómicos (PSA) es un cuestionario de 74 preguntas (9 dominios) no se ha estimado la reproducibilidad del instrumento ni la validez de criterio El objetivo de este estudio fue determinar la validez y reproducibilidad del cuestionario comparado con mediciones objetivas en la detección de síntomas y el diagnóstico de NAC. Materiales y Métodos 103 participantes diabéticos respondieron mediante entrevista el cuestionario perfil de síntomas autonómicos versión español. En 52 participantes se estimó el nivel de la prueba y los valores predictivos positivo y negativo. Mediante la metodología bayesiana se calculó la prevalencia, sensibilidad y especificidad del puntaje obtenido con la presencia de NAC. Se estableció la consistencia interna mediante el alpha de cronbach. Resultados La consistencia interna de los síntomas de hipotensión ortostática, síncope, vasomotores, secretomotores, diarrea autonómica, estreñimiento y alteración del reflejo pupilar fue buena (alpha >0.7). El delta E/I fue la medición con la mejor reproducibilidad (CCI 0.98 IC 95% 0.97-0.99) seguido de la media de los intervalos R-R y la razón E/I (CCI 0.97 IC95% 0.95-0.98).La reproducibilidad del puntaje total del cuestionario fue pobre (CCI 0.36 0.06-0.6) y tuvo baja capacidad discriminativa comparado con el delta E/I (Área ROC 0.5). Conclusiones El cuestionario evalúa consistentemente los síntomas de función autonómica, tiene una baja reproducibilidad y tiene una pobre capacidad discriminativa para definir la presencia de NAC.
dc.description.abstractenglishThe cardiovascular autonomic neuropathy (CAN) It is characterized by the deterioration of the small autonomous nervous fibers, that innerve the heart and blood vessels and results in abnormalities in heart rate control and vascular dynamics. The diabetes mellitus is the illness that produces it with more frequency and increases the risk of silent myocardial ischemia and intraoperative cardiovascular lability. Additionally, of the 27 to 56% of the patients with this diagnosis die in the following 5-10 years. The diagnosis of NAC has been carried out classically by means of a battery of tests that I continue in a electrocardiograph registration, These can being of breathing type (test of controlled inspiration), orthostatic or heart automatism (mean R-R). Their main disadvantage is the software necessity, trained personnel and the cost for patient that can ascend to the 140 dollars for test. The autonomic symptom profile it is a questionnaire of 74 questions (9 domains) created by investigators specialized in autonomous function and previously evaluated in their facial validity and of having contained by Suárez and cols. In this phase of the validation it was not considered the reliability of the instrument neither the validity of approach of the obtained measurements of the reference standard for separate. With this purpose we carry out a study to determine the validity and reliability of the profile of autonomous symptoms in the detection of symptoms and the diagnosis of NAC. Materials and Methods During the months of June to December of 2005, 103 diabetic participants responded by means of interview the questionnaire Spanish version. The internal consistency of the questionnaire settled down for each domain by means of the cronbach alpha and the reliability test-retest of the questionnaire. Additionally and by means of a prospective sampling, 52 participants that attended the taking of the objective tests of autonomic function were considered the level of the test and the predictive values for defined court points each 10 points of the scale of qualification of the questionnaire. By means of the Bayesian methodology proposed by Kraemer the prevalence, sensibility and specificity of the score obtained with the presence of NAC was calculated. Results The validity of content of the profile of autonomous symptoms was good for the domains of symptoms of orthostatism, symptoms related with syncope, vasomotor, secretomotor, autonomous diarrhea, constipation and alteration of the pupilar reflection (alpha >0.7). The delta E/I was the measurement with the best reliability (CCI 0.98 IC 95% 0.97- 0.99) followed by the mean of the intervals R-R and the E/I ratio (CCI 0.97 IC95% 0.95-0.98). The reliability of the total score questionnaire was poor (CCI 0.36 0.06-0.6) and the domain with the best reliability was that of the symptoms associated to erectile failure (ICS 0.55 IC 95% 0.58-0.86). The discriminative capacity of the questionnaire for the detection of the defined NAC with the delta E/I was poor for anyone of the selected court points. (Area ROC 0.5). Conclusions Questionnaire that evaluates the symptoms of autonomous function consistently has a low reliability and it has a poor discriminative capacity to define the presence of NAC. The reading among appraisers of the tests of autonomous function is reliable for clinical use and of investigation and they don't depend on the reader's experience.
dc.description.degreelevelMaestría
dc.description.degreenameMagíster en Epidemiología
dc.format.mimetypeapplication/pdf
dc.identifier.instnameUniversidad Industrial de Santander
dc.identifier.reponameUniversidad Industrial de Santander
dc.identifier.repourlhttps://noesis.uis.edu.co
dc.identifier.urihttps://noesis.uis.edu.co/handle/20.500.14071/19284
dc.language.isospa
dc.publisherUniversidad Industrial de Santander
dc.publisher.facultyFacultad de Salud
dc.publisher.programMaestría en Epidemiología
dc.publisher.schoolEscuela de Medicina
dc.rightshttp://creativecommons.org/licenses/by/4.0/
dc.rights.accessrightsinfo:eu-repo/semantics/openAccess
dc.rights.creativecommonsAtribución-NoComercial-SinDerivadas 4.0 Internacional (CC BY-NC-ND 4.0)
dc.rights.licenseAttribution-NonCommercial 4.0 International (CC BY-NC 4.0)
dc.rights.urihttp://creativecommons.org/licenses/by-nc/4.0
dc.subjectFunción Autonómica
dc.subjectReproducibilidad
dc.subjectValidez
dc.subjectBateria De Swing
dc.subjectSíntomas Autonómicos
dc.subject.keywordUtonomous Function
dc.subject.keywordReproducibilidad
dc.subject.keywordValidity
dc.subject.keywordBattery Of Jive
dc.subject.keywordAutonomous
dc.titleValidez y reproducibilidad del cuestionario perfil de síntomas autonómicos
dc.title.englishValidez y reproducibilidad del cuestionario perfil de síntomas autonómicos
dc.type.coarhttp://purl.org/coar/version/c_b1a7d7d4d402bcce
dc.type.hasversionhttp://purl.org/coar/resource_type/c_bdcc
dc.type.localTesis/Trabajo de grado - Monografía - Maestria
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