Judicial Vulnerability on the Exercise of Orthodontics: Construction and Validation of a Questionnaire

Abstract Objective: To develop and validate a questionnaire to measure the vulnerability of orthodontists, measuring the risks of being involved in civil liability lawsuits. Material and Methods: In-depth interviews were performed with three groups: G1- law professionals, G2 - orthodontists, and G3 - orthodontic patients. From the analysis of the content of Bardin, domains for the construction of the first version of the 53-question questionnaire were identified. The questionnaire was submitted to experts for validation, inclusion and exclusion of questions, but maintaining the 53-question format. It was submitted to the test-retest phases and verification of internal consistency. Results: 247 professionals answered the final version of the questionnaire. The intraclass correlation coefficient was 88.8%. Cronbach's alpha was 0.946, with high internal consistency. The Kaiser-Meyer-Olkin and Bartlett's tests confirmed internal consistency showing the values of 0.909 and significance of <0.001, respectively. From the total score and factorial analysis, the sample was divided into three groups of judicial vulnerability. Conclusion: The results of this study demonstrated that the questionnaire is a valid tool to measure the risks of involvement in civil liability lawsuits by orthodontists. It presented a multidimensional character and might be applied as well as face to face or online, without prejudice to quality (AU).

Plain access to justice and the orthodontist's activity in Brazil: vulnerability in the professional practice in the face of risks of malpractice lawsuits.

OBJECTIVE: the present study aimed at evaluating the risks and vulnerability of orthodontists to legal compensation actions and verifying the hypothesis of these health care professionals having little knowledge concerning their rights and obligations as service providers. METHODS: Three groups were formed to participate in a semi-structured interview. The first group had thirteen law professionals, the second group was composed of eleven orthodontists and the third group was made up of nine randomly selected orthodontic patients. RESULTS: Relevant aspects related to the exercise of the professional activity of orthodontists that influence on the vulnerability of orthodontists in lawsuits were identified. After transcription, reading, and comparing the answers of the interviews, items capable of influencing judicial decisions, from the standpoint of Brazilian Justice Courts, were evaluated. CONCLUSION: It was verified that Brazilian orthodontists do not have adequate formation concerning the legal consequences of the exercise of their professional activity. Orthodontists also failed to establish proper contractual relationship, organize orthodontic records, and, most importantly, failed in communicating the risks and the therapeutic processes to patients during all phases of treatment.

Plain access to justice and the orthodontist's activity in Brazil: vulnerability in the professional practice in the face of risks of malpractice lawsuits

ABSTRACT Objective: the present study aimed at evaluating the risks and vulnerability of orthodontists to legal compensation actions and verifying the hypothesis of these health care professionals having little knowledge concerning their rights and obligations as service providers. Methods: Three groups were formed to participate in a semi-structured interview. The first group had thirteen law professionals, the second group was composed of eleven orthodontists and the third group was made up of nine randomly selected orthodontic patients. Results: Relevant aspects related to the exercise of the professional activity of orthodontists that influence on the vulnerability of orthodontists in lawsuits were identified. After transcription, reading, and comparing the answers of the interviews, items capable of influencing judicial decisions, from the standpoint of Brazilian Justice Courts, were evaluated. Conclusion: It was verified that Brazilian orthodontists do not have adequate formation concerning the legal consequences of the exercise of their professional activity. Orthodontists also failed to establish proper contractual relationship, organize orthodontic records, and, most importantly, failed in communicating the risks and the therapeutic processes to patients during all phases of treatment.

RESUMO Objetivo: o presente trabalho teve como objetivo apurar os riscos e a vulnerabilidade dos profissionais ortodontistas serem envolvidos em lides judiciais com finalidade indenizatória, além de verificar a hipótese de que esses profissionais possuem pouco conhecimento a respeito de suas obrigações e deveres como prestadores de serviço, bem como dos mecanismos que podem evitar tais demandas judiciais. Métodos: foram formados três grupos para entrevistas semiestruturadas, compostos por profissionais da área jurídica, profissionais ortodontistas e pacientes ortodônticos: no primeiro grupo, foram entrevistados 13 (treze) profissionais da área jurídica; no segundo grupo de entrevistados, foram abordados 11 (onze) profissionais ortodontistas; para o terceiro grupo de entrevistas, foram sorteados 9 (nove) pacientes em tratamento ortodôntico. Resultados: foram identificados itens ou domínios relevantes, relacionados ao exercício da atividade profissional dos ortodontistas, que repercutem diretamente em aspectos de vulnerabilidade deles, quando confrontados, objetivamente, com fundamentos de decisões judiciais envolvendo questões indenizatórias em face de tais profissionais da área da saúde. Após o trabalho de transcrição das entrevistas, leitura, compilação e comparação das respostas, passou-se à análise dos temas capazes de influenciar na rotina forense, a partir das tendências doutrinárias e jurisprudenciais encontradas nos Tribunais brasileiros. Conclusão: verificou-se que os ortodontistas não apresentam formação adequada para o completo entendimento sobre as consequências jurídicas do exercício de sua atividade profissional. Constataram-se, também, falhas por parte do profissional ortodontista, desde o estabelecimento da relação contratual, formação de documentação ortodôntica organizada e, sobretudo, registro, documentação e informação aos pacientes, ou responsáveis legais, em todas as etapas do tratamento.

Tradução, adaptação transcultural e validação da versão brasileira do "Impact of Fixed Appliances Measure" (B-IFAM) / Translation, cross-cultural adaptation and validation of the questionnaire "Impact of Fixed Appliances Measure" to the Brazilian Portuguese language

Introdução: O objetivo deste estudo foi traduzir e adaptar transculturalmente o instrumento condição-específico "Impact of Fixed Appliances Measure" (IFAM) para o idioma português do Brasil, avaliando a sua validade e confiabilidade para uso em crianças/adolescentes brasileiros. Métodos: O instrumento foi traduzido do idioma inglês para o português de forma independente por dois tradutores bilíngues. Em seguida, as duas versões traduzidas foram submetidas ao comitê de revisão, originando uma única versão, que foi retro-traduzida por outro tradutor bilíngue. Essa primeira versão do instrumento em português foi pré-testada em uma amostra de 15 crianças/adolescentes, produzindo a versão brasileira do IFAM (B-IFAM). O B-IFAM foi aplicado em 161 crianças/adolescentes, entre 10 a 18 anos de idade, que estavam em tratamento ortodôntico na clínica de Especialização em Ortodontia da Faculdade de Odontologia da Universidade Federal de Minas Gerais. A consistência interna foi avaliada por meio do teste Cronbach alfa (α) e a confiabilidade teste-reteste pelo coeficiente de correlação intraclasse (CCI). A validade de constructo e a validade convergente foram mensuradas através da correlação de Pearson. Para a validade convergente, observou-se a correlação entre o B-IFAM e a versão brasileira do "Child Oral Impact on Daily Performance" (Child-OIDP). A validade discriminante foi avaliada através da comparação das médias e desvio padrão do B-IFAM em relação ao gênero e classificação de Angle das crianças/adolescentes usando teste t de Student. Resultados: A consistência interna foi de 0,89 para a pontuação total do B-IFAM e 0,55-0,86 para as subescalas. A confiabilidade teste-reteste demonstrou um CCI de 0,81 para a pontuação total do B-IFAM, e variou entre 0,55 e 0,78, para a subescalas. A correlação de Pearson entre a pontuação total do B-IFAM e o Child-OIDP foi de r=0,28 (p<0,01). O B-IFAM demonstrou validade de constructo aceitável, com a maioria das correlações apresentando p<0,05. A validade discriminante demonstrou diferença estatisticamente significativa entre crianças/adolescentes com Classe I e Classes II/III de Angle nas subescalas Estética e Limitação Funcional (p<0,05). Conclusões: O B-IFAM demonstrou propriedades psicométricas adequadas em relação à confiabilidade e validade. O estudo apresentou um instrumento condição-específico viável para mensurar o impacto do tratamento ortodôntico na qualidade de vida de crianças/adolescentes brasileiros

Introduction: The aim of this study was translate and cross-culturally adapt the condition-specific instrument Impact of Fixed Appliances Measure (IFAM), to Brazilian Portuguese , assessing its validity and reliability for use among Brazilian children/adolescents. Methods: The instrument was translated from English to Portuguese independently by two bilingual translators. Then, the two translated versions were submitted to the committee review, resulting in a single version, which was backtranslated by another bilingual translator. This first version of the instrument in Portuguese was pretested on a sample of 15 children/adolescents, resulting in the Brazilian version of IFAM (B-IFAM). The B-IFAM was tested on 161 children/adolescents, between 10 to 18 year old, who were undergoing orthodontic treatment at the Orthodontic Clinic, School of Dentistry, Federal University of Minas Gerais. Internal consistency was assessed using Cronbach's alpha (α) and test-retest reliability by intraclass correlation coefficients (ICC). The construct validity and convergent validity were assessed by Pearson's correlation. Convergent validity was conducted among the B-IFAM and the Brazilian version of Child Oral Impact on Daily Performance (Child-OIDP). Discriminant validity was evaluated by comparisons of BIFAM's means and SD with gender and children's/adolescents' Angle's classification using Student's t-test. Results: Internal consistency was 0.89 for overall score and 0.55 to 0.86 for subscales. ICC for test-retest reliability for B-IFAM's overall score was 0.81 and for subscales, ranged from 0.55 to 0.78. Pearson's correlation between overall score of B-IFAM and Child-OIDP was r=0.28 (p<0.01). The B-IFAM demonstrated acceptable construct validity, which most correlations presenting p<0.05. Discriminant validity demonstrated statistically significant difference between children/adolescents classified as Class I and Class II/III malocclusion in Aesthetic and Functional Limitation subscales (p <0.05). Conclusions: The B-IFAM demonstrated adequate psychometric properties regarding reliability and validity. The study achieved a specific-condition instrument feasible to measure the impact of orthodontic treatment on quality of life of Brazilians children/adolescent