Factors confounding oral health related quality of life questionnaires outcomes in elderly people : a systematic review

Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas MonizBackground: Oral health related quality of life can be evaluated by many validated questionnaires reported in the literature. However, some confounding variables can change the results of the questionnaires. To globally address this issue, we reviewed which confounding variables influence more the Oral Health Related Quality of Life (OHRQoL) questionnaires in elderly people outcomes, specifically the Geriatric Oral Health Assessment Index (GOHAI) and the Oral Health Impact Profile (OHIP). Methods: The following databases we used for data collection: PubMed, Cochrane Central Register of Controlled Trials, Scopus, Bon and Web of Science. The search strategy used was (("GOHAI") AND ("OHIP")) NOT ("Review"). Studies from 1st January 2001 to 15th January 2022 were included. The risk of bias was assessed using the “Methods commentary: Risk of bias in crosssectional surveys of attitudes and practice” (Agarwal et al., 2017) and the plots generated by the ROBVIS Tool. The results were subjected to randomeffects metaanalysis using the software Open Meta Analyst. Statistical results were considered significant if p<0.05. Results: In total, 197 articles were found. After removing duplicates, 125 articles remained. After the first screening by title and abstract, 40 articles were selected. After a second screening for inclusion criteria compliance (population over 60 years old without cognitive impairment and the use of the GOHAI and OHIP questionnaires), 8 articles including 1613 elderly patients were included. The metaanalysis revealed a substantial disparity between the results for both questionnaires. The confounding variable that had the most significant effect on OHRQoL in the elderly was xerostomia; however, the gross domestic product (the standard measure of the value added created by the production of products and services in a country over a specified period) did not appear to affect the outcomes. In addition, the questionnaires' sensitivity differs for each covariate: While the GOHAI was highly sensitive to the ratio of women to men, xerostomia, and the population human capital index, the OHIP14 was more sensitive to edentulism, denture use, and the population poverty index. Conclusion: This study demonstrated that some variables substantially affect the OHRQoL of elderly patients. Dentists and other health professionals must be aware of these variations to minimize their impact on treatment. Thus, the clinical approach to geriatric patients requires knowledge of evaluation tools, their domains, and sensitivity.Introdução: A qualidade de vida relacionada à saúde bucal pode ser avaliada por diversos questionários validados e relatados na literatura. No entanto, algumas variáveis de confusão podem alterar os resultados. Para abordar globalmente essa questão, revisamos quais são as variáveis que influenciam mais os questionários de Qualidade de Vida Relacionada à Saúde Bucal (QVRSB) em idosos, especificamente o Geriatric Oral Health Assessment Index (GOHAI) e o Oral Health Impact Profile (OHIP). Métodos: Utilizamos as seguintes bases de dados para coleta de dados: PubMed, Cochrane Central Register of Controlled Trials, Scopus, Bon e Web of Science. A estratégia de busca utilizada foi (("GOHAI") AND ("OHIP")) NOT ("Review"). Foram incluídos estudos de 1º de janeiro de 2001 a 15 de janeiro de 2022. O risco de viés foi avaliado usando o “Methods commentary: Risk of bias in crosssectional surveys of attitudes and practice” (Agarwal et al., 2017) e os gráficos gerados pela ferramenta ROBVIS. Os resultados foram submetidos à metaanálise de efeitos aleatórios utilizando o software Open Meta Analyst. Os resultados estatísticos foram considerados significativos se p