Validation of the IFBRA severity scale among Persons with Disabilities in Brazilian social welfare

Validación de la escala IFBRA

Abstract

This article reports on Brazilian validation project of the Brazilian Functioning Index Adapted (IFBRA) for granting retirement benefits. It assesses the functionality of Persons with Disabilities (PwD), considering the Functional Independence Matrix (FIM), performance, barriers and severity classification. The study was developed in three phases: 1. Construct and content: Collective consensus and technical review groups on the relevance of the object, measures, scope, domains and questions; 2. Face validity: National purposive sampling on acceptability, social, cultural, and linguistic interpretation; and 3. Accuracy: National census survey for reference standards; sensitivity, specificity, and effectiveness. A central in-person national training session, twelve national video conferences and six regional training sessions did validate the combination of International Classification of Functioning, FIM, and ancillary measures. Qualitative interviews that involved physicians, social workers and PwD policyholders in five Brazilian regions found the IFBRA acceptable and interpreted it homogeneously. A national census survey analyzed the agreement between 17,350 PwD policyholders and IFBRA applicators on their perception as to severity. Maximum effectiveness was achieved when two evaluators did match. IFBRA was considered valid as to relevance, comprehensiveness, acceptability, interpretation and accuracy, turning to be a new reference standard. The provisional classification used prior to validating the IFBRA was considered restrictive and unfair.