title: Expanded protocol of orofacial myofunctional evaluation with scores: Validity and reliability.
abstract: OBJECTIVE
  Clinical evaluation of the stomatognathic system is indispensable for the diagnosis of orofacial myofunctional disorders. In order to obtain a more precise diagnosis, the protocol of orofacial myofunctional evaluation with scores (OMES protocol) (Int. J. Pediatr. Otorhinolaryngol. 72 (2008) 367-375) was expanded in terms of number of items and scale amplitude. The proposal of this study is to describe the expanded OMES protocol (OMES-E) for the evaluation of children. Validity of the protocol, reliability of the examiners and agreement between them were analyzed, as also were the sensitivity, specificity and predictive values of the instrument.
  
  
  METHODS
  The sample consisted of videorecorded images of 50 children, 25 boys (mean age=8.4 years, SD=1.8) and 25 girls (mean age=8.2 years, SD=1.7) selected at random from 200 samples. Three speech therapists prepared for orofacial myofunctional evaluation participated as examiners (E). The OMES and OMES-E protocols were used for evaluation on different days. E1 evaluated all images, E2 analyzed children with recordings from 1 to 25 and E3 analyzed children with recordings from 26 to 50. The validity of OMES-E was analyzed by comparing the instrument to the OMES protocol using the Pearson correlation test complemented with the split-half reliability test (p<0.05). The linear weighted Kappa coefficient of agreement (Kw'), the sensitivity, specificity and predictive values and the prevalence of OMD were calculated.
  
  
  RESULTS
  There was a statistically significant correlation between the OMES and OMES-E protocols (0.79>r<0.94, p<0.01) and a significant test-retest correlation with the OMES-E (0.75>r<0.86, p<0.01), with a reliability range of 0.86-0.93. The correlation and reliability coefficients between examiners were: E1×E2 (r=0.74, 0.84), E1×E3 (r=0.70, 0.83) (p<0.01). Kw' coefficients with moderate and good strength predominated. The OMES-E protocol presented mean sensitivity=0.91, specificity=0.77, positive predictive value=0.87 and negative predictive value=0.85. The mean prevalence of OMD was 0.58.
  
  
  CONCLUSIONS
  The OMES-E protocol is valid and reliable for orofacial myofunctional evaluation.
authors.affiliation: Faculty of Medicine of Ribeirão Preto, University of São Paulo, Department of Otorhinolaryngology, Ophthalmology and Head and Neck Surgery, Brazil. cfelicio@fmrp.usp.br
authors.forename: Cláudia Maria
authors.initials: CM
authors.lastname: de Felício
authors.forename: Gislaine Aparecida
authors.initials: GA
authors.lastname: Folha
authors.forename: Cláudia Lúcia Pimenta
authors.initials: CL
authors.lastname: Ferreira
authors.forename: Ana Paula Magalhães
authors.initials: AP
authors.lastname: Medeiros
mesh_terms: D002648:Child; D003680:Deglutition Disorders / Q000175:diagnosis*; D005152:Facial Muscles / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008310:Malocclusion / Q000175:diagnosis*; D008409:Mastication / Q000502:physiology*; D009069:Movement Disorders / Q000175:diagnosis* / Q000503:physiopathology; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012120:Respiration Disorders / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D014741:Video Recording