Quality of Life of Sign Language Interpreters: A Systematic Review Protocol

Backgroud The sign language interpreter is a professional who has the ability to be the communication link between users of two languages (oral and sign). Due to the physical and mental demand in the performance of this profession, health studies that includes sign language interpreters are necessary, such as health related Quality of Life (QoL). Methods The study will be conducted by two independent reviewers following the rules of the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA), a search will be carried out in the main databases: LILACS; SciELO; ScienceDirect; Scopus Elsevier; PubMED; Web of Science for the selection of articles published until 2020. There will be no language or locale limitations. The assessment of methodological quality will be carried out using instruments from the Joanna Briggs Institute (IJB). This systematic review aims to analyze the QoL of sign language interpreters from a systematic review.

articles published until 2020. There will be no language or locale limitations. The assessment of methodological quality will be carried out using instruments from the Joanna Briggs Institute (IJB).

Discussion
This systematic review aims to analyze the QoL of sign language interpreters from a systematic review.

Background
The concept of health de ned by the World Health Organization (WHO) concerns not only the absence of disease, but also physical, mental and social well-being, in perfect state of harmony. Because it presents a predictor of reliability to the self-assessment of health status, it can be indicated for the epidemiological survey, and thus to outline new approaches to worker health care [1,2].
Occupational health in the eld of public health is understood as a set of multidisciplinary practices with the common objective of promotion, prevention, recovery and rehabilitation. In this perspective, the area of knowledge that aims to understand the relationships between work and the health of the employer is the health of the worker. Monitoring the work environment and the worker is an important instrument for early detection of abnormal conditions in the work environment and thus to intervene speci cally in the problem raised [3].
WHO has de ned some factors that characterize quality of life (QoL) as being positive or negative. QoL can be de ned as a particular perception, that each person has of themselves, in relation to their culture, standard of living, concerns, social position, values, objective and health condition that will determine whether the individual has a good perception or poor QoL [4].
One of the manifestations of a people's cultural identity is their mother tongue, as it allows the expression of subjectivity and becomes a cultural heritage for their successors. Sign language is considered the native language of the deaf, it is "alive" like any other language and for that reason it presents linguistic variations over the years. Sign language acquisition will occur through contact between the deaf and their peers in the deaf community [5].
The sign language interpreter is the professional who has the training to be the communication link between users of two languages, one auditory-oral and one visual-gestural, their function is to transmit the contextualized content, even when there are no direct referents, from a source language to a target language, that is, it works with two language pairs. This group of workers has a psychological overload due to the cognitive demand resulting from many hours a day dedicated to translation work, with little or no rest time, in addition to physical overload due to repetitive movements that can lead to musculoskeletal disorders [6,7].
It is known that the worker who needs to use the upper limbs (UL) with repetitive movements, speed, vibration, with an uncomfortable position and who needs muscular strength in his performance has a high prevalence of musculoskeletal disorders, and when the dominant upper limb of the professional is affected, their perception of QoL decreases signi cantly [8].

Objectives
The objectives of this systematic review are: 1. Analyze the perception of QoL of a sign language interpreter; 2. Correlate the functionality of sign language interpreters and the perception of quality of life.

Methods
This is a systematic review of studies that analyze QoL in sign language interpreters. The review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database [9] with registration number CRD42020181573. This protocol was structured according to the guidelines of the Preferred Report Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) [10] (see Additional le 1).
The guiding question of this study was: do sign language interpreters have an impact, positive or negative, on the perception of quality of life due to their professional performance?

Eligibility criteria
The studies will be selected according to the criteria described below: Participants Studies with people of both sexes, with or without pathologies.

Study designs
Only observational studies that used generic or speci c QoL tools should be included. Qualitative studies will be excluded.

Interventions or exposure
Professionals who are sign language interpreters. Exclusion of other professionals.

Comparators
Not applicable.

Primary outcome
The main outcome to be considered are the QoL indicators described in the studies according to the domains of the psychometric instruments used for QoL analysis.

Secondary outcomes
Secondary outcomes will not be considered in this review.

Search methods
The terms that will be used in the search were consulted in the Health Sciences Descriptors (DeCS) [11] and Medical Subject Headings (MeSH) [12], Searches will be conducted in the following databases: Latin American and Caribbean Health Sciences Literature (LILACS) [13], Scienti c Electronic Library Online (SciELO) [14], ScienceDirect [15], Scopus Elsevier [16], United States National Library of Medicine (PubMED) [17], Web of Science [18]. The search for articles will take place in the year 2020 and no date and language lters will be used in the databases.
The reference lists of the included articles will be analyzed to ensure studies that have not been found by searching the databases. For database searches, the following keywords or search terms will be used: "quality of life" OR "hrqol" OR "health related quality of life" OR "health-related quality of life" OR "life quality" AND "sign language interpreter" OR "Interpreters" OR "Interpreter" OR "Sign Language Translator" OR "Translator". The data found in the search process will be organized in a Microsoft Excel spreadsheet.

Selection of studies
Two independent reviewers will conduct the search following three phases. After each phase, the authors will check the included and excluded studies and in case of disagreement the authors will analyze and decide on the studies' eligibility for review.
In phase 1, the title of the articles identi ed by the surveys will be selected according to the following criteria:

Is the study with sign language interpreters? (Yes, it is not clear or not)
Is it a quality of life study? (Yes, it is not clear or not) In phase 2, the abstracts of the studies selected in phase 1 will be read and selected according to the following criteria: Is the study with sign language interpreters? (Yes, it is not clear or not) Is it a quality of life study? (Yes, it is not clear or not)

Does the study use any validated psychometric instrument for QoL analysis? (Yes, it is not clear or not)
In phase 3, the studies will be read in full and a table will be drawn up with the following information: Authors' names Country of origin

Study title
Year of publication of the study Objective of the study Analysis tool

Sample Number
Main results

Assessment of study risk bias
Immediately after lling in the information related to phase 3, the authors will present the reasons for exclusion from the studies and thus register in text for later consultation. None of the authors of this review will be blind to the titles of the journals or authors or institutions of study. A study owchart will be made containing measures, such as identi cation, screening, eligibility and inclusion of items with quantities, and an explanation of the reason for exclusion.
Additional information from the authors of the included studies will be requested to resolve questions about study eligibility.

Data extraction and management
Using a detailed step-by-step, reviewers will be able to extract studies from the databases independently following the same "path" and organize them in Excel software spreadsheets. The summarized data will include the name of the authors of the studies, title of the journal, date of publication; country of origin of the studies; the assessment instruments of the participants' QoL; socioeconomic pro le of sign language interpreters; methodology; details of intervention and results. In case of possible differences found in the QoL tools, they will be analyzed by grouping the same or similar domains of the instruments. The reviewers will resolve any differences. In case of lack of information, the reviewers will contact the authors of the studies that were included in this review via email.

Quality assessment
The evaluation of the methodological quality of the articles will be carried out with instruments from the Joanna Briggs Institute (IJB) [19], according to the design of the selected study.
The classi cation of the studies will be identi ed as: "low risk of bias" when more than 80% of the established criteria are reached; "Medium risk of bias" when the criteria ful lled are between 50% to 80% and "high risk of bias" when less than 50% of the criteria are reached according to the instrument used.

Evidence synthesis
A systematic narrative synthesis will be provided with information presented in the selected studies using tables to summarize and explain the characteristics and results of the included studies (authors; country; title; year of publication; objective; sample; instrument; result).

Dissemination
The results of this review will be submitted in a journal of the same theme, and from the peer review the results will be reported according to the items in the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) [20]. A ow chart will be used to show the selection of articles with the reasons for exclusion. The characteristics of the study and the results will be presented in summary tables. The current protocol follows the rules of PRISMA-P [10].
The results will also be disseminated to the research community and key stakeholders through presentations at relevant academic and non-academic meetings and through social media.

Discussion
This is the rst systematic review of sign language interpreter QoL, as far as researched. We hope that this study will contribute to the discussion and creation of public policies as an insertion of protective Page 7/9 means in the work environments of these professionals so that the perception of QoL is positive. Discuss the importance of having a speci c time for continuous interpretation and then a rest aiming at physical and mental recovery and a better quality in performing the work function.
The research will be part of a master's thesis, articles, posters and discussions that may instigate further research on this theme. This systematic review may have limitations, for example, the exclusion of works not published in scienti c journals or presented at scienti c events.