Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jan 18, 2019; 10(1): 23-32
Published online Jan 18, 2019. doi: 10.5312/wjo.v10.i1.23
Validation of the Danish version of the musculoskeletal tumour society score questionnaire
Casper Kloster Pingel Saebye, Johnny Keller, Thomas Baad-Hansen
Casper Kloster Pingel Saebye, Johnny Keller, Thomas Baad-Hansen, Sarcoma Centre of Aarhus University Hospital, Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus N 8200, Denmark
Author contributions: Saebye CKP collected the majority of the data; Saebye CKP, Keller J and Baad-Hansen T designed the study and analyzed the data; Saebye CKP, Keller J and Baad-Hansen T wrote the manuscript.
Institutional review board statement: The study was preapproved in accordance with the national ethical guidelines, since this type of study does not require approval in Denmark, furthermore the study is in accordance with the Helsinki Declaration.
Informed consent statement: All patients gave their verbally informed consent for participating in the study, however signed consent was not required according to Danish guidelines, since the study was based on questionnaires.
Conflict-of-interest statement: All authors declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Casper Kloster Pingel Saebye, MD, PhD, Doctor, Sarcoma Centre of Aarhus University Hospital, Department of Orthopedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, Aarhus N 8200, Denmark. caspersaebye@clin.au.dk
Telephone: +45-78450000
Received: August 24, 2018
Peer-review started: August 24, 2018
First decision: October 4, 2018
Revised: December 1, 2018
Accepted: December 12, 2018
Article in press: December 13, 2018
Published online: January 18, 2019
Processing time: 147 Days and 14.9 Hours
ARTICLE HIGHLIGHTS
Research background

The musculoskeletal tumour society score (MSTS) questionnaire is a physician/patient-completed questionnaire designed to assess functional outcome for patients with sarcomas in the extremities. The MSTS questionnaire was originally developed in English. Over the past decades there has been increased focus on the aptness of questionnaires to measure correctly. This also includes the aptness of questionnaires after being translated from one language to another.

Research motivation

To ensure that the Danish version of the MSTS questionnaire measures the same aspects of functional outcome in sarcoma patients as the English version, it is important to validate the measurement properties of the Danish version of the MSTS questionnaire and compare it to other language versions of the questionnaire. Furthermore, cultural differences need to be considered during the translation process, as this is a part of ensuring the original measurement properties. This rigorous process provides the possibility to compare results from national studies with other international studies.

Research objectives

The objectives of this study were: (1) to validate the Danish version of the MSTS questionnaire; and (2) to investigate the correlation between functional outcomes as measured by questionnaires, such as the MSTS, and the objective measurement, Timed Up and Go (TUG).

Research methods

The translation of the MSTS was conducted in accordance with international guidelines. Patients, age 18 or above, operated for sarcomas and aggressive benign tumors were consecutively invited to participate in the study. The psychometric properties of the Danish version of the MSTS were tested in terms of validity and reliability and for the risk of floor or ceiling effects. Spearman’s rank coefficient was used to compare the MSTS lower extremity version with the objective test, TUG.

Research results

The upper extremity version of the MSTS questionnaire demonstrated an excellent intra- and inter-rater reliability. The lower extremity version of the MSTS questionnaire showed an excellent intra- and inter-rater reliability. A ceiling effect, however, was found in both versions. Both versions of MSTS questionnaire were shown to have good validity. The MSTS questionnaire showed a possible presence of a measurement error. A poor correlation was found between the objective measurement, TUG, and the functional outcome measured by questionnaires.

Research conclusions

The Danish version of the MSTS questionnaire was found to have good reliability and validity, however a substantial ceiling effect as well as the possibility of measurement error were identified. The Danish version of the MSTS questionnaire can be used to measure functional outcome in sarcoma patients and to compare these results with other international studies.

Research perspectives

The measurement errors and ceiling effects are concerns which are not to be overlooked. It is highly recommendable to further investigate these issues and the measurement properties of the MSTS questionnaires, such as its aptness in detecting significant clinical changes in the functional outcome.