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. 2021 Dec;31(8):1631-1638.
doi: 10.1007/s00590-021-02921-5. Epub 2021 Mar 15.

Cross-cultural adaptation and validation of the Musculoskeletal Tumor Society (MSTS) scoring system and Toronto Extremity Salvage Score (TESS) for musculoskeletal sarcoma patients in Greece

Ioanna K Bolia  1 , Olga D Savvidou  2 , Hyunwoo P Kang  3 , Nikolaos Chatzichristodoulou  2 , Panayiotis D Megaloikonomos  2 , Evanthia Mitsiokapa  2 , Andreas F Mavrogenis  2 , Panayiotis J Papagelopoulos  2
Affiliations

Cross-cultural adaptation and validation of the Musculoskeletal Tumor Society (MSTS) scoring system and Toronto Extremity Salvage Score (TESS) for musculoskeletal sarcoma patients in Greece

Ioanna K Bolia et al. Eur J Orthop Surg Traumatol. 2021 Dec.

Abstract

Purpose: To perform translation, cross-cultural adaptation, and validation of the Toronto Extremity Salvage Score (TESS) and Musculoskeletal Tumor Society (MSTS) scoring system in Greek patients with lower extremity sarcoma.

Methods: The Greek version of the MSTS for the lower extremity and TESS questionnaires was developed using previously reported methods. Included were 100 patients with musculoskeletal sarcoma who underwent limb salvage surgery. The test-retest reliability [interclass correlation coefficient (ICC) between 2 different time points], internal consistency (Cronbach's alpha), construct validity (Kaiser's criteria, Eigenvalue > 1 rule), and external validity (Short form-36, Spearman's Rho) were assessed.

Results: The test-retest reliability (ICC was 0.99 for MSTS-LE and 1 for TESS) and internal consistency were high (Cronbach's alpha was 0.763 for MSTS-LE and 0.924 for TESS) for both questionnaires. Based on the Scree plot, the number of factors retained was 1 for MSTS-LE and 2 for TESS. The TESS showed a strong correlation with SF-36 (Spearman's rho = 0.714, p < 0.001), but the correlation between MSTS for lower extremity and SF-36 was weak (Spearman's Rho = 0.313, p = 0.002).

Conclusions: The Greek version of both the MSTS for lower extremity and TESS questionnaire showed sufficient reliability, internal consistency and good performance using the loading factor analysis when used postoperatively in Greek patients who underwent surgical resection of lower extremity sarcoma. However, only the TESS showed strong correlation with the SF-36, indicating that MSTS for lower extremity was not as powerful for the evaluation of the global health status of these patients.

Keywords: Extremity; Function; MSTS; Patient-reported; Sarcoma; TESS.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Principal factor analysis of the Greek version of TESS: scree plot with eigenvalues of TESS indicating a 2-factor model
Fig. 2
Fig. 2
Factor loading values of the 30 items in the Greek version of TESS questionnaire
Fig. 3
Fig. 3
Principal factor analysis of the Greek version of MSTS-LE: scree plot with eigenvalues of TESS indicating a 1-factor model
See this image and copyright information in PMC

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