Department of Midwifery, Physiotherapy, Occupational Therapy, and Psychomotor Therapy, Faculty of Health, University College Copenhagen, Copenhagen, Denmark.
Musculoskeletal Tumor Section, Department of Orthopedic Surgery, University Hospital Rigshospitalet, Copenhagen, Denmark.
BMC Cancer. 2024 Aug 16;24(1):1019. doi: 10.1186/s12885-024-12686-9.
The Musculoskeletal Tumor Society Score (MSTS) is widely used to evaluate functioning following surgery for bone and soft-tissue sarcoma. However, concerns have been raised about its content validity due to the lack of patient involvement during item development. Additionally, literature reports inconsistent results regarding data quality and structural validity. This study aimed to evaluate content, structural and construct validity of the Danish version of the MSTS for lower extremity (MSTS-LE).
The study included patients from three complete cohorts (n = 87) with bone sarcoma or giant cell tumour of bone who underwent bone resection and reconstruction surgery in hip and knee. Content validity was evaluated by linking MSTS items to frameworks of functioning, core outcome sets and semi-structured interviews. Data quality, internal consistency and factor analysis were used to assess the underlying structure of the MSTS. Construct validity was based on predefined hypotheses of correlation between the MSTS and concurrent measurements.
Content validity analysis revealed concerns regarding the MSTS. The MSTS did not sufficiently cover patient-important functions, the item Emotional acceptance could not be linked to the framework of functioning, the items Pain and Emotional acceptance pertained to domains beyond functioning and items' response options did not match items. A two-factor solution emerged, with the items Pain and Emotional acceptance loading highly on a second factor distinct from functioning. Internal consistency and construct validity showed values below accepted levels.
The Danish MSTS-LE demonstrated inadequate content validity, internal consistency, and construct validity. In addition, our analyses did not support unidimensionality of the MSTS. Consequently, the MSTS-LE is not a simple reflection of the construct of functioning and the interpretation of a sum score is problematic. Clinicians and researcher should exercise caution when relying solely on MSTS scores for assessing lower extremity function. Alternative outcome measurements of functioning should be considered for the evaluation of postoperative function in this patient group.
肌肉骨骼肿瘤学会评分（MSTS）广泛用于评估骨和软组织肉瘤手术后的功能。然而，由于在项目开发过程中缺乏患者参与，人们对其内容效度提出了质疑。此外，文献报告了数据质量和结构效度方面的不一致结果。本研究旨在评估丹麦版下肢 MSTS（MSTS-LE）的内容、结构和构念效度。
该研究纳入了来自三个完整队列（n=87）的患者，这些患者患有骨肉瘤或骨巨细胞瘤，接受了髋关节和膝关节的骨切除和重建手术。内容效度通过将 MSTS 项目与功能框架、核心结局集和半结构化访谈联系起来进行评估。数据质量、内部一致性和因子分析用于评估 MSTS 的潜在结构。构念效度基于 MSTS 与同期测量之间相关性的预设假设。
内容效度分析显示 MSTS 存在问题。MSTS 没有充分涵盖患者重要的功能，项目“情感接受”无法与功能框架联系起来，项目“疼痛”和“情感接受”涉及功能以外的领域，并且项目的反应选项与项目不匹配。出现了一个两因素解决方案，其中疼痛和情感接受这两个项目在一个与功能不同的第二个因素上高度加载。内部一致性和构念效度显示值低于可接受水平。
丹麦 MSTS-LE 表现出内容效度、内部一致性和构念效度不足。此外，我们的分析不支持 MSTS 的单维性。因此，MSTS-LE 不能简单地反映功能的构建，总分的解释存在问题。临床医生和研究人员在依赖 MSTS 评分评估下肢功能时应谨慎。对于评估该患者群体术后功能，应考虑使用替代功能测量方法。
