Abstract
The Musculoskeletal Tumor Society (MSTS) scoring system developed in 1993 is a widely used disease-specific evaluation tool for assessment of physical function in patients with musculoskeletal tumors; however, only a few studies have confirmed its reliability and validity. The aim of this study was to validate the MSTS scoring system for the upper extremity (MSTS-UE) in Japanese patients with musculoskeletal tumors for use by others in research. Does the MSTS-UE have: (1) sufficient reliability and internal consistency; (2) adequate construct validity; and (3) reasonable criterion validity in comparison to the Toronto Extremity Salvage Score (TESS) or SF-36? Reliability was performed using test-retest analysis, and internal consistency was evaluated with Cronbach's alpha coefficient. Construct validity was evaluated using a scree plot to confirm the construct number and the Akaike information criterion network. Criterion validity was evaluated by comparing the MSTS-UE with the TESS and SF-36. The test-retest reliability with intraclass correlation coefficient (0.95; 95% CI, 0.91-0.97) was excellent, and internal consistency with Cronbach's α (0.7; 95% CI, 0.53-0.81) was acceptable. There were no ceiling and floor effects. The Akaike Information Criterion network showed that lifting ability, pain, and dexterity played central roles among the components. The MSTS-UE showed substantial correlation with the TESS scoring scale (r = 0.75; p < 0.001) and fair correlation with the SF-36 physical component summary (r = 0.37; p = 0.007). Although the MSTS-UE showed slight correlation with the SF-36 mental component summary, the emotional acceptance component of the MSTS-UE showed fair correlation (r = 0.29; p = 0.039). We can conclude that the MSTS is not an adequate measure of general health-related quality of life; however, this system was designed mainly to be a simple measure of function in a single extremity. To evaluate the mental state of patients with musculoskeletal tumors in the upper extremity, further study is needed.
Highlights
The humerus is the third-most-common site for primary bone tumors such as osteosarcoma or Ewing’s sarcoma [25], and soft tissue sarcomas such as liposarcoma or angiosarcoma arise in the upper extremity, especially the upper arm
Surgical procedures for the upper extremity should take into account different factors than do procedures for the lower extremity; for example, in the upper extremity, retention of precise movement may be more important than massive muscle power, which is more important for lower extremity tumor resections
The aim of our study was to perform a validation analysis of the Musculoskeletal Tumor Society (MSTS)-UE in Japanese patients with musculoskeletal tumors of the upper extremity from the viewpoint of psychometric characteristics; we sought to evaluate whether the MSTS scoring system for the upper extremity (MSTS-UE) has (1) sufficient reliability and internal consistency; (2) adequate construct validity; and (3) reasonable criterion validity in comparison to the Toronto Extremity Salvage Score (TESS) or SF-36
Summary
The humerus is the third-most-common site for primary bone tumors such as osteosarcoma or Ewing’s sarcoma [25], and soft tissue sarcomas such as liposarcoma or angiosarcoma arise in the upper extremity, especially the upper arm. The Musculoskeletal Tumor Society (MSTS) scoring system developed in 1993, which is completed by a member of the treatment team (rather than the patient, and so is not considered a patient-reported outcomes tool), was designed to measure functional outcome and quality of life after treatment for musculoskeletal tumors. It was developed in 1985 [7] and revised in 1993 [8]. Society (MSTS) scoring system developed in 1993 is a widely used disease-specific evaluation tool for assessment of physical function in patients with musculoskeletal tumors; only a few studies have confirmed its reliability and validity. This work was performed at The University of Tokyo Hospital, Tokyo, Japan
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