Background:The Systemic Sclerosis Quality of Life Questionnaire (SScQoL) has been validated in six European languages.1Previous adaptation into German revealed issues with the dichotomous response structure in 10 items necessitating a review of the tool and further psychometric testing with patients in German speaking countries.Objectives:The aim of this study was to assess the German version of the SScQoL, extend the response structure and test its construct validity using Mokken scale analysis.Methods:This was a mixed methods study involving cognitive debriefing and survey methods. The expert committee extended the response structure of the 10 items from dichotomous to polytomous (4-point) responses: ‘always’, ‘usually’, ‘sometimes’ and ‘never’. In cognitive debriefing, a small convenience sample of patients with SSc completed the new version while ‘thinking aloud’ and commented on relevance of the items and the response structure.Results:In cognitive debriefing, six patients with SSc completed the new German SScQoL and reported problems with the remaining dichotomous items. These were subsequently converted into polytomous 4-point response structure by the expert committee.Conclusion:The German SScQoL has been revised into polytomous item structure and shown to be a valid and reliable measure of health-related quality of life in SSc. Further cross-cultural validity tests are required to assess its measurement equivalence with other SScQoL versions and thus enable multinational comparisons.