title: Validation of the Brazilian version of the musculoskeletal tumor society rating scale for lower extremity bone sarcoma.
abstract: BACKGROUND
  The Musculoskeletal Tumor Society (MSTS) rating scale is an English-language instrument used worldwide to assess functional evaluation of patients with musculoskeletal cancer. Despite its use in several studies in English-speaking countries, its validity for assessing patients in other languages is unknown. The translation and validation of widely used scales can facilitate the comparison across international patient samples.
  
  
  OBJECTIVE
  The objectives of this study were (1) to translate and culturally adapt the MSTS rating scale for functional evaluation in patients with lower extremity bone sarcomas to Brazilian Portuguese; (2) analyze its factor structure; and (3) test the reliability and (4) validity of this instrument.
  
  
  METHODS
  The MSTS rating scale for lower limbs was translated from English into Brazilian Portuguese. Translations were synthesized, translated back into English, and reviewed by a multidisciplinary committee for further implementation. The questionnaire was administered to 67 patients treated for malignant lower extremity bone tumors who were submitted to limb salvage surgery or amputation. They also completed a Brazilian version of the Toronto Extremity Salvage Score (TESS). Psychometric properties were analyzed including factor structure analysis, internal consistency, interobserver reliability, test-retest reliability, and construct validity (by comparing the adapted MSTS with TESS and discriminant validity).
  
  
  RESULTS
  The MSTS rating scale for lower limbs was translated and culturally adapted to Brazilian Portuguese. The MSTS-BR proved to be adequate with only one latent dimension. The scale was also found to be reliable in a population that speaks Brazilian Portuguese showing good internal consistency (Cronbach's alpha = 0.84) and reliability (test-retest reliability and interobserver agreement of 0.92 and 0.98, respectively). Validity of the Brazilian MSTS rating scale was proved by moderate with TESS and good discriminant validity.
  
  
  CONCLUSIONS
  The Brazilian version of the MSTS rating scale was translated and validated. It is a reliable tool to assess functional outcome in patients with lower extremity bone sarcomas. It can be used for functional evaluation of Brazilian patients and crosscultural comparisons.
authors.affiliation: Department of Orthopaedics, University of São Paulo, Rua Dr. Ovídio Pires de Campos, 333, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil, danirebolledo@gmail.com.
authors.forename: Daniel Cesar Seguel
authors.initials: DC
authors.lastname: Rebolledo
authors.forename: João Ricardo Nickenig
authors.initials: JR
authors.lastname: Vissoci
authors.forename: Ricardo
authors.initials: R
authors.lastname: Pietrobon
authors.forename: Olavo Pires
authors.initials: OP
authors.lastname: de Camargo
authors.forename: Andre Mathias
authors.initials: AM
authors.lastname: Baptista
mesh_terms: D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000175:diagnosis* / Q000523:psychology / Q000601:surgery; D001938:Brazil; D004185:Disability Evaluation; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012516:Osteosarcoma / Q000175:diagnosis* / Q000523:psychology / Q000601:surgery; D011594:Psychometrics; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D014177:Translations
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