Translation, validation and cross‐cultural adaptation of the mouth handicap in systemic sclerosis questionnaire into the Turkish language

Abstract

Aim: The aim of this study was to translate and adapt the Mouth Handicap in Systemic Sclerosis (MHISS) Questionnaire into the Turkish language and evaluate its validity and reliability in Turkish systemic sclerosis (SSc) patients. Method: The MHISS was translated according to Beaton guidelines. Patients being diagnosed with SSc, being between 18-65 years old and receiving no treatment between test-retest assessments were included to study. Test-retest reliability was evaluated, comparing the results of two administrations, with Spearman's correlation. Internal consistency was assessed by Cronbach's α. Validity of the questionnaire was assessed by comparison with mouth opening, total scores of Disabilities of Arm, Shoulder and Hand Questionnaire (DASH) and Health Assessment Questionnaire (HAQ). Construct validity was tested by factor analysis. Results: Forty-five SSc patients were included in the study. The Turkish version of the MHISS (MHISS-T) met set criteria of reliability and validity. Internal consistency (Cronbach's α = 0.863) and test-retest reliability were excellent (r = .88). The correlations between MHISS-T and inter-incisor distance, MHISS-T and HAQ and MHISS-T and DASH were negatively and statistically significant (r = −0.739, P < .001), very good and statistically significant (r = .664, P < .001), good and statistically significant (r = .570, P < .001), respectively. Regarding factor analysis, MHISS-T has three subscales. Conclusion:Our results demonstrated that the Turkish version of the MHISS-T has excellent test-retest reliability and very good validity. As a result of this study we determined that MHISS-T is a valid and reliable instrument to measure mouth disabilities in Turkish-speaking SSc patients. K E Y W O R D S disability, mouth, questionnaire, systemic sclerosis, Turkish version

The reliability and validity of the Arabic version of the Mouth Handicap in Systemic Sclerosis (MHISS) Questionnaire in Arabian systemic sclerosis patients

“…We studied the external validity of the Arabic version of MHISS, and there was a significant negative correlation with mouth opening (r = − 0.512, p < 0.05) indicating the value of MHISS in assessing the decreased mouth opening and the related oral health complications in SSc patients. This correlation was similar to the results of the original French [11], Italian [18], Dutch [19], and Turkish [20] versions of MHISS, where they reported a significant correlation of the total MHISS and the mouth opening (r = 0.34, − 0.38, − 0.51, − 0.73, respectively). Moreover, in our study of the validity of the MHISS and the oral xerostomia measured on the VAS scale (0-10), there was a significant positive correlation (r 0.577, p < 0.001), which was again similar to the results of the Dutch version of MHISS, where they found a positive correlation with subjective xerostomia (r = 0.53, p < 0.001) [19].…”

“…Test-retest reliability analysis of the Arabic version gave ICC of 0.99 which is almost similar to the original French (0.96) [11], Italian (0.93) [18], Dutch (0.94) [19], and Turkish (0.88) [20] versions of MHISS, which indicates that the tested items within the questionnaire are stable.…”

“…Moreover, in our study of the validity of the MHISS and the oral xerostomia measured on the VAS scale (0-10), there was a significant positive correlation (r 0.577, p < 0.001), which was again similar to the results of the Dutch version of MHISS, where they found a positive correlation with subjective xerostomia (r = 0.53, p < 0.001) [19]. However, there was no correlation with HAQ-DI (r = 0.11, p > 0.05) which is following the previous Italian validation study, where they found no correlation between MHISS and HAQ [18], in contrast to the original French [11], Dutch [19], and Turkish [20] versions which showed a positive correlation with HAQ. The lack of correlation between MHISS and HAQ-DI in our study is accepted as the MHISS measures of health aspects not assessed with HAQ, such as reduced mouth opening, dryness of the mouth, as well as aesthetic features which are the main OHRQol in SSc patients.…”

“…On testing the internal consistency of the Arabic version of MHISS questionnaire with Cronbach's α values, they were 0.892 for the total score and 0.854, 0.905, and 0.888 for subscales 1, 2, and 3, respectively, which is in great consistency with the Dutch version, where their values were 0.88 for the total score and 0.86 and 0.79 for subscales 1 and 2, respectively [19]. Our values were near to the values of the Italian version [18], as they reported that Cronbach's α value was 0.99 for the total score, while the Turkish version reported the Cronbach's α values were 0.86 for the total score and 0.92, 0.905. and 0.78 for the subscales 1, 2, and 3, respectively [20]. These data recorded from different versions indicate that the items are consistent even with translation.…”

“…Eighteen patients (47.4 %) have diffuse SSc, while 20 patients (52.6%) have localised SSc. The mean of the total MHISS score was 12.21 ± 3.51, which is less than that of other studies, where the scores for the original French, Italian, Dutch, and Turkish versions of MHISS were 18.8 ± 10.2, 17.65 ± 5.20, 20.3 ± 9.7, and 22.4 ± 10.72, respectively [11,[18][19][20]. This could be due to ethnic variance especially that the tested patients are of different ethnic groups, yet all are Arabian, or due to climate difference; however, there are no studies that showed the climate influence on the MHISS score.…”