Validation of the Danish version of the musculoskeletal tumour society score questionnaire

BACKGROUND The musculoskeletal tumour society score(MSTS) is a well-known questionnaire for measuring functional outcome in patients with neoplasms in the extremities.Standardized guidelines for cross-cultural translation and validation ensure the equivalence of content between the original and translated versions. The translation and validation provide the possibility to compare different sarcoma populations on an international level. This study is based on the hypothesis that the Danish MSTS questionnaire is a valid tool for measuring the end result after surgery for neoplasms in the extremities.AIM To validate the Danish version of the upper and lower extremity version of the MSTS.METHODS The translation of the MSTS was conducted in accordance with international guidelines. Patients operated for sarcomas and aggressive benign tumors were invited to participate in the study. The psychometric properties of the Danish version of the MSTS were tested in terms of validity and reliability and for the risk of floor or ceiling effect. Spearman's rank coefficient was used to test the validity by comparing with the Toronto Extremity Salvage Score(TESS). The Intraclass Correlation Coefficient(ICC) was used to evaluate inter-rater reliability. Cronbach's alpha was used to test for internal consistency. Spearman's rank coefficient was used to compare the MSTS lower extremity version with the objective test, Timed Up and Go(TUG).RESULTS The upper extremity version demonstrated an ICC of 0.95 in the inter-rater reliability test. The lower extremity version had an ICC of 0.88 in the inter-rater reliability test, respectively. Both MSTS versions showed a ceiling effect. Thevalidity of the MSTS was measured by Spearman's rank correlation coefficient by comparing the MSTS with the TESS and found it to be of 0.80(P < 0.01) and 0.83(P < 0.01) for the upper extremity and lower extremity version, respectively. A Spearman's rank correlation coefficient of-0.26(P < 0.01) was found between the TUG and the MSTS questionnaire. A Spearman's rank correlation coefficient of-0.38(P < 0.01) was found between the TUG and the lower extremity version of the TESS questionnaire.CONCLUSION The Danish version of the MSTS questionnaires were found to have good reliability and validity, however a substantial ceiling effect was identified.

Is there consensus regarding surgical treatment of bone sarcomas?

AIM To perform an Internet based survey on the surgical management of bone sarcomas in the lower extremity amongst sarcoma surgeons. METHODS All orthopedic surgical members of the Scandinavian Sarcoma Group were invited to participate in an online questionnaire. The questionnaire consisted of a clinical case involving resection of a malignant bone tumor. Several questions were asked, subdivided into categories. Among these, surgical/technical considerations, e.g., choice of implant; choice of antibiotics, dosage, and duration of treatment, choice of antithrombotic drug, initial start-up, dosage, and duration were included.RESULTS In terms of choice of implant fixation, the majority of surgeons preferred an uncemented prosthesis in younger patients until the age of 50. All participants administer intravenous prophylactic antibiotics for endoprosthetic reconstructive surgery. First choice of antibiotics was cephalosporin. Less common used was glycopeptide, penicillin, or a combination. Duration of prophylactic antibiotics ranged from less than one day to more than four days. All participants used low molecular weight heparins as antithrombotic prophylaxis and 55% of the participants answered that initial treatment was started preoperatively, 3% perioperatively and 42% postoperatively. Duration of the antithrombotic treatment ranged from five days to more than twenty-eight days.CONCLUSION The use of resection prosthesis in the treatment of bone sarcomas is a well-established procedure. However, therse is a significant discrepancy in the surgical treatment algorithm between the sarcoma centers. Still the treatment is mainly based on best clinical practice,due to the lack of evidence-based medicine in the surgical management of bone sarcomas.