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The 88-item Multiple Sclerosis Spasticity Scale: a Rasch validation of the Italian version and suggestions for refinement of the original scale

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Abstract

Background

In multiple sclerosis (MS), the impact of spasticity on the patient’s life is a key issue, and it is fundamental that existing tools measuring the patient’s perspective undergo psychometric analysis and refinement to optimize confidence in their use in clinical practice and research.

Objective

We examined—by Rasch analysis (RA)—the main metric characteristics of the 88-item Multiple Sclerosis Spasticity Scale (MSSS-88) to: (i) further validate its Italian version (MSSS-88-IT), previously validated through classical test theory methods only and (ii) independently verify the measurement properties of the original scale.

Methods

MSSS-88 data from a convenience sample of 232 subjects with MS underwent RA, mainly examining item fit, reliability indices, test information function, dimensionality, local item independence, and differential item functioning (DIF).

Results

Most items fitted the Rasch model, but 13/88 items showed a misfit in infit and/or outfit values. Rasch reliability indices were high (> 0.80). Test information functions in most subscales showed a sharp decrease in measurement precision as the ability level departs from the quite limited central range of maximal information. The unidimensionality of each subscale was confirmed. Thirteen item pairs showed local dependency (residual correlations > 0.30) and three items presented DIF.

Conclusion

Reliability, dimensionality and some internal construct validity characteristics of the MSSS-88-IT were confirmed. But, drawbacks of the original MSSS-88 emerged related to some item misfit, redundancy, or malfunctioning. Thus, further large independent studies are recommended, to verify the robustness of previous findings and examine the appropriateness of a few targeted item replacements.

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Acknowledgements

This paper is based on research conducted by LP and MO during their PhD program in “Advanced Sciences and Technologies in Rehabilitation Medicine and Sports”, at the University of Rome “Tor Vergata”, Rome, Italy. They express special thanks to Prof. Calogero Foti and Prof. Diego Centonze for their helpful support in the PhD theses.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Unit of Functional Rehabilitation, Azienda USL Toscana Centro, Via Rozzalupi, 57, 50053, Empoli, FI, Italy

    Leonardo Pellicciari

  2. Department of Physical & Rehabilitation Medicine, ICS Maugeri SpA SB, Via Missolungi, 14, 16167, Nervi, GE, Italy

    Marcella Ottonello

  3. Bioengineering Service, ICS Maugeri SpA SB, Via Revislate, 13, 28010, Veruno, NO, Italy

    Andrea Giordano

  4. Specialty School in Physical and Rehabilitation Medicine, Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, Viale Montpellier, 1, 00133, Rome, Italy

    Caterina Albensi

  5. Department of Physical Medicine and Rehabilitation, ICS Maugeri SpA SB, Via Bernasconi 16, 20035, Lissone, MB, Italy

    Franco Franchignoni

Authors
  1. Leonardo Pellicciari
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  2. Marcella Ottonello
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  3. Andrea Giordano
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  4. Caterina Albensi
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  5. Franco Franchignoni
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Correspondence to Leonardo Pellicciari.

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Pellicciari, L., Ottonello, M., Giordano, A. et al. The 88-item Multiple Sclerosis Spasticity Scale: a Rasch validation of the Italian version and suggestions for refinement of the original scale. Qual Life Res 28, 221–231 (2019). https://doi.org/10.1007/s11136-018-2005-2

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