Reliability and Validity of the Persian Version of Multiple Sclerosis Spasticity Scale in Iranian Patients with Multiple Sclerosis

Document Type : Original Article


1 M.Sc. Student of Physiotherapy. Muscloskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

2 Ph.D Student of Physiotherapy. Department of Physiotherapy, Muscloskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

3 Assistant Professor of Physiotherapy.Department of Physiotherapy, Rehabilitation School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

4 Associate Professor of Physiotherapy. Department of Physiotherapy, Rehabilitation School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

5 Associate Professor of Physiotherapy. Department of Physiotherapy, Paramedical School, Mashhad University of Medical Sciences, Mashhad, Iran.

6 Associate Professor of Neurology. Department of Neurology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.


Background and Objective: The aims of this study was to culturally adapt and validate the Persian-version of the Multiple Sclerosis Spasticity Scale and to present data on its psychometric properties in a sample of Iranian patients with multiple sclerosis.
Subjecrs and Methods: After standard forward and backward translations, 92 patients with MS completed the Persian versions of the MSSS-88 and MSQoL-54 in the first visit. With time interval of 2 days after the first visit, 40 patients filled out the MSSS-88 in the second visit. Test-retest reliability and internal consistency were assessed using intraclass correlation coefficient (ICC) and Cronbach's α coefficient, respectively. To evaluate construct validity of MSSS-88 compared to similar concepts of MSQoL-54, the spearman's rank correlation was used.
Results: MSSS-88 has a high ICC level. The minimum Cronbach's alpha level of 0.70 was exceeded by MSSS-88. In terms of construct validity, most of a priori hypotheses were confirmed.
Conclusion: These results demonstrate the the Persian-version of the MSSS-88 is a culturally-adapted, reliable and valid measure in Iranian patients with Multiple Sclerosis.


1-DeBolt LS, McCubbin JA. The effects of home-based resistance exercise on balance, power, and mobility in adults with multiple sclerosis. Archive of Physical and Medical Rehabilitation 2004; 85:290-297.
2-Ghaem H, Haghighi AB, Jafari P, Nikseresht AR. Validity and reli­ability of the Persian version of the Multiple Sclerosis Quality of Life questionnaire. Neurol India. 2007;55:369–375.
3-Peter W Thomas, Sarah Thomas, Paula Kersten, Rosemary Jones, Alison  Nock, Vicky Slingshy, et al. Multi- centre parallel arm randomi zed controlled trial to assess the effectiveness and cost-effectiveness of a group-based cognitive behavioral approach to managing fatigue in people with multiple sclerosis. BMC Neurology2010; 10: 43.
4-Aymerich Marta, Guillamon Imma, Jovell Albert J. Health-related quality of life assessment in people with multiple sclerosis and their family caregivers. A multicenter study in catalonia (southern Europe). Dove press 2009: 3: 311-321.
5-Gutierrez GM, Chow JW, Tillman MD, McCoy SC, Castellano V, White LJ. Resistance Training Improve Gait Kinematics in Persons With Multiple Sclerosis. Arch Phys Med Rehabil 2005;86:1824-9.
6-Barten Laurie J, Allington Douglas R, Procacci Kendra A, Rivey Michael P. New approaches in the management of multiple sclerosis. Dove Press 2010; 4: 343-366.
7-de Seze J, Borgel F, Brudon F Patient perceptions of multiple sclerosis and its treatment . Patient Prefer Adherence. 2012;6:263-73.
8-Hobart JC, Riazi A, Thompson AJ, Styles IM, Ingram W, Vickery PJ et al., Getting that measure of spasticity in multiple sclerosis: The Multiple Sclerosis Spasticity Scale (MSSS-88), Brain 129 (2006), 224–234.
9-Pappalardo A, Castiglione A, Restivo D.A, calabrese A, Cimino V, Patti F. Pharmacologic management of spasticity in multiple sclerosis. Neurol Sci 2006; 27: s310-s315.
10-Balantrapu S, Sandroff BM, Sosnoff JJ, Motl RW. Perceived impact of spasticity is associated with spatial and temporal parameters of gait in multiple sclerosis. Neurol. 2012; 2012:675431.
11-Pynsent PB. Choosing an outcome measure. J Bone Joint Surg Br 2001;83:792e4.
12-Crossley KM, Bennell KL, Cowan SM, Green S. Analysis of outcome measures for persons with patellofemoral pain: which are reliable and valid? Arch Phys Med Rehabil 2004;85:815-22.
13-Marx RG, Jones EC, Allen AA, Altchek DW, O’Brien SJ, Rodeo SA, et al. Reliability, validity, and responsiveness of four knee outcome scales for athletic patients. J Bone Joint Surg Am 2001;83-A: 1459–1469.
14-Beaton DE, Bombardier C, Guillemin F,  Bosi Ferraz M. Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures. Spine 2000;25(24): 3186–3191.
15-Bullinger M, Alonso J, Apolone G, Leplège A, Sullivan M, Wood-Dauphine S, et al. Translating health status questionnaires and evaluating their quality: The IQOLA Project approach. J Clin Epidemiol 1998; 51(11): 913–923.
16-Negahban H, Mazaheri M, Salavati M, et al. Reliability and validity of the foot and ankle outcome score: a validation study from Iran. Clin Rheumatol 2010; 29: 479-86.
17-Henze T, von Mackensen S, Lehrieder G, Zettl UK, Pfiffner C, Flachenecker P. Linguistic and psychometric validation of the MSSS-88 questionnaire for patients with multiple sclerosis and spasticity in Germany. Health and quality of life outcomes. 2014 Aug 1;12(1):1.
18-Rodic SZ, Knezevic TI, Kisic-Tepavcevic DB, Dackovic JR, Dujmovic I, Pekmezovic TD, Drulovic JS, Konstantinovic LM. Validation of the Serbian Version of Multiple Sclerosis Spasticity Scale 88 (MSSS-88). PLoS One. 2016 Jan 1;11(1).