Development and validation of a scale for mouth handicap in systemic sclerosis: the Mouth Handicap in Systemic Sclerosis scale

Abstract

Objective: To develop and assess the reliability and construct validity of a scale assessing disability involving the mouth in systemic sclerosis (SSc). Methods: We generated a 34-item provisional scale from mailed responses of patients (n = 74), expert consensus (n = 10) and literature analysis. A total of 71 other SSc patients were recruited. The test-retest reliability was assessed using the intraclass coefficient correlation and divergent validity using the Spearman correlation coefficient. Factor analysis followed by varimax rotation was performed to assess the factorial structure of the scale. Results: The item reduction process retained 12 items with 5 levels of answers (total score range 0-48). The mean total score of the scale was 20.3 (SD 9.7). The test-retest reliability was 0.96. Divergent validity was confirmed for global disability (Health Assessment Questionnaire (HAQ), r = 0.33), hand function (Cochin Hand Function Scale, r = 0.37), inter-incisor distance (r = 20.34), handicap (McMaster-Toronto Arthritis questionnaire (MACTAR), r = 0.24), depression (Hospital Anxiety and Depression (HAD); HADd, r = 0.26) and anxiety (HADa, r = 0.17). Factor analysis extracted 3 factors with eigenvalues of 4.26, 1.76 and 1.47, explaining 63% of the variance. These 3 factors could be clinically characterised. The first factor (5 items) represents handicap induced by the reduction in mouth opening, the second (5 items) handicap induced by sicca syndrome and the third (2 items) aesthetic concerns. Conclusion: We propose a new scale, the Mouth Handicap in Systemic Sclerosis (MHISS) scale, which has excellent reliability and good construct validity, and assesses specifically disability involving the mouth in patients with SSc.

Recommendations for the care of oral involvement in patients with systemic sclerosis

“…Mouth-related disability can be assessed by the MHISS scale, which is reliable and has good construct validity. The 3 factors extracted from the scale represent handicap induced by reduced mouth opening, sicca syndrome, and aesthetic concerns that altogether contribute 63% of the total variance in handicap (16). With these data, mouthrelated disability contributes to 35% of the variance in global disability as assessed by the Health Assessment Questionnaire (16).…”

“…Therefore, patients often experience aesthetic concerns with skin sclerosis and telangiectasia, diminished mouth opening, altered dentition, difficulties during dental sur-gery and/or dry mouth. Mouth-related disability can be assessed by the Mouth Handicap in Systemic Sclerosis (MHISS) scale (16). Interestingly, factor analysis of this scale extracted 3 factors representing handicap induced by reduced mouth opening, sicca syndrome, and aesthetic concerns (16).…”

“…Mouth-related disability can be assessed by the Mouth Handicap in Systemic Sclerosis (MHISS) scale (16). Interestingly, factor analysis of this scale extracted 3 factors representing handicap induced by reduced mouth opening, sicca syndrome, and aesthetic concerns (16). These data are directly associated with the 3 main problems dentists face in caring for patients with SSc: 1) oral mucosa involvement and ulcerations associated with dry mouth; 2) manducatory apparatus involvement responsible for dysphagia, retraction of lips, perioral streaks, and limitation in mouth opening; and 3) treatment-related adverse events (17).…”

The rehabilitation of facial involvement in systemic sclerosis: efficacy of the combination of connective tissue massage, Kabat’s technique and kinesitherapy: a randomized controlled trial

“…The functional involvement of face and mouth was assessed by the Mouth Handicap in Systemic Sclerosis (MHISS) scale [28] [29].…”

Chirurgie implantaire et sclérodermie systémique (ScS) : à propos d’un cas suivi sur 5 ans

“…1). Des lésions endo-parodontales profondes sur les dents 12,13,21,22,26,36,46 (Fig. 2), avec mobilités dentaires de stade III (classification de Mülheman), étaient observées.…”