Article Text

Download PDFPDF
Development and validation of a scale for mouth handicap in systemic sclerosis: the Mouth Handicap in Systemic Sclerosis scale
  1. L Mouthon1,*,
  2. F Rannou2,*,
  3. A Bérezné1,
  4. C Pagnoux1,
  5. J-P Arène1,
  6. E Foïs1,
  7. J Cabane3,
  8. L Guillevin1,
  9. M Revel2,
  10. J Fermanian4,
  11. S Poiraudeau2
  1. 1
    Paris-Descartes University, Faculty of Medicine, EA 4058, Department of Internal Medicine, Reference Center for Vasculitides and Systemic Sclerosis, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
  2. 2
    Paris-Descartes University, Department of Rehabilitation, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, INSERM Institut Féderatif de Recherche sur le Handicap (IFR 25), France
  3. 3
    Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris, Saint-Antoine Hospital, Paris 6 University, Paris & Groupe Français de Recherche sur la Sclérodermie, France
  4. 4
    Department of Biostatistics, AP-HP, Necker Hospital, Paris-Descartes University, Paris, France
  1. L Mouthon, Department of Internal Medicine, Cochin Hospital, 27 rue du Faubourg Saint-Jacques, 75679 Paris Cedex 14, France; luc.mouthon{at}


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 = −0.34), 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.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Both authors contributed equally to the work.

  • This work was presented at the 70th ACR/ARHP Annual Scientific Meeting, 10–15 November 2006, Washington, DC, USA.

  • Competing interests: None declared.

  • Abbreviations:
    Cochin Hand Function Scale
    diffuse systemic sclerosis
    Hospital Anxiety and Depression
    Health Assessment Questionnaire
    intraclass coefficient correlation
    limited systemic sclerosis
    McMaster-Toronto Arthritis
    Mouth Handicap in Systemic Sclerosis
    systemic sclerosis