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The medial tibial stress syndrome score: a new patient-reported outcome measure
  1. Marinus Winters1,
  2. Maarten H Moen2,3,
  3. Wessel O Zimmermann4,5,
  4. Robert Lindeboom6,
  5. Adam Weir7,
  6. Frank JG Backx1,
  7. Eric WP Bakker6
  1. 1Department of Rehabilitation, Nursing Science & Sports, University Medical Centre Utrecht, Utrecht, The Netherlands
  2. 2Bergman Clinics, Naarden, The Netherlands
  3. 3The Sports Physician Group, St Lucas Andreas Hospital, Amsterdam, The Netherlands
  4. 4Department of Training Medicine and Training Physiology, Royal Netherlands Army, Utrecht, The Netherlands
  5. 5Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
  6. 6Division of Clinical Methods and Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
  7. 7Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
  1. Correspondence to Marinus Winters, Department of Rehabilitation, Nursing Science & Sports, University Medical Centre Utrecht, P.O. Box 85500, Utrecht 3508 GA, The Netherlands; marinuswinters{at}


Background At present, there is no validated patient-reported outcome measure (PROM) for patients with medial tibial stress syndrome (MTSS).

Aim Our aim was to select and validate previously generated items and create a valid, reliable and responsive PROM for patients with MTSS: the MTSS score.

Methods A prospective cohort study was performed in multiple sports medicine, physiotherapy and military facilities in the Netherlands. Participants with MTSS filled out the previously generated items for the MTSS score on 3 occasions. From previously generated items, we selected the best items. We assessed the MTSS score for its validity, reliability and responsiveness.

Results The MTSS score was filled out by 133 participants with MTSS. Factor analysis showed the MTSS score to exhibit a single-factor structure with acceptable internal consistency (α=0.58) and good test–retest reliability (intraclass correlation coefficient=0.81). The MTSS score ranges from 0 to 10 points. The smallest detectable change in our sample was 0.69 at the group level and 4.80 at the individual level. Construct validity analysis showed significant moderate-to-large correlations (r=0.34–0.52, p<0.01). Responsiveness of the MTSS score was confirmed by a significant relation with the global perceived effect scale (β=−0.288, R2=0.21, p<0.001).

Conclusions The MTSS score is a valid, reliable and responsive PROM to measure the severity of MTSS. It is designed to evaluate treatment outcomes in clinical studies.

  • Evaluation
  • Shin splints
  • Reliability
  • Observational study

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