Development

Development followed international guidelines for quality of life scales

The original MRS was designed to provide physicians with a scale that documented changes in climacteric symptoms during treatment ¹.  Initital feedback from women suggested that the initial scale did not accurately capture sensitive information, limiting both its theorectical and practical use ². Subsequent revisions of the scale incorporated the the following key points:

• scale verification in a representative population
• development of a patient-reported outcome questionnaire that sensitively addresses sexual-health symptoms unlikely to be divulged to medical professionals
• modification of the scale so that it can be understood by consumers (laypersons)
• psychometric analysis of the collected data and development of simple-to-use evaluation aids,
• provision of a classification of complaints derived from an examination of the normal population, e.g. for comparisons with special patient groups.

The MRS was formally standardized according to psychometric rules. It consists of a list of 11 symptoms; respondent have a choice among 5 categories: no symptom, mild, moderate, marked, and severe.

During the standardization of the MRS, three independent dimensions were identified explaining 58.8% of the total variance (factor analysis): psychological, somato-vegetative, and urogenital sub-scale.

Each of the eleven symptoms contained in the scale can get 0 (no symptom) or up to 4 scoring points (severe symptom) depending on the severity of the complaints perceived by the women completing the scale (an appropriate box is to be ticked). The total score of the MRS ranges between 0 (asymptomatic) and 44 (highest degree of complaints). The minimal/maximal scores vary between the three dimensions depending on the number of complaints allocated to the respective dimension of symptoms:

• sychological sub-scale
• somato-vegetative domain
• urogenital domain

A simple evaluation and scoring scheme

Evaulation and scoring is straightforward: the score increases point by point with increasing severity of subjectively perceived complaints in each of the 11 items (severity expressed in 0 – 4 points in each item).

By checking these 5 possible boxes of “severity” for each of the items the respondent provides his personal perception.

The total score of the MRS ranges between 0 (asymptomatic) and 44 (highest degree of complaints).

The minimal/maximal scores vary between the three dimensions depending on the number of complaints allocated to the respective dimension of symptoms:

• psychological symptoms: 0 to 16 scoring points ( 4 symptoms: depressed, irritable, anxious, exhausted) somato-vegetative
• symptoms: 0 to 16 points (4 symptoms: sweating/flush, cardiac complaints, sleeping disorders, joint & muscle complaints)
• urogenital symptoms: 0 to 12 points (3 symptoms: sexual problems, urinary complaints, vaginal dryness).

The composite scores for each of the dimensions (sub-scales) is based on adding up the scores of the items of the respective dimensions.

The composite score (total score) is the sum of the dimension scores. The three dimensions, their corresponding questions and the evaluation are detailed and summarized here.

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