Cross cultural adaptation and analysis of psychometric properties of Sinhala version of Menopause Rating Scale

Nirmala Rathnayake, Janaka Lenora, Gayani Alwis, Sarath Lekamwasam, Nirmala Rathnayake, Janaka Lenora, Gayani Alwis, Sarath Lekamwasam

Abstract

Background: Menopause Rating Scale (MRS) evaluates eleven menopausal symptoms and health related quality of life (HRQOL) of postmenopausal women under three subscales. In this study we attempted cross cultural adaptation and evaluation of psychometric properties of a Sinhala translation of MRS.

Methods: Sinhala version of MRS was adapted following standard methodology; forward and backward translations, review by an expert group, focus group discussion (FGD) and pre-testing. It was self-administered among randomly selected healthy, Sinhalese, community-dwelling 166 postmenopausal women (aged; median = 56.5, IQR, 53.0-59.0 years) along with the Short Form 36 (SF-36) survey questionnaire. MRS was re-administered among a subsample (n = 80) after two weeks of first administration. Psychometric properties; reliability and validity were evaluated.

Results: In Sinhala version of MRS, both internal consistency (Cronbach's alpha coefficient = 0.79) and test retest reliability (intra class correlation / ICC = 0.86, 95%CI = 0.82-0.91, p < 0.001 and Pearson correlation / r = 0.93) were high. Factor analysis (FA) with Principal Component Analysis (PCA) extracted three factors explaining 59.82% cumulative variance with few exceptions from the original version. In the item-subscale correlation analysis items showed stronger correlations within their own subscale score (r range between 0.56-0.84) than with other subscales scores and subscales' scores showed strong correlations with the overall MRS score (r range between 0.70-0.86) indicating strong convergent validity. Mean (SD) symptom severities of each item were significantly different between symptomatic and asymptomatic women (p < 0.05) emphasizing good discriminant validity. The overall MRS and SF-36 scores correlated significantly (Pearson correlation: - 0.52, p < 0.01 and Kendall's tau-b: - 0.39, p < 0.01) ensuring strong criterion validity.

Conclusions: The Sinhala version of MRS we adapted is an informative tool with high reliability and validity and this tool can be used to evaluate the menopausal symptoms and HRQOL in postmenopausal women conversant in Sinhala.

Keywords: Cross cultural adaptation; Menopause rating scale; Psychometric properties; Reliability; Sinhala version; Validity.

Conflict of interest statement

Authors’ information

NR; Lecturer, Department of Nursing, Faculty of Allied Health Sciences, University of Ruhuna, Sri Lanka, JL; Professor, Department of Physiology, Faculty of Medicine, University of Ruhuna, Sri Lanka, GA; Senior Lecturer, Department of Anatomy, Faculty of Medicine, University of Ruhuna, Sri Lanka, SL; Professor of Medicine, Department of Medicine, Faculty of Medicine, University of Ruhuna, Sri Lanka.

Ethics approval and consent to participate

Ethical clearance for the study was obtained from the ethical review committee, Faculty of Medicine, University of Ruhuna, Sri Lanka. Informed written consent was obtained from each participant prior to the commencement of the study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Screen plot of factor extracting in MRS with PCAᅟ

References

    1. Dalal PK, Agarwal M. Postmenopausal syndrome. Indian J Psychiatry. 2015;57(Suppl 2):S222–S232. doi: 10.4103/0019-5545.161483.
    1. Waidyasekera H, Wijewardena K, Lindmark G, Naessen T. Menopausal symptoms and quality of life during the menopausal transition in Sri Lankan women. Menopause. 2009;16(1):164–170. doi: 10.1097/gme.0b013e31817a8abd.
    1. Moravcová M, Ježek S, Mares J. Menopause Rating Scale-Validation Czech version specific instrument for assessing health related quality of life in postmenopusal women Oseti porod asist. 2014;5(1):36–45. Available from; [Accessed on 10 Nov 2016].
    1. Hauser GA, Huber IC, Keller PJ, Lauritzen C, Schneider HP. [Evaluation of climacteric symptoms (menopause rating scale)]. Zentralblatt fur Gynakologie. 1994;116(1):16–23. PubMed PMID: 8147175. Available from; [Accessed on 10 Nov 2016].
    1. Potthoff P, Heinemann LA, Schneider HP, Rosemeier HP, Hauser GA. [The menopause rating scale (MRS II): methodological standardization in the German population]. Zentralblatt fur Gynakologie 2000;122(5):280–286. PubMed PMID: 10857215. Available from; [Accessed on 10 Nov 2016].
    1. Chuni N, Sreeramareddy CT: Frequency of symptoms, determinants of severe symptoms, validity of and cut-off score for menopause rating scale (MRS) as a screening tool: a cross-sectional survey among midlife Nepalese women. BMC Womens Health. 2011;11(1):30. Available from; [Accessed on 10 Nov 2016].
    1. Harlow SD, Gass M, Hall JE, Lobo R, Maki P, Rebar RW, Sherman S, Sluss PM, de Villiers TJ, Group SC: Executive summary of the stages of reproductive aging workshop + 10: addressing the unfinished agenda of staging reproductive aging. Fertil Steril. 2012;97(4):843–851. Available from; [Accessed on 10 Nov 2016].
    1. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine 2000;25(24):3186–3191. PubMed PMID: 11124735. Available from; [Accessed on 10 Nov 2014].
    1. Ware Jr JE, Sherbourne CD: The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Medical care 1992:473-483. Available from; [Accessed on 10 Nov. 2016]
    1. Gunawardena NS, Seneviratne SRD, Atauda AT. An approach to validation of a multi-dimensional tool. J Coll Community Physicians Sri Lanka. 2003;8:18–26.
    1. Hair JE, Anderson RE, Tatham RL, Black WC. Multivariate data analysis: with readings. Englewood Cliffs, NJ: Prentice -Hall; 1995. p. 757.
    1. Schneider HP, Heinemann LA, Rosemeier HP, Potthoff P, Behre HM. The menopause rating scale (MRS): comparison with Kupperman index and quality-of-life scale SF-36. Climacteric : the journal of the International Menopause Society. 2000;3(1):50–8. PubMed PMID: 11910610. Available from; [Accessed on 10 Nov. 2016]
    1. Arafat SM. Psychometric validation of the Bangla version of the patient-doctor relationship questionnaire. Psychiatry J. 2016;2016:9385364. doi: 10.1155/2016/9385364.
    1. Arafat S: Cross cultural adaptation & psychometric validation o f instruments: Step-wise description. Int J Psychiatry. 2016;1(4). Available from; [Accessed on 10 Nov 2016]
    1. Arafat SMY, Chowdhury HR, Qusar MMAS, Hafez MA. Cross Cultural Adaptation & Psychometric Validation of research instruments: a methodological review. J Behav Health. 2016;5(3):129–36. Available from; [Accessed on 10 Nov 2017]
    1. Heinemann K, Ruebig A, Potthoff P, Schneider HP, Strelow F, Heinemann LA, et al. The menopause rating scale (MRS) scale: a methodological review. Health Qual Life Outcomes. 2004;2(45) 10.1186/1477-7525-2-45. PubMed PMID: 15345062; PubMed Central PMCID: PMC516787. Available from; [Accessed on 10 Nov 2016]
    1. Field A. Discovering statistics using IBM SPSS statistics: sage. 2013.
    1. Nie G, Yang H, Liu J, Zhao C, Wang X. Psychometric properties of the Chinese version of the menopause-specific quality-of-life questionnaire. Menopause. 2017;24(5):546–554. doi: 10.1097/GME.0000000000000784.
    1. Wu HC, Wen SH, Hwang JS, Huang SC. Validation of the traditional Chinese version of the menopausal rating scale with WHOQOL-BREF. Climacteric : the journal of the International Menopause Society. 2015;18(5):750–756. doi: 10.3109/13697137.2015.1044513.
    1. Gazibara T, Dotlic J, Kovacevic N, Kurtagic I, Nurkovic S, Rancic B, et al. Validation of the menopause rating scale in Serbian language. Arch Gynecol Obstet. 2015;292(6):1379–1386. doi: 10.1007/s00404-015-3743-9.
    1. Shakila P, Sridharan P, Thiyagarajan S. Assessment of women’s awareness and symptoms in menopause: a study with reference to academic women in Sri Lanka. International Journal of Management & Organizational Studies. 2015;4(1):26–33.

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