Abstract
Introduction. The interest in clinical investigations in health-related quality of life (HRQoL) of aging men has increased over recent years, particularly in the context of partial androgen deficiency. The aim of this paper is to inform the scientific community about a harmonized Italian Aging Males' Symptoms (AMS) scale.
Methods. There were two slightly different Italian AMS scales, which both underwent an up-to-date linguistic & cultural translation process, i.e., were both valid to be applied in clinical research. However, there are potential long-term problems associated with having two Italian language versions of the scale in the same country. Therefore, an ad hoc committee of key persons related to both versions met with the scale's developer, to create a harmonized single Italian AMS.
Results. The harmonization meeting came up with a consensus item-by-item and the new Italian reference scale was agreed upon. It was decided that this scale should be published to avoid any confusion among future users.
Conclusion. The Italian AMS scale published in this paper should be used for future clinical and other research.
Introduction
The Aging Males' Symptoms (AMS) scale is a health-related quality of life scale (HRQoL) and was originally developed in Germany in 1999 Citation[1]. The scale was designed as a self-administered scale to: (a) assess symptoms of aging (independent from those which are disease related) between groups of males under different conditions, (b) evaluate the severity of symptoms over time, and (c) measure changes pre- and post-androgen replacement therapy Citation[1]. It was developed in response to the lack of fully standardized scales available to measure the severity of aging symptoms, and specifically their impact on HRQoL in males Citation[2],Citation[3]. The AMS scale was internationally well accepted: it is now available in 21 languages, almost all in published form Citation[2],Citation[4],Citation[5], (i.e., it can be downloaded from the internet, either through www.aging-males-symptom-scale.info or from the relevant publication Citation[4]).
The evaluation of the AMS scale is simple, and has been published again recently Citation[4], and there are norm values provided for comparison Citation[1],Citation[3]. The conventional psychometric requirements of test reliability and validity, as well as demands regarding clinical utility and outcomes sensitivity, were also recently published Citation[6].
Although the scale was not developed to be a screening instrument for androgen deficiency, comparisons with internationally used screening instruments for androgen deficiency in adult males (ADAM scale of Morley et al. Citation[7] and the Screener of Smith et al. Citation[8]) found that the AMS has obviously similar test characteristics Citation[9]. In addition, Kratzik et al. Citation[10] observed, in a population-based cross-sectional study in Vienna, an impressive association between subscales of the AMS and free testosterone level. Recently, Japanese research groups under Itoh et al. Citation[11] and Soh et al. Citation[12] reached a similar conclusion, with results of a correlation between the AMS scores and the testosterone level. A Polish research group found a similar, but less defined, result Citation[13]. Moreover, as far as the AMS scale per se and its association with testosterone level is concerned, the situation is controversial: some studies could not find associations with testosterone level Citation[14],Citation[15], while others found close associations Citation[10-13].
The aim of this paper is to inform the scientific community about the agreement on a harmonized Italian AMS scale.
The Italian AMS scales
Although the communication among various interested parties went fairly well, the translation into Italian language led to two different versions, which were both published Citation[4],Citation[16], and one version was applied in a population survey Citation[17]. Both versions underwent an up-to-date linguistic and cultural translation/adaptation process, i.e., followed international methodological recommendations for linguistic and cultural adaptation of HRQoL measures. In other words, both Italian versions were valid to be applied in clinical trials or observational studies.
However, the simultaneous existence of two valid Italian versions may be cause for misunderstandings and confusion in the future. Therefore, a meeting was organized to explore the possibilities of a consensus. The ad hoc committee concluded that the two Italian versions were conceptually identical and compatible with the source language, which was the English version. Consequently, the committee considered it possible to create a harmonized version that took into consideration the variations in wording and phrasing from the earlier two translations. The guidance of the developer of the original German scale facilitated some fine-tuning and consensus finding.
Harmonization
The harmonization meeting took place in February 2005 in Milan, Italy. The ad hoc committee compared the two Italian versions item-by-item, in relation to both the German and English version of the scale.
Proposals for a common wording were discussed until a consensus among the native Italian-speaking members was reached, i.e., taking also into consideration experiences gathered in practical applications of both versions of the scale in previous investigations as well as learning from opinions expressed by medical experts.
Finally, the ad hoc committee agreed on a harmonized Italian AMS scale that should be used for further research in this field. The ad hoc committee agreed to publish the harmonized version of the Italian translation of the AMS scale (Appendix 1). The English version is also attached for non-Italian speaking readers (Appendix 2).
Conclusion
Although not desirable, multiple translations of a scale into the same language cannot be absolutely avoided. There might be different ways to arrive at a common version, but a consensus meeting of experienced translation teams and experts with the inventor of the scale is one option, which was chosen in this case.
The Italian AMS scale published as an appendix of this paper should be used for future research.
References
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