University of Hertfordshire

Content validity and clinical meaningfulness of the HFMSE in spinal muscular atrophy

Research output: Contribution to journalArticlepeer-review


  • Maria C Pera
  • Giorgia Coratti
  • Nicola Forcina
  • Elena S Mazzone
  • Mariacristina Scoto
  • Jacqueline Montes
  • Amy Pasternak
  • Anna Mayhew
  • Sonia Messina
  • Maria Sframeli
  • Marion Main
  • Robert Muni Lofra
  • Tina Duong
  • Sally Dunaway
  • Rachel Salazar
  • Lavinia Fanelli
  • Matthew Civitello
  • Roberto de Sanctis
  • Laura Antonaci
  • Leonardo Lapenta
  • Simona Lucibello
  • Marika Pane
  • John Day
  • Basil T Darras
  • Darryl C De Vivo
  • Francesco Muntoni
  • Richard Finkel
  • Eugenio Mercuri
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Original languageEnglish
Pages (from-to)39
Number of pages10
JournalBMC Neurology
Publication statusPublished - 23 Feb 2017


BACKGROUND: Reports on the clinical meaningfulness of outcome measures in spinal muscular atrophy (SMA) are rare. In this two-part study, our aim was to explore patients' and caregivers' views on the clinical relevance of the Hammersmith Functional Motor Scale Expanded- (HFMSE).

METHODS: First, we used focus groups including SMA patients and caregivers to explore their views on the clinical relevance of the individual activities included in the HFMSE. Then we asked caregivers to comment on the clinical relevance of possible changes of HFMSE scores over time. As functional data of individual patients were available, some of the questions were tailored according to their functional level on the HFMSE.

RESULTS: Part 1: Sixty-three individuals participated in the focus groups. This included 30 caregivers, 25 patients and 8 professionals who facilitated the discussion. The caregivers provided a comparison to activities of daily living for each of the HFMSE items. Part 2: One hundred and forty-nine caregivers agreed to complete the questionnaire: in response to a general question, 72% of the caregivers would consider taking part in a clinical trial if the treatment was expected to slow down deterioration, 88% if it would stop deterioration and 97% if the treatment was expected to produce an improvement. Caregivers were informed of the first three items that their child could not achieve on the HFMSE. In response 75% indicated a willingness to take part in a clinical trial if they could achieve at least one of these abilities, 89% if they could achieve two, and 100% if they could achieve more than 2.

CONCLUSIONS: Our findings support the use of the HFMSE as a key outcome measure in SMA clinical trials because the individual items and the detected changes have clear content validity and clinical meaningfulness for patients and their caregivers.


© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated

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