**Background:** Sarcopenia is a progressive aging syndrome characterized by loss of skeletal muscle mass and function, leading to increased risk of falls, disability, hospitalization, and death. Its prevalence in healthy older adults is about 10%, and in Greece, a recent study reported probable sarcopenia in 25.4% and sarcopenia in 13.2% of elderly. Early diagnosis is crucial for timely intervention. The Mini Sarcopenia Risk Assessment (MSRA) questionnaire, available in 7-item (MSRA-7) and 5-item (MSRA-5) versions, was developed as a pre-screening tool for sarcopenia risk. It has been validated in Italian, Brazilian Portuguese, Polish, Chinese, and Thai. The SARC-F questionnaire is widely used but has low sensitivity. This study aimed to translate, culturally adapt, and validate the MSRA-7 and MSRA-5 into Greek for use in older Greek adults.
**Methods:** The study was conducted from April 2021 to June 2022 at the Internal Medicine and Orthopaedic outpatient departments of the General Hospital of Heraklion, “Venizeleio-Pananeio”. Ninety participants (56 females, 34 males) aged 65-89 years (mean 74.9, SD 6.5) with normal cognitive function, ability to walk, and no mobility impairments were enrolled via convenience sampling. Translation and cultural adaptation followed WHO guidelines and Minimal Translation Criteria, including forward translation, reconciliation, back-translation, face validity testing in 10 participants, and content validity assessment by 3 experts. One cultural adaptation was made: the term “ragout” was replaced with a local Mediterranean diet term. Content validity was assessed using Content Validity Ratio (CVR) and Content Validity Index (CVI). Intra-rater reliability (test-retest) was evaluated in 16 participants (9 females, 7 males; mean age 75.8, SD 6.0) with a 2-week interval, using Intra-class Correlation Coefficient (ICC). Concurrent validity was assessed by correlating Greek MSRA-7 and MSRA-5 scores with the Greek version of SARC-F using Spearman's rank correlation coefficient (rho). Sample size calculations: minimum 16 for reliability (expected ICC 0.95, power 99%) and 83 for validity (2-tailed α ≤ 0.01, power >99%, correlation threshold 0.50). Statistical significance set at p < 0.05.
**Key Results:** Content validity: 100% of items (n=7) had acceptable CVR (>0.70), and CVI was >0.80. Intra-rater reliability: ICC for the Greek MSRA questionnaire between initial and reassessment was 0.986 (95% CI: 0.961–0.995), indicating excellent consistency. Concurrent validity: Greek MSRA-7 showed very high correlation with SARC-F (rho = -0.741, p < 0.001). Greek MSRA-5 also showed very high correlation with SARC-F (rho = -0.724, p < 0.001).
**Clinical Implications:** The Greek versions of MSRA-7 and MSRA-5 are reliable and valid pre-screening tools for sarcopenia risk in older Greek adults in hospital outpatient settings. They are low-cost, easy to administer, and can facilitate early detection of sarcopenia, enabling timely interventions to prevent functional decline, falls, and disability. The MSRA questionnaire includes dietary domains (meals per day, dairy, protein) that may capture nutritional risk factors for sarcopenia, complementing the SARC-F. However, sensitivity and specificity were not assessed in this study, and further diagnostic confirmation (e.g., using EWGSOP2 criteria) is needed. Future studies with larger samples and diverse settings are warranted to confirm utility.