Cross-cultural adaptation of patient-reported outcome measures: Methodological guidance for a better practice

Literature on the development of patient-reported outcome measures (PROMs) has continue to expand over the past two decades. With the increasing global use of PROMs in research and clinical practice, there is a need for their rigorous and systematic translation and cultural adaptation to ensure appropriate use in new contexts. This requires a structured approach to ensure linguistic and cultural equivalence, the quality of cross-cultural adaptation (CCA), and psychometric properties of the adapted PROMs. Poor CCA can be a challenge to the transferability and applicability of PROMs. A reasonable approach to ensure high-quality CCA could involve selecting certified translators, reconciling feedback, conducting pilot tests with end users, forming an expert committee, and consulting with the original tool developers. However, there are gaps in how the process of CCA was applied and reported. Although numerous guidelines for CCA exist, none are regarded as a gold standard. In addition, there is a lack of consensus on the best and most effective method of translation. This methodological paper addresses these gaps by describing methodological guidance for CCA, including comprehensive, step-by-step instructions and toolkits to enhance researchers' understanding and application of the CCA process.