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Cross Cultural Adaptations and Validation Committee

Chair Vasilios Korakakis



Questionnaire development, cross-cultural adaptation and validation ECOSEP committee

The main objectives of this committee will be: i) the development of new questionnaires where needed, ii) the translation and cross cultural of existing scales into other languages, and iii) the evaluation of their psychometric properties.

Patient-reported outcome measures (PROMs) are essential in clinical practice and comparative research Measurement of health outcomes is essential in scientific research and in clinical practice.  Patient-reported outcome measures or general health status measurement instruments can provide objective data that can be used for decision-making about the application of subsequent diagnostic tests and treatments.4 The importance of monitoring the effectiveness of treatment on the basis of patient’s perspective is widely recognized.3

Standardized PROMs provide a convenient method to compare different patient populations, evaluate the outcome of treatment, facilitate comparisons between studies and research centres, determine the patient’s clinical severity, provide a guideline for treatment and monitor treatment effects.5 The value of PROMs is further highlighted given the fact they measure patient perceptions of specified aspects of their own health that either cannot be directly observed (eg. Pain) or that are not practical or feasible to directly observe (eg. performance of daily activities).2

Most PROMs are developed for English-speaking individuals Despite that the number of available health status questionnaires has increased dramatically over the past decades, most of these instruments are developed for English-speaking patients. PROMs in order to be used in different language and culture populations require a specific procedure and methodology called “cross-cultural adaptation”. The purpose of this procedure is the adequate linguistic translation as well as the cultural adaptation to maintain the content validity of the instrument across different cultures.1

Appropriate measurement propertiesPROM instruments are imperative to be reliable and valid. Otherwise there is a serious risk of imprecise or biased results that might lead to wrong conclusions and treatment decisions. Recently, guidelines for the assessment of methodological quality of health status measurement instruments have been proposed. Following these guidelines not only the development but the cross-cultural adaptation of these instruments will guarantee appropriate measurement properties.6 Following this rigorous methodology psychometric properties’ quality will be ensured in all dimensions of validity, reliability and responsiveness.


  1. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine. 2000;25:3186-3191.
  2. Davidson M, Keating J. Patient-reported outcome measures (PROMs): how should I interpret reports of measurement properties? A  practical guide for clinicians and researchers who are not biostatisticians. British Journal of Sports Medicine. 2014;48:792-796.
  3. Delitto A. Are measures of function and disability important in low back care? Physical Therapy. 1994;74:452-462.
  4. DeVellis R. In: eds. Scale development. Theory and applications. London: Sage 2003:
  5. McGrail K, Bryan S, Jennifer D. Let’s all go to the PROM: The case for routine patient-reported outcome measurement in Canadian healthcare. Healthcare Papers. 2012;11:8-18.
  6. Terwee CB, Bot SDM, de Boer MR, et al. Quality criteria were proposed for measurement properties of health status questionnaires. Journal of Clinical Epidemiology. 2007; 60:34-42.


Vasileios Korakakis

Clinical Lead Physiotherapist / Researcher West Expansion Aspetar, Sports Medicine Hospital