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The global burden of ASD was huge compared with other self-reported chronic conditions in the general population of eight industrialized countries. The impact of ASD on HRQL warrants the same research and health policy attention as other important chronic diseases.

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With a minor revision of question 18 (related to going out) the internal consistency of the SRS-22 Function domain has been improved in idiopathic scoliosis patients < 18 years of age. Deletion of question 15 (related to financial considerations) has a variable, small effect depending on patient group. Retention of question 15 is recommended unless a cultural variable, such as differences in healthcare payment schemes, substantially lowers domain psychometric properties.

This study demonstrated that, if measures are to be used across cultures, the items must not only be translated well linguistically but also must be culturally adapted to maintain the content validity of the instrument at a conceptual level across different cultures. This may necessitate several validation studies to ensure and improve consistency in the content and face validity between source and target versions of a questionnaire due to difficulty in detecting subtle differences in the living habits of different cultures.