From Translation to Version Management: A History and Review of Methods for the Cultural Adaptation of the EuroQol Five-Dimensional Questionnaire

Abstract

The EuroQol five-dimensional (EQ-5D) questionnaire is used worldwide as a patient-reported outcome (PRO) instrument for the measurement and valuation of health. Several variants of the instrument now exist, including versions with three and five levels of severity and one for respondents aged 8 to 14 years. From the outset, a demand for new language versions of the EQ-5D questionnaire meant that there was a need to implement standardized procedures, which ensured that such versions were produced following international recommendations for the cultural adaptation of patient-reported outcomes. The availability of new variants and formats of the instrument, such as telephone-administered or electronic formats, complicated the task of providing and controlling the quality of cultural adaptations. Although cultural adaptations of the instrument are widely used, the procedures currently used to produce them have not been widely disseminated. The present article therefore describes the evolution of the production of other language versions of the instrument from the earliest days of simultaneous production and translation of the EQ-5D questionnaire to the more recent, broader-based strategy of version management. We describe current adaptation procedures and innovations within those procedures. We also describe how version management is organized within the EuroQol Group, review aspects related to quality control, and provide an overview of the number of currently available language versions for each variant of the EQ-5D questionnaire: three-level, five-level, and youth versions. We conclude by discussing some of the relevant issues related to cultural adaptation for frequently used instruments such as the EQ-5D questionnaire.

Application of validity theory and methodology to patient-reported outcome measures (PROMs): building an argument for validity

“…Reviews have been done to describe common components of translation methods (e.g. use of forward and back translations, consensus meetings) [15, 83] and guidelines and recommendations are published [30, 76, 84] but qualitative studies that include examination of the core elements of a translation procedure are uncommon. It is critical that a PROM translation method can detect errors in the translation, can identify the introduction of linguistically correct but hard-to-understand wording in the target language, and can determine the acceptability of the underlying concepts to the local culture.…”

“…age, gender, number of comorbidities) and to anticipated outcomes (e.g. change after effective interventions).There is conceptual and measurement equivalence of the translated HLQ with the English HLQ, which is necessary to transfer the meaning of the constructs for interpretation in the target language [76] such that intended benefits of testing are more likely attained. …”

Short-Term Efficacy of Ultramicronized Palmitoylethanolamide in Peripheral Neuropathic Pain

“…After a preliminary screening, patients were asked to participate at the study and then were evaluated by means of VAS scale, NP Symptom Inventory (NPSI) [10], and health questionnaire five dimensions (EQ-5D) for quality of life [11]. NPSI single items were also evaluated separately: burning (superficial) spontaneous pain (Factor 1); pressing (deep) spontaneous pain (Factor 2); paroxysmal pain (Factor 3); evoked pain (Factor 4); paresthesia/dysesthesia (Factor 5).…”

EQ-5D and the EuroQol Group: Past, Present and Future

“…This group has responsibility not just for different language versions, but also for testing and approving electronic versions of the EQ-5D (tablet, web-based, PDAs), demand for which has risen [11]. …”

“…Second, once the labels had been decided on, the UK English, Spanish and French versions could then be used as source content for any new language versions required. These are produced following the EuroQol Group’s translation methodology, which also includes in-depth semantic testing of all wording in the target language, with a particular focus on the severity labels (see [11]).…”