Translation and cultural adaptation of the EAR-Q into Arabic, Chinese, French and Spanish for use in an international field-test study
Our team developed a new patient-reported outcome measure to evaluate outcomes in patients having surgery for an acquired or congenital external ear anomaly. The aim of this study was to translate and culturally adapt the EAR-Q into Arabic, Chinese, French, and Spanish (Spain).
Translation and cultural adaptation guidelines set forth by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) were followed.
The EAR-Q consists of 30 items in 2 scales measuring the look and feel of one’s ears in addition to 2 stand-alone items about scars and 1 item about hearing aids. Forward translations revealed no items, instructions, or response options that were difficult to translate into any of the languages. After back translation, the meaning of 6 (18%) items from the Arabic and Spanish translations, and 4 (12%) items from the Chinese and French translations, respectively, differed from the English version and required revision. Final translations were shown to 28 patients with an ear condition who took part in cognitive debriefing interviews. Participants were recruited from plastic surgery centers in Qatar, China, Spain, and an Ear Nose and Throat center in France. Mean age for participants was 10 years (5 to 18), 15 were male, and 50% had prominent ears (n = 14). Participants reported few difficulties with understanding the scales.
Translation and cultural adaptation of the EAR-Q resulted in 4 translations that maintained semantic, idiomatic, experiential, and conceptual equivalence to the original English version.
Level of evidence: Level III, risk/prognostic study.
KeywordsEAR-Q patient-reported outcome translation cultural adaptation International Society for Pharmacoeconomics and Outcomes Research (ISPOR)
We would like to thank all the translators as well as Dr. Khalid El-Maaytah (Royal Medical Services, Jordan) and Ms. Sophia Zhao for their valuable contributions in developing the Arabic and Chinese translation of the EAR-Q, respectively. We would also like to thank the patients who participated in the study.
Compliance with ethical standards
The authors are grateful for grant funding provided by the Canadian Institutes for Health Research and the Plastic Surgery Foundation.
Conflict of interest
The authors declare that they have no conflict of interest.
This study was approved by the Hamilton Integrated Research Ethics Board (HiREB) along with the Research Ethics boards at each of the following participating hospitals: Ninth People’s Hospital Shanghai, China; McGill University, Montreal, Canada; Hospital Necker Enfants Malades, Paris, France; Hospital General Universitario Gregorio Maranon, Madrid, Spain; and Hamad Medical Corporation in Doha, Qatar.
All participants and/or their legal guardians (when appropriate) provided written informed consent or assent.
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