Tri-country translation, cultural adaptation, and validity confirmation of the Scored Patient-Generated Subjective Global Assessment

  • Nicole EricksonEmail author
  • Lena J. Storck
  • Alexandra Kolm
  • Kristina Norman
  • Theres Fey
  • Vanessa Schiffler
  • Faith D. Ottery
  • Harriët Jager-Wittenaar
Original Article



The Scored Patient-Generated Subjective Global Assessment (PG-SGA) is the only malnutrition (risk) assessment tool that combines patient-generated measures with professional-generated (medical) factors. We aimed to apply international standards to produce a high quality, validated, translation and cultural adaptation of the original PG-SGA for the Austrian, German, and Swiss setting.


Analogue to methodology used for the Dutch, Portuguese, and Thai versions of PG-SGA, the ten steps of the International Society for Pharmacoeconomics and Outcomes Research’s principles of good practice for translation and cultural adaptation were followed. Comprehensibility and difficulty of the translation were assessed in 103 patients and 104 healthcare professionals recruited from all three German-speaking countries. Content validity of the translation was assessed among healthcare professionals (HCP). Item and scale indices were calculated for content validity (I-CVI; S-CVI), comprehensibility (I-CI; S-CI), and difficulty (I-DI; S-DI).


Patients' perceived comprehensibility and difficulty of the PG-SGA fell within the range considered to be excellent (S-CI = 0.90, S-DI = 0.90), HCP-perceived content validity (S-CVI = 0.90) was also excellent, while HCP-perceived comprehensibility fell within the high range of acceptable (S-CI = 0.87). The professional component of the PG-SGA was perceived as below acceptable (S-DI = 0.72) with the physical exam being rated the most difficult (I-DI=0.29-0.75).


The systematic approach resulted in a high-quality validation of the German language version of the PG-SGA, that is internationally comparable, comprehensible, easy to complete, and considered relevant for use in Austria, Germany and Switzerland.


PG-SGA Disease-related malnutrition Screening Nutritional Assessment Validation 



The authors would like to thank everyone who supported this study, be it in recruiting patients and professionals, spreading the word, or doing “busy work” like filing the completed questionnaires. In particular, we would like to thank Diana Schweizer, Caroline Kiss, Ursula Lukas, Carmen Lautner, the dietitian association in Germany and thier oncology specialists group. Furthermore, we would like to thank Roche, for providing funding for the completion of steps 1-6 (translation and back translation). Roche was not involved for the completion of steps 7-10.

Compliance with ethical standards

Conflict of interest

F. O is co-creator PG-SGA and co-founder PG-SGA/Pt-Global Platform. She was co-developer of the PG-SGA-based Pt-Global app/web tool. H. J.-W. was co-developer of the PG-SGA-based Pt-Global app/web tool. All other authors have no conflict of interest to declare. All authors have full control of all primary data and agree to allow the journal to review their data if requested.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Comprehensive Cancer CenterLudwig-Maximilian University ClinicMunichGermany
  2. 2.Departement MedizinKantonsspital WinterthurWinterthurSwitzerland
  3. 3.Department GesundheitFachhochschule St. Pölten GmbHSt. PöltenAustria
  4. 4.Department of Nutrition and Gerontology, German Institute of Human Nutrition Potsdam-RehbrückePotsdam-RehbrückeNuthetalGermany
  5. 5.Research Group on GeriatricsCharite Universitätsmedizin BerlinBerlinGermany
  6. 6.Ottery & Associates, LLCVernon HillsUSA
  7. 7.Research Group Healthy Ageing, Allied Health Care and NursingHanze University of Applied SciencesGroningenNetherlands
  8. 8.Department of Maxillofacial Surgery, University of GroningenUniversity Medical Center GroningenGroningenNetherlands

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