Danish and Dutch linguistic validation and cultural adaptation of the WOUND-Q, a PROM for chronic wounds

Tert C Van Alphen,Lotte Poulsen,Emiel L W G Van Haren,Elena Tsangaris,Jens A Sørensen,Anne F Klassen,Amalie L Jacobsen,Andrea L Pusic,Maarten M Hoogbergen,René R J W Van Der Hulst

doi:10.1007/s00238-019-01529-7

Abstract

Chronic wounds represent a significant problem to patients, healthcare professionals, and healthcare systems alike. The inclusion of patient-reported outcome measures (PROMs) into wound care outcome assessment will provide important information. The WOUND-Q is a new PROM developed to measure outcomes for people with chronic wounds. This study aimed to perform a linguistic validation/cultural adaption of the WOUND-Q from English into Danish and Dutch. The field-test version of the WOUND-Q is a comprehensive PROM composed of 222 items in 16 independently functioning scales. We followed the rigorous guidelines set forth by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and the World Health Organization (WHO). These guidelines involved two forward translations, one back translation, an expert panel meeting, and cognitive debriefing interviews with patients. In the forward translation, the psychological function scale showed the greatest number of discrepancies from the English version. Comparison of the back translation of the Danish and Dutch versions with the English version identified 19 and 24 items respectively where the meaning had changed and required re-translation. A total of 38 cognitive debriefing interviews resulted in minor adjustments and demonstrated that the questionnaire had sufficient comprehensibility. The linguistic validation and cultural adaptation process is an essential step to adapting PROMs for use in other languages and cultures. The described method of translation and linguistic validation can be recommended for future translations of any PROM into any target language. The translation process led to conceptually equivalent Danish and Dutch versions of the WOUND-Q.Level of Evidence: Not ratable.

Highlights

Chronic wounds represent a significant health problem and challenge to patients, healthcare professionals, and healthcare systems alike
The panel is recommended to involve experts who are bilingual including translators, and clinical experts in the health field for which the instrument is being translated, as well as patient-reported outcome measures (PROMs) experts with knowledge of instrument development and validation
By comparing the back translations of the Danish and Dutch versions to the original English version of WOUND-Q, the developers identified 19 and 24 items respectively (7 common to both) whose meaning differed from the English version

Summary

Introduction

Chronic wounds represent a significant health problem and challenge to patients, healthcare professionals, and healthcare systems alike. Chronic wounds are defined as wounds that fail to heal within 3 months [1]. The most common chronic wounds are pressure ulcers, diabetic foot ulcers, venous stasis wounds, and ischemic wounds of arterial or post-irradiation etiology [2, 3]. Millions of patients worldwide require treatment for chronic wounds each year. Wound treatment often requires a multidisciplinary care team approach, since patients often present with comorbidities that can affect wound healing [3,4,5]. The impact of chronic wounds on patients varies greatly with respect to recovery, return to usual activities, as well as health-related quality of life (HR-QoL) [6,7,8]

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