OBJECTIVES: The MusiQOL questionnaire was co-developed in 15 countries to assess the quality of life of patients with Multiple Sclerosis. The objective of this study was to test the cultural relevance of the instrument in 4 Arabic countries (Egypt, Morocco, Saudi Arabia and Tunisia) and Iran, not involved in the initial development, and to assess the conceptual equivalence of the translations with the UK original used as a basis for translation. METHODS: In each country, the translation process was conducted by a linguistic expert, using either the standard forward/ backward methodology or the adjusted process (adaptation from the Saudi Arabia version), including cognitive interviews with 6 patients. The basis for discussion was the concept list developed in collaboration with the author. RESULTS: Linguistic and cultural issues emerged during the translation process. First, the acronym “MS” used throughout the original version for “Multiple Sclerosis” was replaced by the full name in Arabic countries for clarity, but not in Iran where the patients preferred the abbreviation. Second, using euphemistic expressions for taboo concepts such as sex life proved necessary to ensure homogenous response across all languages without any negative connotation. Finally, leisure activities (e.g. shopping, going out to a movie, gardening) described in the original had to be adapted to the religious and social context in the target countries. CONCLUSIONS: The 5 language versions of the MusiQol were established following a proven standardized methodology, on the basis of a concept list worked out with the author, to allow international data pooling and mining whilst addressing the specific challenges of regional adaptation. The process as a whole supports the advantage of integrating continuous and diverse international feedback on wording during the linguistic validation process.

Trevin, A., et al. (2011). "Content validity of the multiple sclerosis international QOL (musiqol) questionnaire in iran, egypt, morocco, saudi arabia and tunisia." Value in Health 14(3): A73.

http://dx.doi.org/10.1016/j.jval.2011.02.411