Can You Feel the Tension? Evaluating the Translatability of Complex Terminology in PROs

OBJECTIVES: Collecting high-quality data via patient reported outcome assessments (PROs) relies on using direct and uncomplicated terminology. This is especially true for linguistic validation (LV) of PROs intended for global administration. Here we review patient and linguist interpretations of the term “tension”, which can describe both physical (stress or strain) and psychological (anxiety) experiences, within a quality-of-life measure for Rheumatoid Arthritis, aiming to provide guidance for improving PRO terminology.

METHODS: We collected feedback on “tension” from cognitive debriefing interviews across 19 translations (13 languages for 16 countries). Respondents were 18-85 years old with 6-23 years of education. Two probe questions gathered patient definitions of “tension” and their interpretation of its in context meaning.

RESULTS: 47% of respondents said “tension” could refer to physical and psychological experiences. 21% thought “tension” was solely physical; 32% solely psychological. Final interpretation was based on patients’ personal experience with Rheumatoid Arthritis. When defining “tension”, those understanding the term as physical referenced the body (muscle pain, joint pain, blood pressure) and used alternatives like stiffness and rigidity. Those interpreting “tension” as a psychological experience referenced quality of life, offering alternatives like anxiety, worry, and nervousness.

63% (10/16) of languages could translate “tension” with conceptual ambiguity as in the source; the rest were linguistically unable. 17/19 (89%) of linguists favored a source wording change to improve translatability. Suggested changes to improve wording included adding adjectives, such as “physical / bodily tension”, “emotional tension”, and “tension from inflammation”.

CONCLUSIONS: This paper explored how patients interpret “tension” in PROs across languages. Results showed strong competition between physical and psychological interpretations, and differential translatability across languages. These factors increase the chance of unreliable data collection for items using “tension”, and highlight the importance of unambiguous source wording or clear marking of the intended domain (e.g., physical; psychological) for items or item sets.