Reviewing translated scales: backtranslation under the spotlight

Linguistic validation of patient-reported outcomes is a costly and time-consuming process involving not only professional translators in the forward and backtranslation processes, but also reviewers, clinicians and project managers. Backtranslation, an essential step in this process, is used as a quality-assurance measure to detect any differences in the adaptation of cross-cultural concepts and to draw attention to poorly drafted wording and blatant errors. It is the gold standard for the translation of patient-reported outcomes.The objectives of this paper are to examine and review examples of patient-reported outcomes that underwent the linguistic validation process into Portuguese and analyse them from the perspective of register, cultural adaptation, semantics, associative meaning and localisation/adaptation and to understand how effective backtranslation is at detecting any possible discrepancies.