Many trials are now run multi-nationally, but even in national trials there is an increasing likelihood that a proportion of patients will not speak the native language of the country they are being treated in. Most of the major developers of QL questionnaires have recognized the need to provide their forms in a number of different languages. For example, the EORTC core questionnaire is currently available in thirty-six languages. The process of translating questions from one language into another is time consuming and detailed. It involves forward and backward translation to ensure all the questions have the same psychometric values as the original. Only properly translated questionnaires should be used as it is rarely adequate, or acceptable, to simply translate questionnaires word for word.

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