Background/Purpose: Translators of self-report forms commonly encounter problems related to untranslatability, a term used to describe words that cannot be meaningfully translated from one language to another.We give an example of Turkish translation of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), a self-report questionnaire, to illustrate the problems mentioned above.

Methods:

It was noted by the physicians in outpatient rheumathology clinic that the translation of “tender points” in the Turkish version of BASDAI was not correctly understood by the patients. For this purpose, we designed a study that would assess patients’ subjective understanding of the item comprising this term to detect enthesitis (4^th question, Q4). Initially, BASDAI self-report form was administered to 106 patients, followed by a semistructured interview lead by trained investigators.

Immediately after the interview, participants were asked to rate (on a scale from 0 to 10 on a visual analogue scale) the 4^th item one more time (after receiving explanation of what was intended to be asked, BASDAI-E). Afterwards, an entheses examination was performed by a blinded investigator using both “Leeds Enthesitis Index” and  “Maastricht Ankylosing Spondylitis Enthesitis Score”, and the patients were asked to evaluate the degree of pain they felt during the exam on a scale from 0 to 10. The physical examination was used as the objective measure for detecting the presence and severity of enthesitis, and the level of patients’ understanding of the 4^thitem was elicited by the difference between the scores given in standart BASDAI and those given with the Q4 replaced with the entheses examination scoring of enthesis (BASDAI-Q4). 

Results:

Of the 106 patients who participated in this study, 41 (38.7%) were male, and 65 (61.3%) were female. Mean age of the participants was 43.8 (SD=10.91). On average, patients have been diagnosed with Ankylosing Spondylitis for 9.25 years (SD=7.03) and recall having symptoms for 13.57 (SD=9.13) years. Thirteen patients reported the Q4 as “not understood”.  Twenty eight patients reported not to have an enthesitis area in BASDAI where as 39 patiens were found to have no enthesitis on physical examination. Twenty patients reported enthesitis in BASDAI  had no enthesitis on physical examination. And 15 reported no enthesitis in BASDAI had on physical examination. Mean BASDAI score (3.94±2.39) was significantly higher when compared to the BASDAI-Q4 (2.95±2.56) (p<0.0001, 95% CI 0.54 to 1.44). Explanation of the domains (BASDAI-E) did not affect the mean BASDAI (3.60±2.62 vs. 3.94± 2.39, p=0.079, 95% CI 0.04 to 0.07).

Conclusion: Discrepancies arising between the real and the comprehended meaning of untranslatable terms in self reports, lead to statistically meaningful changes in the total BASDAI score, therefore affecting the whole treatment approach of these patients. We argue that this type of terms should not be tried to be translated into single-sentence questions in self reports. Instead, other methods, including visual or verbal explanations should be attempted for a better understanding by the patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/problems-of-untranslatability-example-of-turkish-version-of-basdai/