Dutch translation and cross-cultural adaptation of the LIMB-Q Kids questionnaire

Table 2 Examples of discrepancies and changes made in the Dutch translation process

Name of scale	Item (English original version)	Forward translation	Problem in forward translation	Backward translation	Expert panel opinion	Cognitive debriefing interviews
Knees symptoms	My knee is swollen or puffy	Gezwollen of opgezet1; Opgezwollen2	At reconciliation meeting decided: ‘dik of opgezwollen’	‘My knee is thick or swollen’	Backward translation is not literally identical, but Dutch phrasing is best option to capture the intended meaning	No concerns raised
Leg-related distress	I get upset when my leg stops me from having fun	Ik raak van slag1; Ik raak van streek2	At reconciliation meeting decided ‘ik vind het vervelend’	‘I don’t like it when people look at my leg’	Double negative should be avoided, but was only present in the back translation and not in the Dutch translation	No concerns raised
Hip symptoms	My hip hurts when it makes sound (clicks or pops)	Mijn heup doet pijn als hij geluid maakt (klikt of plopt)1,2	No remarks	‘My hip hurts when it makes a noise (when it clicks or pops)’	Not identical, but similar meaning	Interviewed children suggested ‘klikt of knakt’ as a more relatable option, which we followed. This was well received in following CDIs
Physical function	… walk without a limp?	… lopen zonder mank te lopen?1; … zonder hinken te lopen?2	Both were not well-flowing formulations, decided to go for: ‘… lopen zonder strompelen?’	‘… walk without stumbling?’	We changed translation to ‘… lopen zonder hinken of manken?’ considering the backward translation this stays closest to the original ‘limp’	The chosen translation was not deemed adequate by several interviewees, especially the word ‘hinken’ was flagged. Suggestions from patients were sought and finally ‘lopen zonder mank te lopen’ was chosen. In subsequent CDIs this was confirmed to be an adequate translation

¹Forward translator one.

²Forward translator two.

CDI: Cognitive debriefing interview.