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International Parkinson and Movement Disorder Society
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MDS Translation Program


The MDS Rating Scales Translation Program develops MDS Official non-English Translations of the MDS-UPDRS and UDysRS. Permission to translate either scale outside of this official program is not permitted. Individuals interested in participating in the development and validation of a non-English Translation Program will be required to follow the protocol below and are requested to submit a Non-English Translation Application.

MDS-UPDRS Translation Program Protocol for non-English Translations


Study Type: This is an observational study

Study Groups/Sites: 10-15 sites within each non-English language sphere for phase III

Study Period: One year: From the approval of the specific language translation program, teams will be given 12 months to complete the translation/back translation, cognitive testing, and validation phases. Data analysis, feedback to program teams and finalization of reports will take place within 3 months of full data set submission by the MDS Translation Steering Committee.

Study Population: Parkinson's disease patients whose native language is not English. 

Primary Study Objective: To validate translations of the MDS-UPDRS

Requirements for Participation:
Local translation/back-translation program will include two teams. One team will develop the forward translation (English to selected native language) and a second team will independently conduct a back-translation (native language translation to English). Both teams operate under one or two Primary Investigators (also referred to as Translation Leads), but otherwise are independent for this phase of the program.

For each team, at least one movement disorder specialist is required who is fluent in English and the native language. Other specialists (professional translator, linguist, cultural expert etc) are optional.

The proposed list of these two teams and the raters who will participate in the validation phase will be submitted to the Chairs of the MDS Rating Scales Program, Dr. Glenn Stebbins and Dr. Pablo Martinez-Martin. This will be shared with members of the MDS Translation Steering Committee. Current members of the Translation Steering Committee include: Christopher Goetz, Glenn T. Stebbins, Pablo Martinez-Martin, Nancy R. LaPelle, and Sheng Luo. The Translation Steering Committee will grant approval to initiate the translation program.

The PI for each language group will agree on behalf of the team to publication guidelines. 

Assessment Type:

Phase I:
Translation and back-translation

A forward translation will be developed by an independent translation team. Translations should be developed with an emphasis on meaning as opposed to a word by word literal translation. Following completion, a second team will independently translate the scale from the native language into English. Any discrepancies should be reviewed and corrected. The translation must include all pages of the MDS-UPDRS including the introductory page and the score sheet. It is recommended that the English MDS-UPDRS be used as a template for the new language translation so that the appearance and format of the scales are uniform.

MDS does not develop translations for a specific dialect or region. All language translations should be conducted to provide facile tools that can be used in any population utilizing a given language based on standard grammar and terminology. For these programs, the translation development team should consider the international representation of a given language to make it broadly applicable.

Once completed, both the forward translation and the back translation will be submitted to Dr. Luo, Dr. Stebbins and the MDS Secretariat along with the final reconciled translation. A review will be conducted of the translation by Drs. Luo and Stebbins and a report will be submitted to the Translation Steering Committee.

The Translation Steering Committee will review the original submission and the critique of the back translation. Based on this review, revisions will be requested or the documents will be approved for Cognitive Testing.

The translation should be provided to the MDS Secretariat for a format review at this stage. The MDS copyright statement, “Copyright © [year] International Parkinson and Movement Disorder Society (MDS). All rights reserved.” will be included by the MDS Secretariat and the provisionally approved translation will be returned to the local translation team. A translation of the copyright statement can be provided.

Phase II:
Cognitive Pre-testing

The provisionally approved translation will be administered in a set of approximately 10 PD patients for cognitive pre-testing. This phase will identify potentially culturally sensitive or complex items.

Questions will be asked to the patients and examiners after each targeted item in order  to assess patient and examiner understanding and comfort, using a guide (in English) prepared by a cognitive specialist (Nancy LaPelle). This guide should be translated into the native language by the translation team. The guide does not need to be back translated into English.

The translated cognitive pretesting guide will be used in conjunction with the translated scale to create language specific cognitive pretesting packets to be used during cognitive pretesting.  These packets will be reviewed by the Translation Steering Committee.

After statistical review by Dr. LaPelle of the data collected from the PD population, recommendations regarding problem areas will be sent to the translation team. In the event that major issues are identified, forward and back-translation changes may be needed. For minor issues, a response from the translation team (in English) to Dr. Luo and Dr. Stebbins should be submitted and will be reviewed by the Translation Steering Committee for provisional approval of the translation that will now be fully tested (Phase III).

If major problems are identified during the first round of cognitive pretesting, additional rounds may be required.

Once the translation is completed and approved, it will be termed the “Official Working Document” The MDS Secretariat may license the scale to clinical trials interested in using the MDS Official Working document with the understanding that the scale has only completed the cognitive pre-testing phase.

Phase III:
Large-scale validation testing.

Each translation team will administer the MDS-UPDRS to 350 PD patients on one visit. These patients should be native speakers of the language being tested and should represent a wide demographic of native language speakers. The patient sample should include samples from different ages, genders, severities of PD, geographical regions and educational levels.

Data entry and analysis: Sites will be encouraged to collect data through the MDS-UPDRS score sheets. Data collection sheets will be provided by the MDS Translation Steering Committee which includes subject registration page for demographic/disease-related variables, and the MDS-UPDRS score sheet where can be recorded. Scanned copies of the score sheets should be created into a single PDF file and submitted via a secure server to Dr. Luo. Alternatively, paper copies of score sheets can be mailed. Please ensure that identifying information such as the patients name is not included on any material. Statisticians in this program will provide the analyses required for verification of the translation. Other analyses that individual groups from each country wish to conduct can be handled by the team for each country and are not part of this program. Questions regarding individual sub-analyses and access to data will be directed to Dr. Luo and Dr. Stebbins.

Primary outcome for designation of approval: confirmatory factor analysis will be run against the established English version factor structure by each part. To be designated as an official translation, Comparative Fit Index (CFI) of the final model for each part of MDS-UPDRS must be ≥ 0.9 relative to the English version.

Once the translation has been completed and approved by the Translation Steering Committee, the statement “MDS Official Translation” will also be included in the footer of the translation and it will be posted on the MDS website. Permission to use the translation is required.

Sample Size: There will be 350 subjects from each translation program spread among several sites. This calculation is based on the need for 5 subjects per item of the questionnaire in order to perform the statistical tasks needed to validate the instrument. There are 65 items on the MDS-UPDRS.

Inclusion Criteria: Patients with Parkinson’s disease fluent in the native language of the site.

Exclusion Criteria: Patients cannot be included if they do not have Parkinson’s disease. Further, they cannot be included if the language translation being tested is not the native language of the patient. 

Study Intervention: None

Primary Outcome Measure: The MDS-UPDRS factor scores and CFI of the final model for each part of the MDS-UPDRS.

Statistical Analysis: A confirmatory factor analysis will be run against the established English-version factor structure, by part. This will be done by Dr. Luo’s team.

Caveats: Translation Leads are invited to serve on the MDS Translation Committee. From time to time, additional review of the translation may be requested. Translation committee members are requested to assist with translation specific inquiries from the MDS Secretariat. Translation leads may be requested to assist with future language translations of other MDS-owned scales as members of the MDS Translation Committee. 

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