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International Parkinson and Movement Disorder Society
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Non-English Assessment Translation Application

* = required field

Please complete and submit this application to express your interest in leading a Non-English Translation Program for the MDS-UPDRS, UDysRS or MDS-NMS. This application will be reviewed by the Chairs of the MDS Clinical Outcome Assessment Program and MDS Translation Steering Committee. If you experience problems submitting this form, please email the MDS Secretariat at ratingscales@movementdisorders.org.

Scale:*
 MDS-UPDRS  UDysRS MDS-NMS  All		 Language:*
 Program Leader(s):*

Primary contact person for the Translation Program: *
Name:   Email: 


Translation Team Member Identification (Please identify up to three in each area)

Mark FE for member who is fluent in English
Mark NLS for member who is a native speaker of the target language
Mark MDS for movement disorder specialist

Translation Team Members*  
(One member must fulfill all three criteria)  
FE NLS MDS
FE NLS MDS
FE NLS MDS
Back-translation Team Members*  
(One member must fulfill all three criteria)  
FE NLS MDS
FE NLS MDS
FE NLS MDS
All team members have read the MDS Translation Program Protocol and publication guidelines and accept them*  Yes
(To view the MDS-established protocol and publication guidelines for non-English Translations, please visit: MDS Translation Program)
All team members agree to the statement below*  Yes

Translation team members agree that they read, comprehend and write in both languages and that the completed translation will be a true and accurate translation of the original to the best of their knowledge. Program leaders agree that a good-faith effort will be made to meet project timelines and communicate changes in timeline with MDS and the Chairs of the MDS Clinical Outcome Assessments Program.

Please provide the names of two movement disorder specialists who are NOT involved in this program, but could be used by the Steering Committee to review the translation independently.*
Name:   Email: 
Name:   Email: 

Budget: 

translation program will be responsible to procure its own funds to cover the costs and expenses associated with conducting the study locally. The MDS Secretariat can assist with seeking sponsorship for translation development.

To help each program make a reasonable budget, we provided an outline to cover the program components which include: conducting all components of the translation/back translation, local cognitive testing, collection of the 250, 300 or 350 patient sample for clinimetric testing for the UDysRS, MDS-NMS, and MDS-UPDRS, respectively, and data entry into the MDS-sponsored central repository. Please use the budget outlined below to provide the estimated project expenses in each area.
Non-English Language Program Team Budget Outline  
Protocol submission/IRB review/set up costs $  USD
Translation/Back-Translation $  USD
Local cognitive testing $  USD
Native speaker patient evaluations (350 for the MDS-UPDRS, 300 for the MDS-NMS or 250 for the UDysRS patient sample) $  USD
Data entry $  USD
Total Estimated Budget       $  USD

Process:

After submission of this application, the Translation Steering Committee will vote on your proposal. If approved, you will then need to procure the funds for local costs of the study and obtain approval from your local IRB or ethics committee. You may also contact MDS to assist with procuring sponsorship for program support. The MDS Secretariat will provide a Collaborative Research Agreement which will grant you permission to translate the scale and establishes that copyright of the translation is maintained by MDS. If the application is not approved, the Program Lead(s) will be contacted with suggestions and advice on improving the application.

Please list any pharmaceutical or foundation contacts who can be approached for sponsorship below.
Name Firm or Foundation Email Telephone