Abstract
BACKGROUND: Vertebral fractures associated with osteoporosis are common in individuals over 65, yet most cases go undiagnosed. This is concerning as those with vertebral fractures are at an increased risk of future fractures. To address this gap in healthcare, and facilitate diagnosis, so that bone-protective medications can be initiated, we developed and validated a clinical decision tool called 'Vfrac'. Vfrac assists healthcare professionals in determining whether an older person with back pain requires a spinal radiograph to diagnose vertebral fractures. However, because Vfrac was developed in English, it remains inaccessible to non-English speakers. Given the high prevalence of vertebral fractures in South Asians, our study aimed to translate Vfrac from English to Urdu using a cross-cultural adaptation approach based on a standardised framework. METHODS: Vfrac was translated into Urdu by five independent translators who were provided with information about the tool's purpose and its components. Five different translators then back-translated the Urdu versions into English. A group of bilingual healthcare professionals and members of the public who spoke both English and Urdu reviewed and discussed the translations in reference to the original English questionnaire. The group selected the translations that best conveyed the intended meaning of each question, producing a final Urdu version of Vfrac. A bilingual healthcare professional conducted a final review and audio-recorded the Urdu Vfrac for accessibility. RESULTS: The group of bilingual adults consisted of two healthcare professionals and three lay members, of whom four were female, and all aged 25 to 69 years. The final translated version of Vfrac written in Urdu was produced, ensuring it accurately reflected the original English version's meaning. To improve accessibility, an audio-recorded version was also created. CONCLUSIONS: This study successfully adapted an English language clinical checklist, Vfrac, into Urdu through a structured cross-cultural adaptation process. To enhance accessibility and address healthcare disparities we strongly recommend incorporating audio-recordings alongside written translations. STUDY REGISTRATION: This study received ethical approval by the Faculty of Health Sciences Research Ethics Committee (FREC Ethics Ref: 13801) on the 27th of April 2023.