The cross-cultural adaptation of a health status questionnaire or tool for use in a new country, culture, and/or language requires a unique methodology in order to reach equivalence between the original source and target languages. It is now recognized that if measures are to be used across cultures, the items must not only be translated well linguistically, but also be adapted culturally to maintain the content validity of the instrument across different cultures. In this way, we can be more confident that we are describing the impact of a disease or its treatment in a similar manner in multi-national trials or outcome evaluations. The term "cross-cultural adaptation” is used to encompass a process which looks at both language (translation) and cultural adaptation issues in the process of preparing a questionnaire for use in another setting (Hill et al. & Kirwan et al.cited Beaton’s et al. 2000). The process of cross-cultural adaptation strives to produce equivalency based on content. This suggests the other statistical properties such as internal consistency, validity and reliability might be retained. However, this is not necessarily the case. For example, if the new culture has a different way of doing a task included within a disability scale that makes it inherently more or less difficult to do relative to other items in the scale, the validity would likely change particularly in terms of item-level analyses (such as item response theory, Rasch). Further testing should be done on an adapted questionnaire to verify the psychometric properties. What's your opinion?