Study design, materials and methods
The project was approved by the institution's IRB. The original English version was forwarded translated into Arabic by native Arabic speaking translators with English as a second language. A first consensus meeting was held to select the most appropriate Arabic translation. Arabic questions with the highest tally score were selected. Those questions with a tie were resubmitted for another voting. The final questions were given to two native English-speaking translators with Arabic as their second language. The translators were blinded to the nature of the questionnaire or its source. A second consensus meeting was held to vote on the agreement between the original and back-translated English versions using a five-point Likert scale. An agreement score was computed for each question. Questions with agreement less than 75% were destined for retranslation. The final version was given to native Arabic speaking patients subsequently presenting in three urology clinics in two days. The patients were asked to fill the questionnaire on their own to assess the ease of comprehension and completeness of answering. Each individual was asked at the end yes or no questions: 1. Were the questions clear for you? 2. Did you feel that you needed help from a nurse or doctor to understand the questions? Age, sex, weight, height, residence and the presenting symptoms were recorded.
A total of 22 questions were translated by 14 translators, who included two professional translators, medical students, nurses, a general physician, urology residents, and urologists. Ten questions passed the first consensus meeting while 12 were submitted for re-voting. Back translation showed that only one question was misinterpreted, and the Arabic phrasing was changed to modify the confusing word. The mean agreement Likert score for all questions was 4.2 (84.4%) SD 0.2, range 3.9-4.6 (77.5-92.5). Fifty-seven patients answered the questionnaire. Thirty-five participants (61.4%) were local residents while the rest were referred from remote regions in the country. Demographics of the participants are shown in table 1. A total of 46 (80.7%) patients filled the questionnaire on their own, while 11 (19.3%) required assistance because of vision problems (n=3), illiteracy (n=6) or unclarity of the questions (n=2). Of the participants, 54 (94.7%) reported that the questions were clear enough to understand, while three stated that they felt they needed a medical staff member to help interpret some of the questions.
Interpretation of results
The Arabic translation of TANGO resulted in an Arabic version with a high agreement of the Original and Backward translations. Testing the questionnaire in urology patients was easily comprehended and completed. As TANGO is not a screening tool, only 57 consecutive patients were included to demonstrate the ease of comprehension and completing the questionnaire. Patients represented a wide range of age and BMI. As a tertiary care referral center, all regions of the country were represented. Measuring the detection rate of nocturia in two groups of patients with an established diagnosis of nocturia and those without the condition is needed in a larger number of patients with more diverse symptomology.