Arabic validation of TANGO questionnaire for nocturia: translation into the Arabian Peninsula dialect.

Altaweel W1, Seyam R1, Alrumayyan M1

Research Type


Abstract Category


Abstract 149
E-Poster 1
Scientific Open Discussion ePoster Session 7
Wednesday 4th September 2019
13:20 - 13:25 (ePoster Station 8)
Exhibition Hall
Nocturia Questionnaire Voiding Dysfunction
1.King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.

Waleed Altaweel




Hypothesis / aims of study
Nocturia has become increasingly recognized as a significant lower urinary tract symptom and a major cause of bothersomeness among patient. TANGO (Targeting the Aetiology of Nocturia to Guide Outcomes) is a validated English language tool that was recently developed to identify underlying factors leading to nocturia (1). Culturally validated Arabic language translation is needed for utilization in the Arabian Peninsula. We set out to provide a culturally correct Arabic version of the TANGO questionnaire in our country.
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.
Concluding message
The Arabic language translation of TANGO questionnaire is a valid tool in the dialect of the Arabian Peninsula. It is valid among different ages and geographical locations of the region. It is a most needed tool for the assessment of patients with nocturia in this area.
Figure 1 Table 1. Demographics of patients.
  1. Bower WF, Rose GE, Ervin CF, Goldin J, Whishaw DM, Khan F. TANGO - a screening tool to identify comorbidities on the causal pathway of nocturia. BJU Int. 2017 Jun;119(6):933-941.
Funding None Clinical Trial No Subjects Human Ethics Committee King Faisal Specialist Hospital Office of Research Affairs, Research Ethics Committee. Helsinki Yes Informed Consent No