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VOLUME 1, ISSUE 2, 2018; ABSTRACT, POSTER PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: 
https://doi.org/10.33137/cpoj.v1i2.32017                                                                         

 

1 

 
OPEN  ACCESS 

 

AOPA’S 101 ST NATIONAL ASSEMBLY ABSTRACTS, SEPTEMBER 26-29, VANCOUVER, CANADA, 2018 
 

ABSTRACT (POSTER PRESENTATION) 

JAPANESE TRANSLATION OF THE PROSTHETIC LIMB USERS SURVEY OF 

MOBILITY 

Geoffrey Balkman*, Soshi Samejima, David Aoki, Brian J. Hafner 

Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA. 

* Email: gbalkman@uw.edu 

DOI: https://doi.org/10.33137/cpoj.v1i2.32017  

 

INTRODUCTION 

Patient-reported outcome measures (PROMs) are used 

by prosthetists to assess and communicate effectiveness 

of prosthetic interventions. The Prosthetic Limb Users 

Survey of Mobility (PLUS-M) is a PROM developed to 

evaluate lower limb prosthetic mobility.1 Valid and 

reliable translations of prosthetics-specific PROMs, like 

PLUS-M, do not exist for Japanese-speaking patients. 

The purpose of this research was to translate PLUS-M to 

Japanese using rigorous translation guidelines in order to 

maintain the meaning and applicability of items across 

both languages.  

METHODS 

Translation efforts followed recommended processes and 

best practices.2 First, PLUS-M items (n=44), response 

options and instructions were independently translated 

by investigators from English to Japanese. Translators 

met with the principal PLUS-M developer to discuss the 

forward translations and resolve any discrepancies. 

Reconciliation guidelines3 were used to code and 

document decisions. The reconciled translation was 

back-translated from Japanese to English by a bilingual 

collaborator. Investigators compared the back-translation 

relative to the English instrument, and the developer 

identified items that required modification. All 

translations and revisions were recorded in a 

comprehensive translation document. Four expert 

reviewers in Japan evaluated the translation and provided 

additional suggestions for revisions.  

RESULTS 

Twenty-one items had to be removed or revised in the 

translation process. One item without a comparable 

situational context was removed during forward 

translation. The PLUS-M item that described shag (high-

pile) carpet was removed because that type of carpet is 

not common in Japan. Seventeen items were revised 

grammatically to  maintain the intended purposes of the  

original English items. For example, a PLUS-M item that 

asks respondents how well they can “step off” an 

escalator was back-translated as how well one could “get 

off” the escalator. The investigators added additional 

terms to the translation (i.e., “get off an escalator step 

over step”) to ensure the item was read and interpreted as 

intended. More substantial revisions were made to three 

items to address cultural or environmental differences. 

For example, the expert reviewers noted that the term 

“block” in the PLUS-M item, “Are you able to walk a 

block on flat ground?” does not translate to Japanese. The 

investigators, in consultation with the expert reviewers, 

suggested the phrases “from one traffic light to the next,” 

“50 – 100 meters,” or “from one intersection to the next,” 

could be used as alternatives. The developer preferred the 

phrase with “intersection.” This revision changed the 

original item, but was understandable in Japanese and 

aligned with the developers’ intended meaning (i.e., 

walking moderate distances outdoors). The final 

translated items were used to create 7- and 12-item short 

forms suited to administration in clinics or research 

studies (Figure 1). 

 
 Figure 1. Japanese translation of PLUS-M short form 

 

mailto:*%20Email:%20gbalkman@uw.edu
https://doi.org/10.33137/cpoj.v1i2.32017


 

 

Balkman G, Samejima S, Aoki D, Hafner B.J. JAPANESE TRANSLATION OF THE PROSTHETIC LIMB USERS SURVEY OF MOBILITY. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, 
VOLUME 1, ISSUE 2, 2018; ABSTRACT, POSTER PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: 
https://doi.org/10.33137/cpoj.v1i2.32017                                                                         

 

2 

 
OPEN  ACCESS 

 

AOPA’S 101 ST NATIONAL ASSEMBLY ABSTRACTS, SEPTEMBER 26-29, VANCOUVER, CANADA, 2018 
 

ABSTRACT (POSTER PRESENTATION) 

CONCLUSION 

The PLUS-M Japanese version is ready for testing by 

prosthetics experts in Japan. Cognitive interviews with 

Japanese prosthesis users will assess the clarity and 

comprehensiveness of items. Large-scale administration 

and comparison to US norms will be conducted to 

quantitatively assess equivalence between the original 

and the Japanese translation of PLUS-M .  

SIGNIFICANCE 

International and cross-cultural comparisons of key 

health outcomes, like mobility, can help to assess the 

relative effectiveness of prosthetic interventions. Use of 

standardized outcome measures, like PLUS-M, can 

facilitate comparisons and improve the standard of care 

worldwide.  

REFERENCES 

1. Hafner BJ, et al. Construct validity of the Prosthetic Limb 

Users Survey of Mobility (PLUS-M) in adults with lower limb 

amputation. Arch Phys Med Rehabil. 2017;98(2):277- 5. 

DOI:10.1016/j.apmr.2016.07.026 

2. Eremenco SL, et al. A comprehensive method for the 

translation and cross-cultural validation of health status 

questionnaires. Eval Health Prof. 2005;28(2):212-32. 

DOI:10.1177/0163278705275342 

3. Koller M, et al. The process of reconciliation: evaluation of 

guidelines for translating quality-of-life questionnaires. Expert 

Rev Pharmacoecon Outcomes Res. 2012;12(2):189-97.  

DOI:10.1586/erp.11.102 

 

DISCLOSURE 

There is no current or pending support pertaining to this 

project. 

 ACKNOWLEDGEMENTS  

The authors thank Toshiki Kobayashi, PhD, Kazuhiro Sakai, 

Masanori Shimamura CPO, and Noriaki Maeda, PhD for their 

review of the PLUS-M Japanese translation. 

 

 

 

https://doi.org/10.1016/j.apmr.2016.07.026
https://doi.org/10.1177/0163278705275342
https://doi.org/10.1586/erp.11.102

