Dutch translation and cross-cultural adaptation of the LIMB-Q Kids questionnaire

doi:10.5312/wjo.v16.i10.109822

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Oct 18, 2025 (publication date) through Oct 27, 2025

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World Journal of Orthopedics

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2218-5836

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Prospective Study

World J Orthop. Oct 18, 2025; 16(10): 109822
Published online Oct 18, 2025. doi: 10.5312/wjo.v16.i10.109822

Dutch translation and cross-cultural adaptation of the LIMB-Q Kids questionnaire

Lea M Kessling, Veronique M Voorn, Johannes HJM Bessems, Anthony P Cooper, Harpreet Chhina, Jaap J Tolk

Lea M Kessling, Veronique M Voorn, Johannes HJM Bessems, Jaap J Tolk, Department of Orthopedics & Sports Medicine, Erasmus University Medical Center Sophia Children’s Hospital, Rotterdam 3015 GD, Netherlands

Anthony P Cooper, Harpreet Chhina, Department of Orthopedics, University of British Columbia, Vancouver V5Z 1M9, Canada

Anthony P Cooper, Department of Orthopedics, British Columbia Children’s Hospital, Vancouver V6H 3N1, Canada

Author contributions: Kessling LM and Voorn VM presented the data and did project administration; Kessling LM cognitive debriefed the patients, wrote the original draft and performed the review, and editing; Voorn VM, Bessems JHJM, Cooper AP, Chhina H, and Tolk JJ contributed to perform manuscript review and editing; Voorn VM, Cooper AP, Chhina H, and Tolk JJ contributed to conceptualization, study design and setup, methodology, discussion and interpretation of the translations within the scientific committee; Voorn VM, Chhina H, and Tolk JJ contributed to discussion and interpretation of the translations within the scientific committee; Voorn VM cognitive debriefed the patients; Bessems JHJM discussed and interpretated the study results; Tolk JJ was also responsible for supervision.

Institutional review board statement: This study was approved by the Ethics Committee of Erasmus University Medical (Approval No. MEC-2023-0402).

Clinical trial registration statement: Registration of this study in a clinical trials registry was not required, as it did not involve a clinical intervention and was limited to the collection of patient-reported outcome measures.

Informed consent statement: In accordance with Dutch legislation, written informed consent was obtained from both parents, and all children provided verbal assent or, if older than twelve years, written assent.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.

Data sharing statement: The dataset supporting the conclusions of this article can be obtained upon reasonable request. Final version of LIMB-Q Kids and the Dutch translation can be obtained from the original developers.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Jaap J Tolk, MD, PhD, Clinical Assistant Professor (Honorary), Senior Researcher, Department of Orthopedics & Sports Medicine, Erasmus University Medical Center Sophia Children’s Hospital, Dr. Molewaterplein 40, Rotterdam 3015 GD, Netherlands. j.tolk@erasmusmc.nl

Received: May 23, 2025
Revised: June 18, 2025
Accepted: September 1, 2025
Published online: October 18, 2025
Processing time: 146 Days and 13.7 Hours

Abstract

BACKGROUND

We aimed to translate and culturally adapt the LIMB-Q Kids questionnaire for use in the Netherlands. The LIMB-Q Kids is a patient-reported outcome measure designed to assess functional, psychosocial, and aesthetic aspects of living with a limb difference in paediatric populations.

AIM

To investigate the feasibility of a questionnaire in the Netherlands, which was translated into Dutch after having already been successfully translated and validated in several other languages.

METHODS

The translation and adaptation process followed best practice guidelines, including forward and backward translation, expert panel review, and cognitive debriefing interviews with patients. The interviews focused on the clarity and comprehensibility of the instructions, response options, and questionnaire items.

RESULTS

The rigorous process resulted in a linguistically and conceptually equivalent Dutch version of the LIMB-Q Kids questionnaire. While some challenges were encountered, no major difficulties were reported. The constructs and cultural relevance were found to be relatable to the Dutch context. Minor adjustments were made based on patient feedback, such as clarifying questions and modifying translations for technical terms.

CONCLUSION

We demonstrated the successful translation and cultural adaptation of the LIMB-Q Kids questionnaire for use in the Netherlands. By following best practices, the researchers have developed a version that is conceptually and linguistically equivalent to the original English version. The availability of this Dutch version will facilitate the assessment of outcomes in paediatric populations with limb differences, and potentially enable cross-cultural comparisons.

Keywords: Limb differences; Lower limb deformity; Children; Patient-reported outcome measure; Translation

Core Tip: This study demonstrates the successful translation and cultural adaptation of the LIMB-Q Kids questionnaire for use in the Netherlands. By following best practices, the researchers have developed a version that is conceptually and linguistically equivalent to the original English version. The availability of this validated Dutch version enhances the ability to assess patient-reported outcomes, supports cross-cultural research and comparisons, and can support improvement of patient-oriented pediatric orthopedic clinical care.