{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T12:44:44Z","timestamp":1789908284069,"version":"4.0.1"},"reference-count":23,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2025,4,17]],"date-time":"2025-04-17T00:00:00Z","timestamp":1744848000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Achalasia, a rare esophageal disease marked by dysphagia, impacts health-related quality-of-life (HRQoL), measurable by disease-specific tools like achalasia-specific questionnaire (ASQ) that assess symptom severity and QoL. However, to ensure its reliability and validity across different populations, cross-cultural adaptation is necessary. So, for this reason, this study aimed to validate an Urdu-translated version of an ASQ in a Pakistani population of achalasia patients.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methodology<\/jats:title>\n<jats:p>A prospective cross-sectional study involving 52 participants was conducted at the Center for Liver and Digestive Diseases, Holy Family Hospital, Rawalpindi. ASQ was translated into the Urdu language by a forward-backwards translation process with expert input. Validation included factor analysis, known-group techniques, Cronbach\u2019s alpha for reliability, and an independent t-test comparing ASQ scores with Eckardt scores for criterion validity.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Among 52 participants (27 males, median age 30 years; 25 females, median age 48 years), 63.5% had Achalasia type I, 26.9% type II, and 9.6% type III. Factor analysis confirmed a well-defined construct with good validity, and internal consistency was strong (Cronbach\u2019s alpha = 0.89). The ASQ scores significantly correlated with Eckardt scores (p &lt; 0.05), confirming its validity. 73.1% of participants found the translated version easy and completed in a short time duration.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Urdu-translated ASQ proved to have good psychometric properties, with strong evidence of validity, reliability, and feasibility regarding health status in Pakistani achalasia patients. It can be recommended as a reliable QoL measure for clinical and research purposes. Future studies should explore its application in larger, more diverse cohorts and further refine its use in achalasia management.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0321933","type":"journal-article","created":{"date-parts":[[2025,4,17]],"date-time":"2025-04-17T17:26:33Z","timestamp":1744910793000},"page":"e0321933","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Urdu adaptation and validation of a disease-specific quality-of-life questionnaire in a Pakistani population of Achalasia"],"prefix":"10.1371","volume":"20","author":[{"given":"Sameen","family":"Abbas","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed Sikandar","family":"Shah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tayyab Saeed","family":"Akhhtar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiran","family":"Hameed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saima","family":"Mushtaq","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6006-4159","authenticated-orcid":true,"given":"Amjad","family":"Khan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,4,17]]},"reference":[{"issue":"1","key":"pone.0321933.ref001","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1038\/s41572-022-00356-8","article-title":"Achalasia","volume":"8","author":"E Savarino","year":"2022","journal-title":"Nat Rev Dis 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Achalasia Quality of Life and Eckardt scores for assessment of clinical improvement post treatment for achalasia","volume":"34","author":"S Slone","year":"2021","journal-title":"Dis Esophagus"},{"issue":"8","key":"pone.0321933.ref006","doi-asserted-by":"crossref","first-page":"1668","DOI":"10.1111\/j.1572-0241.2005.50141.x","article-title":"A measure of disease-specific health-related quality of life for achalasia","volume":"100","author":"DR Urbach","year":"2005","journal-title":"Am J Gastroenterol"},{"issue":"7","key":"pone.0321933.ref007","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1016\/j.jclinepi.2010.02.006","article-title":"The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes","volume":"63","author":"LB Mokkink","year":"2010","journal-title":"J Clin 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for COPD (SGRQ-C) after adaptation to Malaysian language and culture, in patients with COPD","volume":"18","author":"AU Rehman","year":"2020","journal-title":"Health Qual Life Outcomes"},{"issue":"7","key":"pone.0321933.ref011","doi-asserted-by":"crossref","first-page":"2209","DOI":"10.3390\/ijerph17072209","article-title":"Physicians\u2019 understanding and practices of Pharmacovigilance: qualitative experience from a lower middle-income country","volume":"17","author":"R Hussain","year":"2020","journal-title":"IJERPH"},{"issue":"1","key":"pone.0321933.ref012","first-page":"2","article-title":"Validating instruments of measure: is it really necessary?","volume":"8","author":"PS Lai","year":"2013","journal-title":"Malays Fam Physician"},{"issue":"6","key":"pone.0321933.ref013","doi-asserted-by":"crossref","first-page":"1300","DOI":"10.1016\/S0016-5085(99)70493-2","article-title":"Chest pain in achalasia: patient characteristics and clinical course","volume":"116","author":"VF Eckardt","year":"1999","journal-title":"Gastroenterology"},{"issue":"4","key":"pone.0321933.ref014","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1007\/s10388-023-01008-w","article-title":"The relationship between manometric subtype and symptom details in achalasia","volume":"20","author":"H Hosaka","year":"2023","journal-title":"Esophagus"},{"issue":"6","key":"pone.0321933.ref015","doi-asserted-by":"crossref","first-page":"2992","DOI":"10.1080\/03610918.2019.1705344","article-title":"Discrimination with unidimensional and multidimensional item response theory models for educational data","volume":"51","author":"M Ul Hassan","year":"2019","journal-title":"Commun Stat Simul Comput"},{"issue":"4","key":"pone.0321933.ref016","doi-asserted-by":"crossref","first-page":"99","DOI":"10.9790\/0837-194399104","article-title":"The strengths and weaknesses of research methodology: comparison and complimentary between qualitative and quantitative approaches","volume":"19","author":"LT Choy","year":"2014","journal-title":"IOSRJHSS"},{"issue":"1","key":"pone.0321933.ref017","doi-asserted-by":"crossref","first-page":"19","DOI":"10.37231\/apj.2020.3.1.121","article-title":"A review on the internal consistency of a scale: the empirical example of the influence of human capital investment on Malcom Baldridge quality principles in TVET Institutions","volume":"3","author":"FA Nawi","year":"2020","journal-title":"APJ"},{"issue":"12","key":"pone.0321933.ref018","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1007\/s11894-021-00831-4","article-title":"Beyond the Eckardt score: patient-reported outcomes measures in esophageal disorders","volume":"23","author":"YC Dorsey","year":"2021","journal-title":"Curr Gastroenterol Rep"},{"key":"pone.0321933.ref019","first-page":"189","volume-title":"Cross-cultural considerations in health-related quality of life in cancer. 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