Linguistic Validation

RWS is the preferred and trusted authority for linguistic validation and management of Clinical Outcomes Assessments (COA). 

Whether intended for a patient (PRO/PerfO), clinician (ClinRO), or observer (ObsRO), our translations are accurate and culturally and conceptually equivalent to the source instrument.

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Our expertise in translating COAs comes from our experience linguistically validating over 20,000 COAs into 500+ language pairs in over 200 different specific therapeutic/disease areas, including cardiovascular, allergy/respiratory, oncology, gastroenterology, inflammation, neurology, infectious diseases and vaccines. 

Our global relationships with translators, interviewers, instrument developers, survey research experts, clinicians and in-country reviewers allow us to expedite each linguistic validation project with ease and scientific accuracy.

We are experts in translating Clinical Outcomes Assessments (COAs)

  • PRO Questionnaires 
  • ClinRO Questionnaires 
  • ObsRO Questionnaires 
  • PerfO Questionnaires 
  • eCOAs 
  • Abstracts & Manuscripts 
  • Patient Diaries


Our state-of-the-art linguistic validation process and COA value-add services ensure both accuracy and timely completion of documents. 

Our linguistic validation process is modeled on the U.S. Food and Drug Administration PRO guidance document as well as on the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Good Practice recommendations. 

The linguistic validation process includes the following key steps:

  • Concept elaboration
  • Clinician review
  • Dual forward translation 
  • Client subsidiary review 
  • Harmonization 
  • Recruitment of patients 
  • Back-translation 
  • Cognitive debriefing of patients 
  • Survey Research Analyst review 
  • Validation reports and certifications
  • Developer review 

We manage the entire life cycle of your COA translations. Our approach provides an array of support services designed to save you time and increase your ROI:

  • Abstract, poster, and manuscript development 
  • Instrument maintenance, including instrument-specific website creation 
  • COA licensing and copyright services 
  • Instrument research 
  • COA repository creation and maintenance 
  • Qualitative (i.e. Usability Testing) and Quantitative (i.e. Equivalence Testing) of eCOAs 
  • COA Translation, Harmonization, Back translation and Cognitive Debriefing 
  • Recruitment of clinician reviewers by therapeutic area 
  • Developer coordination 
  • Translatability assessments
  • eCOA strategy, consulting, and adaptation 

With more and more sponsors using electronic devices to conduct their clinical trials, it is extremely important that the eCOAs are developed and linguistically validated with the same level of precision as traditional paper COAs. Partnering with RWS ensures a thorough review and proper linguistic validation of the adapted instrument for use on an eCOA or ePRO device when required. 

Our experience and expertise in this area have led us to develop a series of best practices for eCOAs including: 

  • Upfront communication between sponsor, eCOA vendor and translation provider 
  • Close coordination throughout project between all three parties via regular teleconferences 
  • Bank of validated eCOAs for future use by the client 
  • Documentation that eCOAs match validated translations 
  • Font pre-test 
  • eCOA device training where applicable

Developer Relations

We understand the complex nature of creating COAs for inclusion in multinational clinical trials. Our meaningful relationships with instrument developers have led to the creation of COA instrument websites. These websites are designed to facilitate the availability and use of these instruments. Each site contains a description of the instrument, instructions for obtaining permissions to use the instrument, an updated list of available translations, developer biographies, related research and more. 

Instrument developers interested in learning more about how we may assist in creating a website to promote the use of an instrument, or sponsors seeking more information on the linguistic validation of COA instruments can contact us via email.

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