Translation and piloting of the Chinese Mandarin version of an intensive care-specific pressure injury risk assessment tool (the COMHON Index)

Objective
To translate an intensive care-specific pressure injury risk assessment tool (the COMHON Index) from English into Chinese Mandarin.

Methods
A four-step approach to instrument translation was utilised: 1) English-Mandarin forward-translation by three independent bilinguists; 2) Mandarin-English back-translation by two other independent bilinguists; 3) comparison of forward and back-translations, identification of discrepancies, with required amendments returned to step one; and 4) piloting of the translated instrument. The pilot study was undertaken in a Chinese surgical intensive care unit with a convenience sample of 20 nurses. A five-point ordinal scale (1 = very difficult; 5 = very easy) was used to assess ease-of-use and understanding. Translations were retained where medians ≥ 4 indicated use and understanding was easy to very easy.

Results
Five iterations of steps 1 to 3, and two sets of amendments to the original English instrument, were required to achieve translation consensus prior to pilot testing. Subscale scoring, sum scoring, and risk categorisation were documented in most pilot assessments (≥ 80%), but three sum scores were incorrectly tallied. The overall tool and all subscales were easy to use and understand (medians ≥ 4), and most assessments (16/20, 80%) took ≤ 5 min to complete. Thus, translations were retained, with minor amendments made to instrument instructions for scoring and risk categorisation.

Conclusions
An easy-to-use Chinese Mandarin intensive care-specific pressure injury risk assessment tool has been introduced through cross-cultural translation. However, it requires further testing of interrater reliability and agreement. A rigorous translation and reporting exemplar is presented that provides guidance for future translations.