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Back translations - useful or waste of time?

Back translations - useful or waste of time? medical translationAnybody doing translation work related to clinical trials knows that so-called "back translations" are a fact of life - most drug companies rely on back translations as a QA tool by comparing the back translation and the source to one another.

However, any translation that is done well will depart from the semantics and structure of the original source language. Grammar is inherently diverse across different languages, and the translator will retain the meaning of the translation, rather than the original grammatical properties of the source text.

Not surprisingly then, there exists a healthy debate on the use and usefulness of back translations.

In our experience, the usefulness of back translations is highly dependent on the content that is being translated. In the context of informed consent forms, the consensus is that back translation should be performed to ensure that the language is a correct translation of the original, i.e., the meaning was not changed but also that the readability of the text has not been affected through the translation process. Additionally some Institutional Review Boards have made back translations a necessary step in the approval process.

For patient reported outcomes, back translations are a necessary part of the validation and cultural adaptation of the instrument for specific markets. The process includes conducting two back translations and harmonization with the original translation to accommodate the findings of the back translation.

Other content, for instance technical material or advertising and marketing material, may be better suited for an in-country review or an additional copy edit or adaptation step.

The bottom line? Use back translations with caution. It is not a silver bullet, and it can be a time-consuming and expensive task. But when employed correctly, back translations are a highly effective validation tool.

For more on the case for - and against - back translations, take a look at the following:

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  1. Paulina said...
    I don't see any advantage that back translation might have over proofreading. It definitely takes more time and costs more, while it does not check anything: the translator doing back translation is just as likely to make a mistake as the one who translated the text "forward". Moreover, I don't see how comparing the text and the back translation could validate the translation. Another person would be needed here to determine if the differences (which are bound to occur in this game of Chinese-whispers) are due to some linguistic factors or indeed change the meaning.
    Anonymous said...
    Back translation would be valid if there were a harmonization step conducted by and with qualified people. The problem I see with all these steps, including and especially so-called editing/proofing/reviewing, is that the reviewer is a usually competitor of the translator and thus has an agenda to tear apart the original text since agencies are too cheap to do this themselves, in-house, as objective professionals experienced and trained in this process) and because these outside editors/reviewers are often hired- on-the-cheap, non-native speakers or people with little experience in medical texts. They are often sloppy and can ruin the quality of an excellent translation. Back-translations are supposed to be somewhat literal and done properly, by professionals, well-trained and experienced in the sector or field in question, are a valid way to identify unclarities in the forward translation. It is dependent upon the people working on all of these steps not on the techniques (back-translation versus editing)themselves. As long as the cheap translator and the over demanding client exists, with agencies that make unrealistic promises and then extract their meager profits on the backs of the translators, this problem will continue.
    Lahiri said...
    In my view it is a utter wastage of time and money . If the CRO people cannot to take a call to find a good translation service and followed by proper understanding of the translated material with a person knowing that language , then in my view by creating several version of forward and backward translation , we are the mercy of translator.
    Anonymous said...
    I think it could be a valid step for languages for which a client does not have a native speaker reviewer for example. It is an expensive form of validation though, and I think proofreading of the original translation is more cost-effective as it can add quality to the original translation. I agree with Paulina, basically. Anyway, it could be useful in some cases if and only if done by professional backtranslators.
    Another consideration is time. It is very time-consuming to go over the possible mismatches, or issues and see if the original translation needs to be changed or not.
    Barbara Thomas said...
    Back translations are an expensive and haphazard procedure. When made by a translator without access to the original source document, the difference between the original source and the back translation may be so great that it is difficult to judge whether the target document has been correctly translated, even when it has been done properly.
    Careful review of a translation aligned with the source document by an expert linguist may be a less expensive alternative, but a standard operating procedure would be useful as a guide to such a review.
    UNIT said...
    As the article refers to, Patient Reported Outcomes often use validated assessments or scripts where any variation can call the results into question. I work with IVRS and the requirement is that all translations go through a back translation as part of the process. That being said, it is an assumed requirement and I don't recall any sponsor questioning the true value of this extra step.
    Barbara Thomas said...
    This is an aside, but I often think that clients would benefit from taking the time to create multilanguage templates for certain segments of their clinical trial documents (e.g, much of the ICF). The effort being dedicated to the eCTD is proportional to the cost inherent to using nonstandardized documents and then multiplying these costs by various languages.
    Simon Andriesen said...
    The topic of back translations often provokes a lot of emotions. And if back translations are done on the cheap, just to comply with some requirement, self-imposed or not, or in case the FDA shows up for an audit, it truely is a waste of time. It is also a waste of time when it is simply used to check the quality of the what in this context is called 'forward' translation. We all know that there are better and more efficient ways to do QA, such as an extra heavy edit round.

    But, QA is not (or should not be) the main point. The point of a back translation is that multiple-language versions of (in many cases) a medical questionnaire are generated. I would agree with Dan Lufkin who writes that people who hate doing back translations should stay away from them. Back translations should be taken extremely seriously. A proper back translation should include lots of comments and remarks about the content of the forward translation. It should focus on 'equivalence' between the original and the translation. A back translation should only start after the forward translation is complete. There are organisations managing series of medical questionnaires that require a method of double forward translations and editing, then reconciliation of those 2 translations into 1 ideal version, and only then (and not earlier) start with the back translation, again by 2 back translators and followed by again reconciliation of those 2 back translations. Back translators also must be aware that they are making a back translation. Otherwise they would silently iron away weak parts and errors in the forward translation.

    To do a cheap forward translation and then have it back translated just for the sake of having it done, creates a very false sense of safety. CROs and translation vendors who simple do a back translation to check the quality of a poor forward translation miss the point completely.
    Joanne said...
    Earlier this week, I was asked to review the back-translation (FR>EN) of a clinical trial protocol synopsis. The poor quality of the BT (as a translation) got me thinking about the value of the whole back translation process...

    If the end client had gotten this "raw" BT, it would not have reflected the original message that is being delivered to the target audience and thus quite misleading.

    So now I know that a BT only has value as a QA step if the translator doing the BT is competent! I agree with Simon that the person doing the BT should go beyond only translating the text and aim to ensure that the correct meaning is being conveyed... then add comments where ever there are discrepancies.
    Anne Seerup said...
    I think it is a complete misunderstanding of how languages and translation work - a ridiculous procedure invented by people with no language skills. Anyone who as worked with any kind of dating of written sources, knows the each time a new writer is involved it veers even further from the original. Recently I was contacted to clear up some issues a client was having with a BT. They were discussing this back and forth like flies trapped next to an open window, treating the BT as if it were a separate entity. So wondering hard how the BT should be and whether it was correct, and really wondering what it was to begin with. Many of the issues and how they had arisen were instantly clear to me simply by looking at the original and the translation. In my humble opinion it is a complete waste of time and money, when you could just hire qualified translators and revisers to do a thorough revision comparing source and target.
    Chris said...
    I think back translation is useful in cases where exact terms have to be used, like medical, legal or technical terms. When it comes to general documents, back translation won't be necessary as the translation work is verified by an editor and a proofreader - if the translation is done by a company. When it comes to freelancers, back translation is advisable as there are no proofreaders involved.

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