Translation and cross-sectional validation of the achalasia patient reported outcomes questionnaire in a Dutch cohort

Abstract Background The Achalasia Patient Reported Outcomes (APRO) questionnaire is developed to assess the frequency and severity of achalasia symptoms in adults with achalasia. The aim of this study was to translate the APRO questionnaire in Dutch, validate the translation and validate the questionnaire in the adult and pediatric achalasia population. Methods In this cross-sectional validation study, English-Dutch forward-backward translation was conducted followed by cognitive debriefing. Field testing was performed between April 2024 and January 2025 in three groups: adults with achalasia, children with achalasia and parents of the included children. Reliability was assessed using Cronbach’s alpha and split-half reliability, while validation was evaluated with principal factor analysis and known-group method. Convergent validation was performed by correlating the APRO questionnaire with other validated questionnaires. Results Cognitive debriefing indicated good understanding of the translated APRO questionnaire by the three groups. In total 111 adults, 30 children (minimum age 10 years) and 27 parents (one of each of the included children) were included for field testing. Internal reliability was high with Cronbach’s alpha of 0.91 for adults, 0.78 for children and 0.86 for parents, and split-half reliability indicated strong consistency. Principal factor analysis did not reveal any subscales. The APRO questionnaire was able to distinguish between active disease (Eckard > 3) and remission (Eckardt ≤ 3) and correlated strong with other questionnaires including Eckardt score, achalasia-specific quality of life and reflux questionnaires. Conclusions The APRO questionnaire is a valid and reliable tool to evaluate achalasia symptoms in adult and pediatric achalasia population and validated for use in the Netherlands.