title: Translation, cross-cultural adaptation, and psychometric validation of the 5-item International Index of Erectile Function (IIEF-5) into Urdu.
abstract: BACKGROUND
  Patients suffering from erectile dysfunction (ED) feel shy to discuss this issue with their physician. Self-report questionnaires are a key instrument to break this barrier. Most of these questionnaires are in English, and their validated translations in Urdu, the official language of Pakistan, are not available.
  
  
  OBJECTIVE
  The aim of our study is to translate, cross-culturally adapt, and perform psychometric validation of an Urdu translation of the 5-item international index of erectile function (IIEF-5).
  
  
  METHODS
  The translation of IIEF-5 was done in Urdu and was refined through reverse translation and expert committee reviews. It was then pretested on 20 bilingual men and reviewed again to develop a final Urdu version of the questionnaire. We selected 47 patients who had been in a stable sexual relationship over the past 6 months and asked them to fill out the IIEF-5 questionnaire in both languages (Urdu and English), followed by evaluation of ED by a clinician, who was blinded to the responses of the patient to the questionnaire.
  
  
  METHODS
  The self-report to questionnaire and independent clinical assessment were compared. Patients refilled out the questionnaire again at the end of the interview to assess test-retest consistency. These data were now analyzed statistically using descriptive statistics, Cohen's kappa, and Cronbach's alpha analysis.
  
  
  RESULTS
  The Cohen's kappa showed a very high degree of agreement between the two versions (P < 0.0001), and a high degree of internal consistency was demonstrated on Cronbach's alpha analysis ([0.882] with 95% confidence interval [0.839-0.916]). The clinical assessment of the presence and severity of ED also matched with the self-report questionnaire.
  
  
  CONCLUSIONS
  We can safely conclude that this Urdu version of IIEF-5 is a valid instrument for use in the literate population of Pakistan.
authors.affiliation: Department of Medicine, KhairunNisa Hospital, Lahore, Pakistan.
authors.forename: Muhammad Asif
authors.initials: MA
authors.lastname: Mahmood
authors.forename: Khaleeq Ur
authors.initials: KU
authors.lastname: Rehman
authors.forename: M Amanullah
authors.initials: MA
authors.lastname: Khan
authors.forename: Tipu
authors.initials: T
authors.lastname: Sultan
mesh_terms: D003431:Cross-Cultural Comparison; D007172:Erectile Dysfunction / Q000175:diagnosis / Q000523:psychology*; D006801:Humans; D008297:Male; D010154:Pakistan; D010410:Penile Erection / Q000523:psychology; D011594:Psychometrics; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires / Q000592:standards; D014175:Translating