46 Chapter 3 Materials and Methods The English-language LORQv3 consists of 40 items divided into 2 primary sections. The first section contains 17 items that assess oral function, orofacial appearance, and social interaction. The second section assesses issues specific to prostheses and patient denture/prosthetic satisfaction [5]. LORQ items refer to problems and symptoms experienced during the previous week and are rated 1 through 4, representing “never,” “sometimes,” “often,” and “always” [6]. Finally, there is a comment section for patients to identify issues not adequately addressed by the questionnaire. The questionnaire is self-administered and takes approximately 10 minutes to complete. It is available online (http://www.headandneckcancer.co.uk). The LORQv3 was translated by 6 different translators into Dutch through the use of the forward-backward approach, following guidelines for cross-cultural adaptation of health-related quality of life (self-administered) measures [7, 8]. Four independent bilingual translators whose native language was Dutch performed the forward translation into Dutch. One of them was a prosthodontist and another a maxillofacial surgeon; the remaining 2 were professional translators with no medical or clinical background. The 4 forward translations were compared and synthesized into one common version by an expert panel (M.E., D.B.), consisting of 2 dentists/prosthodontists and 1 psychologist specializing in the field of dentistry. Competing options for a translation were debated until consensus was reached. The resulting consensus forward translation was translated back into English by 2 independent, professional translators whose native language was English. The 2 back-translations were again discussed by the expert panel, comparing equivalence between the 2 versions. The back-translations were reviewed against the original English language LORQv3 by the expert panel. Finally, the resulting LORQv3-NL was read and commented upon by a prosthodontist (C.vH.) outside the expert panel. To study the reliability and construct validity of the LORQv3-NL, a sample of 158 participants was recruited over a period of 2 years. The participants were enrolled during their procedure for new dentures at the dental faculty of Radboudumc in Nijmegen, or during regular examinations at the Centre for Special Oral Care of the Radboudumc in Nijmegen and Maastricht UMC+ in Maastricht and in general practices in the Nijmegen area. Dentists from general practice were
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