Reviewer’s report
Title: 
The Translation and Validation of the Arabic Version of the Polycystic
Ovary Syndrome Health-Related Quality of Life Questionnaire (AR-PCOSQ)
Version: 
0 
Date: 
14 Oct 2019
Reviewer's report:
The study entitled "The Translation and Validation of the Arabic Version of the
Polycystic Ovary Syndrome Health-Related Quality of Life Questionnaire (AR-
PCOSQ)" translated a commonly used instrument that assesses specific quality
of life (QoL) among women with Polycystic Ovary Syndrome (PCOS). The
study aim is meaningful and I do appreciate such instrument developed study to
assist in collecting health-related data in clinical use. However, there are some
problems in this manuscript and should be well taken care of. Below please see
my specific comments.
1. In the Abstract Background, I think that the authors should describe the health
problems of women with PCOS instead of talking something on generic or
specific QoL instruments.
2. In the Abstract Results, please also provide SD information for age and BMI
3. Please use the following reference to support the notion "Generic HRQoL
scales such as the Short Form Health Survey (SF-36) or abbreviated version of
World Health Organization Quality of Life (WHOQOL-BREF) scale may not be
as accurate as the disease-specific HRQoL scales in measuring the HRQoL
among patients with specific health care conditions such as PCOS."
Ou HT, Wu MH, Lin CY, Chen PC. Development of Chinese Version of
Polycystic Ovary Syndrome Health-Related Quality of Life Questionnaire (Chi-
PCOSQ). PLoS One. 2015;10(10):e0137772. Published 2015 Oct 9.
doi:10.1371/journal.pone.0137772
3. In the Background, the authors should clearly mention that there is no specific
QoL instrument to use on women with PCOS.
4. I am surprised to see the inclusion criterion of "married". Is there any reason
to have such a criterion? I know that the PCOSQ has a domain of infertility
concerns, but not only married women concern about infertility.
5. The scoring of the PCOSQ is not clearly presented in the current form (e.g.,
how to sum up the score, any reverse coded items). Also, the descriptions of two
interviews under the section of Measurement are confusing. Specifically, the two
interviews are used for "face validity" and "test-retest reliability". However, the
authors did not clearly state this. Also, the two interviews are not actually related
to the Measurement; instead, they are related to the procedure.
6. The justification of the timeline between the two reviews is invalid.
Specifically, what recall bias the authors want to eliminate? Given that the
PCOSQ asks the respondents to recall in the past two weeks. It does not matter
when the authors did the interview. That is, even the authors do the second
interview 1 month later, the interviewees are still recalling two weeks before.
Thus, the short interval between the two interviews cannot be justified using
recall bias. Instead, the authors can consider another reason for the short interval;
that is, whether the interviewees can maintain the same condition in a long time.
Given that they were suffering from PCOS, the interviewees could change their
QoL if their PCOS condition changes. Therefore, in order to keep in the similar
condition of PCOS progress, it is better to have a short interval between the two
intervals. However, the authors still need to acknowledge the limitation of the
use of short interval: learning effects. That is, the interviewees may remember
what they have answered two days ago; therefore, their responses for the second
interview are impacted by their memory in the first interview. This may also
somewhat explain why the authors obtained such high test-retest reliability. 
7. The translation procedure should not belong to the Measurement section.
Please use another heading for the translation procedure. Also, the translation
procedure is not comprehensive; specifically, who compared the back-
translations and the original PCOSQ? If there is any inconsistency between the
back-translations and original PCOSQ, what was the next step? Who were the
experts to converge the two forward-translations into one?
8. Please provide some basic information, such as age, gender, and years of
experience, for the 10 specialists in gynecology who helped in content validity. 
9. Similar basic information (age, gender, and years of onset) should also be
provided for the patients who assisted in face validity.
10. A major problem is the presentation of the analyses. Because the authors
used exploratory factor analysis (EFA) to study the Arabic PCOSQ and a
different structure was found, the results of other psychometric properties are not
that relevant to the new structure the authors found. I would suggest the authors
report the EFA results first; then, use the new structure to present other
psychometric results (e.g., Cronbach's alpha).
11. The strength of the sample size in this study, in my opinion, is not a strength
given that previous studies also have similar size. 
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the
authors.
Unable to assess
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you
recommend an additional statistical review?
If an additional statistical review is recommended, please specify what aspects
require further assessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
Declaration of competing interests
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