Linguistic Validation of the Angioedema Control Test in the Bengali Language

Dear Editor, Angioedema is a condition characterized by sudden, transient swelling of the deeper layers of skin and mucosa, which can significantly impair quality of life.[1] To effectively manage angioedema, regular monitoring of disease control from the patient’s perspective is essential. The angioedema control test (AECT) is a validated, patient-reported outcome measure specifically designed to assess the level of disease control in individuals with recurrent angioedema, regardless of the etiology.[2] The AECT comprises four questions that evaluate symptom frequency, impact on daily life, and overall disease management over the preceding four weeks.[3,4] The same questionnaire is also used to assess disease control for the previous three months. Its straightforward format allows for routine use in both clinical practice and research to guide therapeutic decisions and evaluate treatment efficacy. Bengali is the sixth most spoken language globally and widely used in parts of South Asia, yet no validated Bengali version of the AECT exists. To enable reliable self-assessment among Bengali-speaking patients and support clinicians in monitoring disease control, it was necessary to translate and culturally adapt the AECT into Bengali. Hence, in this study, we linguistically validated the AECT into Bengali for use among Bengali-speaking individuals with recurrent angioedema. The linguistic validation of the AECT into Bengali followed a structured and expert-driven process to ensure accuracy and relevance.[5] In the first phase, three professionals-a dermatologist, a public health specialist, and a language expert independently translated the original English version of the AECT into Bengali. These forward translations were then reviewed collectively and reconciled into a single Bengali version through consensus. In the second phase, the reconciled Bengali version was back-translated into English by another independent group consisting of a different dermatologist, public health expert, and language specialist. These back-translations were compared and reconciled to produce a single English version, which was then reviewed by the original developer of the AECT. The developer assessed the version for conceptual equivalence and clarity and provided approval for further testing. Following this, the pre-final Bengali version was administered to five patients diagnosed with recurrent angioedema for cognitive debriefing, after obtaining written consent for participation and requisite clearance from the Institutional Ethics Committee (CMSDH/IEC/25/06-2025; date: June 16, 2025). The patients represented a range of ages and both genders. All participants reported that the language was clear, the questions were easy to understand, and the intended meaning was preserved. The cognitive debriefing details were sent to the developer and were approved. Hence, the final Bengali version of the AECT was confirmed as a linguistically valid questionnaire [Table 1].Table 1: Characteristics of the Bengali version of AECTThe current validation method has some limitations. As per developer guidelines, we used only five patients for the cognitive interview. However, a higher number of patients could provide better insight. Psychometric properties of the Bengali version, including internal consistency and test–retest reliability, were not examined and warrant further validation. Additionally, the questionnaire comprises only four items assessing related but conceptually diverse domains (frequency, quality-of-life impact, anticipatory concern, and treatment control), which limits the suitability and interpretability of internal consistency measures such as Cronbach’s alpha. The Bengali version of the questionnaires is available as supplementary files 1 and 2. Authors’ contributions We confirm that all authors have read and approved the manuscript for submission. All authors meet authorship criteria, and the manuscript represents honest work. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Use of artificial intelligence (AI) The preparation of this manuscript was carried out entirely by the authors without the use of artificial intelligence technologies.