The Greek LYMPH-Q upper extremity module for breast cancer-related lymphedema: Translation and cultural adaptation

INTRODUCTION: Breast cancer-related lymphedema is a chronic symptomatic condition associated with breast cancer treatment. It affects upper-extremity function and psychosocial well-being. Clinical assessments do not fully capture its multidimensional impact on quality of life, highlighting the need for patient-reported outcome measures (PROMs). The LYMPH-Q Upper Extremity Module is a validated, lymphedema-specific PROM designed to evaluate these dimensions from the patient's perspective. However, a Greek version suitable for clinical and research use has not been available. METHODS: A Greek translation of the LYMPH-Q Upper Extremity Module was produced using the Q-Portfolio translation and cultural adaptation methodology. The translation process included two independent forward translations, reconciliation, back translation, expert review, and cognitive debriefing interviews with five Greek-speaking patients with upper-extremity lymphedema after breast cancer treatment. The interview findings were used to improve the final version. RESULTS: Comparison of forward translations identified multiple wording-level differences, most of which reflected alternative phrasing rather than conceptual disagreement. During back-translation, several items required closer examination because of semantic drift, particularly regarding differences between the arm versus hand, and terminology related to compression garments. Cognitive debriefing revealed nine issues that affected comprehensibility. These discrepancies were resolved through targeted linguistic revisions. The questionnaire demonstrated good conceptual clarity. CONCLUSIONS: The Greek version of the LYMPH-Q Upper Extremity Module is a reliable, linguistically and culturally adapted PROM for assessing the physical and psychological impact of upper extremity lymphedema in Greek-speaking patients.