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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Hindi Translation and Validation of the Manchester COPD Fatigue Scale: A Cross-sectional Study
Correspondence Address :
Dr. Mousumi Saha,
Assistant Professor, Maharishi Markandeshwar Institute of Physiotherapy and
Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana,
Ambala-133207, Haryana, India.
E-mail: msaha0029@gmail.com
Introduction: The most common yet under-evaluated symptom in patients with Chronic Obstructive Pulmonary Disease (COPD) is fatigue which has significant implications for quality of life and functional status. To assess this multidimensional construct accurately a disease specific tool is essential. The Manchester COPD Fatigue Scale (MCFS) is a validated tool to measure fatigue but due to its unavailability in Hindi it cannot be put to use in the Indian population with COPD. So for that reason, the aim of the study is to translate it into Hindi language and validate it to ensure correct assessment of fatigue in Hindi speaking patients with COPD.
Aim: To systematically translate the MCFS into the Hindi language and evaluate its content validity in patients with COPD.
Materials and Methods: The present cross-sectional study was conducted at the Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Mullana, Ambala, Haryana, India, from September 2025 to February 2026. The study was conducted by using a methodological design which included forward-backward translation and expert review by Delphi method to appropriately assess the clarity and conception of the translated version of the scale. The statistical analysis was done using the Item level Content Validity Index (I-CVI). The purpose of the current study is to create a Hindi version of this scale so, after the approval from the original developer, the authors created the Hindi version of the scale using a forwardbackward translation process. Eight experts then evaluated the content validity of the scale.
Results: The Hindi version of the MCFS demonstrated excellent content validity with high item-level and scale-level content validity indices i.e., 0.97.
Conclusion: The Hindi version of the MCFS was successfully translated and demonstrated excellent content validity in Hindi speaking patients with COPD.
Chronic obstructive pulmonary disease, Functional status, Humans, Language, Pulmonary disease, Quality of life
The COPD has a major impact on healthcare costs and is associated with smoking and biomass smoke exposure. COPD leads to decline in the lung function with persistent progressive airflow limitation (1). Symptoms like cough, phlegm and dyspnoea and clinical presentation varies according to different stages. Clinical, physiological and pathological heterogeneity of COPD hampers the effective treatment (2). By 2050, it is estimated that COPD cases will reach up to 592 million among adults aged 25 or older and by 2030 it will become the third leading cause of death worldwide as estimated by World Health Organisation (WHO) in around 2005 although, the current data states that it is the fourth leading cause of the death, responsible for 3.5 million deaths alone in 2021(3). The most common cause of high mortality rate across the globe is chronic inflammatory lung disease (4). The prevalence of COPD among women are gradually increasing day by day with that of the men. The reason being is that the women are more likely to be exposed to other factors like biomass smoke etc., (5).
The COPD patients experience a broad range of pulmonary and extra pulmonary symptoms fatigue being one of them. Fatigue can be defined as the subjective and unpleasant feeling ranging from mild tiredness to severe exhaustion that can limit an individual’s ability to carry out normal activities (3). After dyspnoea, fatigue is the next symptom that a COPD patient experiences and it shows a major effect on the overall health status, quality of life and daily activities (6). Due to fatigue there are some other associated symptoms like pain, dyspnoea, sleep disturbances, depression, anxiety, etc., that can be seen in COPD patients. The prevalence of fatigue in COPD patients ranges from 17% to 95% and 47% to 72% (7). Fatigue also affects motivation, which results in decreased concentration of the patients and lack of ability to perform daily activities like household chores etc., (8).
Despite being one of the most important symptoms of COPD, there are very few questionnaires that are specifically designed to measure fatigue accurately. There are many general and often simple scales and questionnaires are there but they may not adequately measure the characteristics of fatigue specific to COPD (9). Fatigue is the most common symptom that is present in other chronic diseases such as rheumatoid arthritis, multiple sclerosis etc., but in COPD it is uniquely associated with dyspnoea (10). In COPD patients, fatigue is a usual feeling which is mostly due to any kind of exertional activity but in asthma patients, fatigue occurs due to the exacerbations which are intensified by exertion (11).
To address the gap of comprehensive assessment of fatigue in COPD patients, the MCFS was created into the Hindi language. The original scale has been translated into many different languages and then validated, is being used worldwide by many clinicians and researchers, and even gets recommended by international guidelines as a useful measure for the assessment of fatigue in COPD patients (9). The MCFS has been proved to be a simple, reliable and valid tool to assess fatigue in the population of China with COPD (12). The MCFS is found to be responsive to the effects of pulmonary rehabilitation in patients with COPD, and change in MCFS correlated with reduced dyspnoea and improved quality of life following pulmonary rehabilitation (13). The main aim of this study was to translate the MCFS into Hindi language and evaluate its content validity by expert panel.
The present cross-sectional observational study was held in Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Mullana, Ambala, Haryana, India, from September 2025 to February 2026. Ethical approval for the study was obtained from Institutional Ethical Committee (IEC), IEC-2595. The study was adhered to the World Medical Associations Helsinki Declaration, Council for International Organisations of Medical Sciences (CIOMS) International Ethical Guidelines, and the Indian Council of Medical Research National Ethical Guidelines. All the study participants signed the informed consent. The permission to use, translates, and validates the hindi version of MCFS was obtained from the primary developer of the scale.
Inclusion and Exclusion criteria: Inclusion criteria include diagnosed cases of COPD as per the GOLD (Global Initiative for Chronic Obstructive Lung Disease) criteria (14), clinically stable patients (both male and female), patients who willingly wanted to participate in the study, Hindi-speaking populations whereas the exclusion criteria included patients with any kind of visual, cognitive or neurological impairments, any other chronic fatigue causing co-morbidities like uncontrolled hypothyroidism, advanced heart failure, chronic kidney disease, malignancies, etc. and non-Hindi speakers.
Sample size: As per the recommendations, a total of 51 patients with COPD were taken to assess the clarity and comprehensibility of the Hindi version of the MCFS. All these samples are a part of a larger study on the reliability analysis of the translated Hindi version of the MCFS. All the samples were taken through convenient sampling method.
Study Procedure
Phase 1: Scale Translation
The MCFS was translated into Hindi language with the permission from its original creators. The scale should ideally go through at least two forward translations from the source language to the chosen language at this point. In order to do this, two bilingual people-T1, who has a medical background and is familiar with the principles, and T2, who does not separately, translated the English scale into Hindi version while adhering to the guidelines (15). The nonmedical translator is aware of the true significance of the original scale (Table/Fig 1).
Scale synthesis: The two translators and a recording bystander sat down together for the synthesis of the results of the restatements. Working from the primary scale also because the first translator’s (T1) and thus the other translator’s (T2) performances, a synthesis of those restatements is first conducted to produce one translated questionnaire with a report care completely establishing the conflation process, each of the addressed issues, and the way they were resolved. It is important that the agreement rather of one person’s compromising his or her passions resolve issues. This phase is completed with this synthesised T-1,2 interpretation of the scale.
Backward translation: To carry forward this step, two bilingual individuals namely BT1 and BT2, who have a sound knowledge of both English and the targeted Hindi language, independently translated Hindi version i.e., T12 back into English to construct the translated English versions 1 and 2. This procedure was done for the validation of the translated version to make sure that it contains the same information as that of the original version. The most popular method of validity checking that identifies significant grammatical or linguistic errors in the translation is back translation. The topics that have already been mentioned were unfamiliar to these two translators. The major goal of this was to prevent the information bias. The back-translated version and the original MCFS were checked for any discrepancies that would point to ambiguous language in the source or mistakes made during the translation process. Beaton DE et al., guidelines served as the foundation for this study (16).
Phase 2: Content validity
Expert panel selection: The MCFS content validation relies on feedback from a review committee using an online Delphi approach. The evaluation of the content validity of the scale was done by the team of eight Delphi experts which includes physiotherapists, rehabilitation specialists, etc., who have an extensive clinical and academic experience in treating COPD patients in India. All the experts have reviewed the scale via Gmail, rating items as: 1) Not relevant; 2) Items needs revision; 3) Relevant but needs minor revision; 4) Very relevant. A four-point rating system is commonly used for the evaluation of the content validation. The expert’s choices have guided the final documentation and rationale for the Hindi version of the scale (Table/Fig 2).
Content validity assessment: All the experts independently evaluated each item of the scale for simplicity, ambiguity, relevance and clarity. The I-CVI and Scale-level Content Validity Index (S-CVI) were calculated using a tabular format. The Delphi method used for the primary validation was through the email only. All the items were assessed with the I-CVI and S-CVI, using the averaging method (S-CVI/Ave) and Universal Agreement calculation (S-CVI/UA). Based on Lynn’s (1986) criteria, for a group of eight review experts, the S-CVI/Ave should be at least 0.90 and the minimum I-CVI should be 0.78 for superior content validity (17),(18). Those items which were not up to the acceptable thresholds were revised or removed from the translated version of the scale after the consensus discussion. The review by the expert panel demonstrated that all the agreements were excellent. They confirmed that the scale items have adequately represented the construct of fatigue in COPD patients.
Hindi Translated Version of the Manchester COPD Fatigue Scale (MCFS) is given in [Annexure-1].
STATISTICAL ANALYSIS
All the data were analysed using the IBM Statistical Package for the Social Sciences (SPSS) statistics version 26.0. The content validity was evaluated using the I-CVI. Eight experts were included who rated each item on a 4-point relevance scale. The rating 3 or 4 were considered relevant and the Scale-level CVI (S-CVI/Ave) was calculated as the average of all the I-CVI values (17). All the ratings with 3 and 4 were recorded as ‘1’ while ratings with 1 and 2 were recorded as ‘0’. The I-CVI was calculated as the proportion of experts rating an as item as relevant and the Scale-Level Content Validity Index (S-CVI/Ave) was calculated as the average of all I-CVI values. The S-CVI/UA was calculated as the proportion of items with universal agreement among experts.
A total of 51 patients with COPD were screened at our hospital and all were included in the study for data analysis. The translation process was completed using forward-backward procedures. There were some minor linguistic modifications that were made after the expert review to make sure the semantic and conceptual equivalence. The final Hindi version was found to be understandable and appropriate during the testing and so no major modifications were required. Eight experts were included in the content validation process. Each and every items of the scale achieved acceptable I-CVI values, the average S-CVI/Ave was 0.97, indicating strong expert agreement about the relevance and clarity. The overall S-CVI demonstrated excellent content validity (Table/Fig 3). Proportion of items judged as relevance across the eight experts Average=0.97
The aim of the present study is to systematically translate the MCFS into the Hindi language and evaluate its content validity in patients with COPD. The findings provide strong evidence that the MCFS is a valid and multidimensional instrument for assessing fatigue in patients with COPD.
The fatigue is one of the most common yet under-recognised symptoms in COPD, but it is most often described by patients as constant, devastating and functionally limiting. In spite of its clinical significance, fatigue is not appropriately captured by many commonly used COPD outcome measures rather they tend to focus mainly on dyspnoea, airflow limitation and health status (19). The MCFS was mainly translated into Hindi language to address this gap in patient-reported episodes of fatigue related to COPD by ensuring strong content relevance and disease specificity. The MCFS includes 27 items covering many fatigue-related parameters that supports the comprehensive nature of the scale and strengthen its content validity.
The primary strength of the study lies in the thorough translation process which includes forward-backward translation and expert panel evaluation. The inclusion of team of experts from relevant clinical backgrounds further strengthened the content validation by including both the theoretical and practical views related to COPD. After being translated into Hindi, the English version of the MCFS was validated by Delphi method. Specifically designed for COPD patients who experiences fatigue, this is the first translation of the fatigue assessment in COPD patients into the mother tongue of a significant portion of India. Only a few small linguistic errors occurred when translating the English version into Hindi, both forward and backward.
All the items of the scale got acceptable I-CVI values, demonstrating strong expert agreement about the relevance and clarity. The overall S-CVI demonstrated excellent content validity with a high S-CVI/ Ave value of 0.97, which indicates strong agreement among all the experts about the relevance and aptness of the translated items of the scale. This also suggests that the Hindi version retains the actual and conceptual meaning of the original MCFS while being adapted to the target population. In the Chinese version of the MCFS, a standardised forward - backward translation approach based on the established models was employed to ensure the conceptual and semantic basis across the languages. The expert panel assessment played an important role in refining the items and ensuring cultural relevance. The high content validity demonstrated in the present study is consistent with the translation frameworks used in the other translated versions thereby supporting the original construct of the scale (12).
The availability of a valid and reliable fatigue-specific measure is very important from a clinical and rehabilitation perspective. The exercise tolerance, physical activity participation, adherence to pulmonary rehabilitation and overall treatment outcomes have been shown to be significantly influenced by fatigue (20).
The strong psychometric properties of the MCFS supports its applicability in physiotherapy assessment, clinical trials and pulmonary rehabilitation programs, enabling therapists to identify fatigue-related limitations, monitor changes over time and tailor-made interventions more proficiently. Incorporating MCFS into routine clinical practice can also assist in more holistic symptom management and patientcentered care.
Limitation(s)
The present study has a limitation that should be taken into consideration. The study was done in a specific clinical setting which may affect the generalisability of the results to broader Hindispeaking populations.
The Hindi version of the MCFS was successfully translated and demonstrated excellent content validity in Hindi-speaking patients with COPD. The multidimensional structure of the MCFS exhibits the complex nature of fatigue in COPD and strongly supports its use as a comprehensive tool for both clinical practice and research.
DOI: 10.7860/JCDR/2026/88640.24242
Date of Submission: Feb 28, 2026
Date of Peer Review: Mar 18, 2026
Date of Acceptance: Jun 12, 2026
Date of Publishing: Sep 01, 2026
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Mar 01, 2026
• Manual Googling: Jun 08, 2026
• iThenticate Software: Jun 10, 2026 (7%)
ETYMOLOGY: Author Origin
EMENDATIONS: 6
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