Liu QZ, Zeng L, Sun NZ. Linguistic exclusion in orthopedic research: Cultural adaptation, multilingual innovations, and pathways to global health equity. World J Orthop 2025; 16(5): 106951 [DOI: 10.5312/wjo.v16.i5.106951]
Corresponding Author of This Article
Nian-Zhe Sun, MD, PhD, Department of Orthopedics, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Kaifu District, Changsha, Hunan, Changsha 410008, Hunan Province, China. sunnzh201921@sina.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. May 18, 2025; 16(5): 106951 Published online May 18, 2025. doi: 10.5312/wjo.v16.i5.106951
Linguistic exclusion in orthopedic research: Cultural adaptation, multilingual innovations, and pathways to global health equity
Qin-Zhi Liu, Lei Zeng, Nian-Zhe Sun
Qin-Zhi Liu, Lei Zeng, Nian-Zhe Sun, Department of Orthopedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
Qin-Zhi Liu, Lei Zeng, Nian-Zhe Sun, National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
Co-corresponding authors: Lei Zeng and Nian-Zhe Sun.
Author contributions: Liu QZ wrote the first draft, developed the main ideas, and led revisions; Sun NZ spearheaded the conception and design of the study and provided critical revision of the manuscript. Zeng L directed the analytical framework, coordinated interdisciplinary collaborations, and supervised the interpretation of results alongside manuscript finalization.
Conflict-of-interest statement: All authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nian-Zhe Sun, MD, PhD, Department of Orthopedics, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Kaifu District, Changsha, Hunan, Changsha 410008, Hunan Province, China. sunnzh201921@sina.com
Received: March 12, 2025 Revised: April 9, 2025 Accepted: April 21, 2025 Published online: May 18, 2025 Processing time: 66 Days and 1.4 Hours
Abstract
This editorial critically evaluated the recent study by AlMousa et al, which examined the impact of the Arabic version of the American Academy of Orthopedic Surgeons Foot and Ankle Outcomes Questionnaire (AAOS-FAOQ) on postoperative quality of life and recovery in Arabic-speaking patients with traumatic foot and ankle injuries. In the context of systemic linguistic exclusion in orthopedic research—where English-language journals dominated most publications and non-English-speaking populations faced dual barriers of trial underrepresentation and semantic distortions (e.g., mistranslations of terms like "joint instability" in Arabic)—AlMousa et al's work highlighted the transformative potential of culturally adapted methodologies. Their rigorous four-stage adaptation framework validated the Arabic AAOS-FAOQ as a reliable tool, enhancing ecological validity and reducing bias in patient-reported outcomes. However, limitations such as regional specificity (Gulf-centric sampling) and short follow-up periods (4 months) underscored broader challenges in non-English research: Redundant studies, prolonged hospital stays for limited English proficiency patients, and underrepresentation of certain ethnic groups in trials. To dismantle linguistic hegemony, we proposed semantic reconstruction (e.g., integrating culturally specific indicators like "prayer posture"), dialect-aware neural translation, and World Health Organization led terminology standardization. In line with these proposed solutions, AlMousa et al’s study exemplified how language-sensitive adaptations could bridge equity gaps, while future efforts would need to balance cultural specificity with cross-study comparability through AI-driven multilingual databases and policy mandates for cultural adaptation roadmaps.
Core Tip: The dominance of English in orthopedic research perpetuated systemic linguistic exclusion, marginalized non-English-speaking populations and compromised global health equity. Culturally adapted tools, such as the Arabic version of the American Academy of Orthopedic Surgeons Foot and Ankle Outcomes Questionnaire, combined with artificial intelligence driven dialect recognition and policy reforms, are essential for enhancing inclusivity, mitigating bias, and addressing disparities in evidence-based medicine.
