OBJECTIVES: The use of in-country reviews in the translation process of PRO measures is an important process. It allows for an existing language version to be modified for use in another country where the same language is spoken. The following languages are examples of where this can apply: English, Portuguese, Spanish, Chinese, Arabic, Russian and French.  If a translation completed for one country is not reviewed for use in another, there is a risk that the translation may not be linguistically or culturally valid in the new country.  This study sets out to outline the level of changes made when carrying out this process. METHODS: A sample of in-country reviews was taken from the translation of the POLO Chart measure. A total of 9 languages were reviewed. All changes that were made to any of the translations as a result of the in-country review were assessed according to whether the change was made as a result of a definitive linguistic and/or cultural difference (in the opinion of the in-country reviewer) or whether the change was made based on subjective preferences on behalf of the reviewer. RESULTS: A total of 213 changes were made across the 9 languages. The majority (140) of changes made were considered to be essential changes which were as a result of linguistic and/or cultural differences between the countries. More changes were made to the Chinese, Portuguese, and Spanish translations than to the English. CONCLUSIONS: In-country reviews are very useful in the translation process of PRO measures. A large number of changes made across the 9 languages and the fact that the majority of changes made to the translations are considered to be essential based on linguistic and/or cultural differences suggest that the in-country review is an important process to undertake.