OBJECTIVES: PRO measures use a variety of response scales/options. These vary according to the type of measure, and can include frequency (time-based) scales, severity (intensity) scales, visual analogue scales (VAS) and levels of agreement. The translation and linguistic validation of response options can cause semantic or conceptual difficulties. This research aims to identify the issues raised during the translation of some response scales, with the aim of aiding the translatability of response options. METHODS: Examples of issues in the translation and linguistic validation of response options were collected from past Oxford Outcomes projects. Those response options which were problematic across PRO measures and languages were evaluated. RESULTS: Numerous cultural and linguistic issues became apparent throughout the translation process which require careful attention being paid to the response options during the translation and linguistic validation process: /Some mid-scale words used in severity scales are particularly difficult to translate, e.g. rather, somewhat. Two response options on a scale, e.g. rather confident, fairly confident can be very small and unclear. /Frequency scales (how often...) are often translated as ‘how many times’, in some languages (particularly Indian). /When using ‘level of agreement’ scales the word ‘strongly’ often proves problematic as some languages find it difficult to express levels of agreement. CONCLUSIONS: Various issues with response options were recognised during the linguistic validation of a considerable number of PRO measures. A full translation and linguistic validation procedure can help to overcome such problems, but care should be taken when choosing response scales during the development of PRO measures. In general, response options, which are particularly close in meaning, e.g. somewhat, rather, are usually more problematic to translate than those with clear parameters, e.g. never, rarely, sometimes, often, always.