OBJECTIVE: The translation of patient reported outcome (PRO) measures typically involves two key stages where the translation is created and refined. METHODS: The first is the reconciliation of two independent translations by an in-country investigator (a lead translator). The second is the back translation review - the reconciled translation is translated back into English and the project manager reviews the English translation(s) against the source text, then the translation is refined through discussion between the project manager and the investigator.  Both stages are conducted via email, and the back translation review report is usually reviewed by the instrument developer once all issues have been addressed. We will present an alternative methodology whereby the reconciliation and back translation review are conducted through live conversations (in teleconferences or otherwise) involving forward translators and the instrument developer. RESULTS: We will compare these two processes in terms of the types of discussion and communication they enable. We will also look at the practicalities of each method, and their relative merits and drawbacks and how these can be addressed to maximise their usefulness in refining and improving the translation. CONCLUSIONS: We will argue that both methods are beneficial in particular circumstances, and will explore the situations in which each one would be the most appropriate.