OBJECTIVES: The last 20 years have seen the development of numerous PRO measures mostly however within and for one culture. Based on the assumption that the original concepts are universally appropriate, instruments destined for international use are translated following a standardized procedure (linguistic validation). This process however reveals the interdependence of translation and original and the importance of integrating an international component into the design of instruments, which can be done through a Translatability Assessment. The presentation will illustrate the methodology and the advantages of this new approach. METHODS: A translatability assessment can be defined as an international critical review of a pre-final original in collaboration with the developer. In the absence of international development, this may be a cost and time effective compromise between the WHO approach to instrument development and translation. The translation process usually reveals difficulties when adapting the format, instructions, concepts, idiomatic expressions, response scales or demographic items to different languages. The translatability assessment proposes to review these aspects and suggest re-formulations in the original considering the context and constraints of other languages/cultures. RESULTS: Several examples of the impact of the Translatability Assessment on the original wording will be given. For instance, although the term "work" in English may refer both to a paid job and voluntary work, other languages may require different expressions to convey this global notion. The reference to "daily activities" may be an alternative facilitating international harmonization across languages and pooling of data. Similarly, reference to "patient initials" being inappropriate for Chinese languages, replacing the original with "patient record number" can improve international acceptability. CONCLUSION: The Translatability Assessment may be a practical and easy way to integrate an international component in the design of new measures, thereby facilitating the subsequent translation by anticipating and solving its difficulties.