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Damian Chi Hong Siu,1,2 Chi Tao So,1,3 Cherry Wai Lee Lau,1,4 Eric Hei Man Hui,1,5 Alexandra Fung,1,6 Tak Ming Chan,1,7 Fion Siu Fun Chan,1,3 Catherine Kam Fung Chan,1,8 William Pang Wai Chen,1,9 Sammy Hoo Ming Cheung,1,10 Katherine Pui Yee Chan,1,11 Peter Poon,12 Michael Cheung,12 Cherry Chan,12 Justin Tse,12 Vanessa Fung,12 Kenneth NK Fong12 1Respiratory Sub-Specialty Group, Occupational Therapy Central Organization Committee, Hospital Authority, Hong Kong SAR; 2Occupational Therapy Department, Prince of Wales Hospital, Hospital Authority, Hong Kong SAR; 3Occupational Therapy Department, Princess Margaret Hospital, Hospital Authority, Hong Kong SAR; 4Occupational Therapy Department, Kowloon Hospital, Hospital Authority, Hong Kong SAR; 5Occupational Therapy Department, Grantham Hospital, Hospital Authority, Hong Kong SAR; 6Occupational Therapy Department, Ruttonjee Hospital, Hospital Authority, Hong Kong SAR; 7Occupational Therapy Department, Haven of Hope Hospital, Hospital Authority, Hong Kong SAR; 8Occupational Therapy Department, Wong Tai Sin Hospital, Hospital Authority, Hong Kong SAR; 9Occupational Therapy Department, Tseung Kwan O Hospital, Hospital Authority, Hong Kong SAR; 10Occupational Therapy Department, Tuen Mun Hospital, Hospital Authority, Hong Kong SAR; 11Occupational Therapy Department, Alice Ho Miu Ling Nethersole Hospital, Hospital Authority, Hong Kong SAR; 12Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SARCorrespondence: Damian Chi Hong SiuOccupational Therapy Department, Hospital Authority, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong SAR Email damiansiu@gmail.comBackground: The Manchester Respiratory Activities of Daily Living Questionnaire (MRADLQ) is a valid and reliable tool measuring the functional level of patients with COPD in multidimensional aspects. However, a local validation of the questionnaire is lacking in Hong Kong.Objective: To develop a Chinese version of MRADLQ with pictorial enhancement (C-MRADLQ) and study its reliability and validity.Patients and Methods: A total of 238 patients suffering from COPD were recruited from nine public hospitals and five Nurse and Allied Health Respiratory Clinics by convenient sampling. A total of 64 patients with normal spirometry results and no previous clinical diagnosis of COPD were invited to complete the C-MRADLQ for comparison and examination of its validity. Ten out of 302 patients were re-assessed with the C-MRADLQ after one week by the same rater for test–retest reliability. The C-MRADLQ was correlated with spirometry result, COPD classifications and groups by Global Initiative for Chronic Obstructive Lung Disease (GOLD), the modified Medical Research Council Dyspnea Scale (mMRC Dyspnea Scale), COPD Assessment Test (CAT), Chinese Version of the Shortness of Breath Questionnaire (C-SOBQ), number of admission and the ADO index.Results: The C-MRADLQ shows good test–retest reliability as indicated by an intra-class correlation coefficient value of 0.975. It is significantly correlated with COPD stage, COPD group, SOBQ score, CAT score, mMRC, ADO index, spirometry results, and number of admissions. The SOBQ score, number of admissions, FEV1/FVC, and COPD group could significantly predict the total C-MRADLQ score. A total of 67.9% of participants’ mMRC levels were correctly classified by using the C-MRADLQ total score. The agreement of the original and new versions of questions 20 and 21 of C-MRADLQ was 97.3% and 90.1%, respectively.Conclusion: The pictorial version of the C-MRADLQ is a validated and reliable functional assessment tool to measure functional status among patients with COPD in the Chinese population.Keywords: pulmonary disease, chronic obstructive, patient-reported outcome measures, activities of daily living, validation study, occupational therapy