Background: Spatial navigation is integral to independence and quality of life; its impairment is a recognized but frequently underassessed sequela of stroke. The Way Finding Questionnaire (WFQ) is a validated 22-item self-report instrument that evaluates navigational ability across three domains Navigation and Orientation, Spatial Anxiety, and Distance Estimation and has demonstrated strong psychometric properties in Western populations. No Urdu-language version existed prior to this study, limiting its applicability within Pakistan's predominantly Urdu-speaking population.

Objective: To translate the original English WFQ into Urdu and to evaluate the validity and reliability of the resulting Urdu version (WFQ-U) in patients with stroke.

Methods: A cross-cultural validation study was conducted at Jinnah Hospital, Lahore, enrolling 70 stroke patients aged 18–65 years via convenience sampling. The translation followed the six-stage Beaton et al. framework, encompassing forward translation, synthesis, backward translation, expert committee review, pilot testing, and documentation submission. Reliability was assessed using Cronbach's alpha (internal consistency) and the intraclass correlation coefficient (ICC; test-retest reliability, one-week interval). Content validity was determined using the Content Validity Index (CVI). Concurrent validity was examined through Pearson correlation with the Floor Maze Test (FMT).

Results: The sample comprised 33 males (47.1%) and 37 females (52.9%), with a mean age of 46.91 ± 9.90 years. The mean total WFQ-U score was 75.29 ± 11.67. Cronbach's alpha was 0.987 (Day 1) and 0.977 (Day 3), indicating excellent internal consistency. The ICC for test-retest reliability was 0.825 (95% CI: 0.780–0.865). The overall CVI was 0.825. Pearson correlation between the WFQ-U and the FMT was r = 0.929 (p < 0.05), demonstrating strong concurrent validity.

Conclusion: The WFQ-U is a valid and reliable patient-reported outcome measure for assessing navigational ability in Urdu-speaking stroke patients. Its adoption in Pakistani clinical and research settings is recommended.