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Patient-reported outcomes measurement information system (PROMIS) domain names and definitions revisions: further evaluation of content validity in IRT-derived item banks

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Content validity of patient-reported outcomes (PROs) is evaluated primarily during item development, but subsequent psychometric analyses, particularly for item response theory (IRT)-derived scales, often result in considerable item pruning and potential loss of content. After selecting items for the PROMIS banks based on psychometric and content considerations, we invited external content expert reviews of the degree to which the initial domain names and definitions represented the calibrated item bank content.


A minimum of four content experts reviewed each item bank and recommended a domain name and definition based on item content. Domain names and definitions then were revealed to the experts who rated how well these names and definitions fit the bank content and provided recommendations for definition revisions.


These reviews indicated that the PROMIS domain names and definitions remained generally representative of bank content following item pruning, but modifications to two domain names and minor to moderate revisions of all domain definitions were needed to optimize fit with the item bank content.


This reevaluation of domain names and definitions following psychometric item pruning, although not previously documented in the literature, appears to be an important procedure for refining conceptual frameworks and further supporting content validity.

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  1. Lohr, K., & For the Scientific Advisory Committee of the Medical Outcomes Trust. (2002). Assessing health status and quality-of-life instruments: Attributes and review criteria. Quality of Life Research, 11, 193–205.

    Article  Google Scholar 

  2. Rothman, M. L., Beltran, P., Cappelleri, J. C., Lipscomb, J., Teschendorf, B., & The Mayo/FDA Patient-Reported Outcomes Consensus Meeting Group. (2007). Patient-reported outcomes: Conceptual issues. Value in Health, 10(Suppl. 2), S66–S75.

    Article  PubMed  Google Scholar 

  3. US Department of Health and Human Services. (2006). Food and drug administration. Guidance for industry. Patient-reported outcome measures: Use in medical product development to support labeling claims. Rockville, MD: US Department of Health and Human Services.

  4. Rothman, M., Burke, L., Erickson, P., Kline Leidy, N., Patrick, D. L., & Petrie, C. D. (2009). Use of existing patient-reported outcome (PRO) instruments and their modification: The ISPOR good research practices for evaluation and documenting content validity for the use of existing instruments and their modification PRO task force report. Value in Health, 8, 1075–1083.

    Article  Google Scholar 

  5. Brod, M., Tesler, L. E., & Christensen, T. L. (2009). Qualitative research and content validity: Developing best practices based on science and experience. Quality of Life Research, 18, 1263–1278.

    Article  PubMed  Google Scholar 

  6. Fries, J. F., Bruce, B., & Cella, D. (2005). The promise of PROMIS: The new sciences behind patient-reported outcomes. Clinical and Experimental Rheumatology, 23, S53–S57.

    CAS  PubMed  Google Scholar 

  7. Cella, D., Yount, S., Rothrock, N., Gershon, R., Cook, K., Reeve, B., et al. (2007). The patient-reported outcomes measurement information system (PROMIS). Progress of an NIH Roadmap cooperative during its first two years. Medical Care, 45(Suppl. 1), S3–S11.

    Article  PubMed  Google Scholar 

  8. DeWalt, D. A., Rothrock, N., Yount, S., & Stone, A. A. (2007). Evaluation of item candidates: The PROMIS qualitative item review. Medical Care, 45(Suppl. 1), S12–S21.

    Article  PubMed  Google Scholar 

  9. Castel, L. D., Williams, K. A., Bosworth, H. B., Eisen, S. V., Hahn, E. A., Irwin, D. E., et al. (2008). Content validity in the PROMIS social health domain: a qualitative analysis of focus group data. Quality of Life Research, 17, 737–749.

    Article  PubMed  Google Scholar 

  10. Christodoulou, C., Junghaenel, D. U., DeWalt, D. A., Rothrock, N., & Stone, A. A. (2008). Cognitive interviewing in the evaluation of fatigue items: Results from the patient-reported outcomes measurement information system (PROMIS). Quality of Life Research, 17, 1239–1246.

    Article  PubMed  Google Scholar 

  11. Reeve, B. B., Hays, R. D., Bjorner, J. B., Cook, K. F., Crane, P. K., Teresi, J. A., et al. (2007). Psychometric evaluation and calibration of health-related quality of life item banks: Plans for the patient-reported outcomes measurement information system (PROMIS). Medical Care, 45(Suppl. 1), S22–S31.

    Article  PubMed  Google Scholar 

  12. Amtmann, D., Cook, K. F., Jensena, M. P., Chen, W.-H., Choi, S., Revicki, D., et al. (2010). Development of a PROMIS item bank to measure pain interference. Pain, 150(1), 173–182.

    Google Scholar 

  13. Cella, D., Riley, W., Stone, A. A., Rothrock, N., Reeve, B. B., Yount, S., et al. (in press). Initial item banks and first wave testing of the Patient Reported Outcomes Measurement Information System (PROMIS) network: 2005–2008. Journal of Clinical Epidemiology.

  14. Embretson, S. E., & Reise, S. P. (2000). Item response theory for psychologists. Mahway, NJ: Lawrence Erlbaum Associates.

    Google Scholar 

  15. Hays, R. D., Bjorner, J. B., Revicki, D. A., Spritzer, K. L., & Cella, D. (2009). Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items. Quality of Life Research, 18, 873–880.

    Article  PubMed  Google Scholar 

  16. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.

    Google Scholar 

  17. Frost, M. H., Reeve, B. B., Liepa, A. M., Stauffer, J. W., Hays, R. D., & The Mayo/FDA Patient-Reported Outcomes Consensus Meeting Group. (2007). What is sufficient evidence for the reliability and validity of patient-reported outcome measures. Value in Health, 10(Suppl. 2), S94–S105.

    Article  PubMed  Google Scholar 

  18. Watson, D. (2005). Rethinking the mood and anxiety disorders: A quantitative hierarchical model for DSM-V. Journal of Abnormal Psychology, 114, 522–536.

    Google Scholar 

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The patient-reported outcomes measurement information system (PROMIS) is a National Institutes of Health (NIH) Roadmap initiative to develop a computerized system measuring patient-reported outcomes in respondents with a wide range of chronic diseases and demographic characteristics. PROMIS was funded by cooperative agreements to a Statistical Coordinating Center (Northwestern University, PI: David Cella, PhD, U01AR52177) and six Primary Research Sites (Duke University, PI: Kevin Weinfurt, PhD, U01AR52186; University of North Carolina, PI: Darren DeWalt, MD, MPH, U01AR52181; University of Pittsburgh, PI: Paul A. Pilkonis, PhD, U01AR52155; Stanford University, PI: James Fries, MD, U01AR52158; Stony Brook University, PI: Arthur Stone, PhD, U01AR52170; and University of Washington, PI: Dagmar Amtmann, PhD, U01AR52171). NIH Science Officers on this project have included Deborah Ader, PhD, Susan Czajkowski, PhD, Lawrence Fine, MD, DrPH, Laura Lee Johnson, PhD, Louis Quatrano, PhD, Bryce Reeve, PhD, William Riley, PhD, Susana Serrate-Sztein, MD, and James Witter, MD, PhD. This manuscript was reviewed by the PROMIS Publications Subcommittee prior to external peer review. See the Web site at for additional information on the PROMIS cooperative group.

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Correspondence to William T. Riley.

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Riley, W.T., Rothrock, N., Bruce, B. et al. Patient-reported outcomes measurement information system (PROMIS) domain names and definitions revisions: further evaluation of content validity in IRT-derived item banks. Qual Life Res 19, 1311–1321 (2010).

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