Conclusion Our findings suggest that people with low literacy skills or learning disabilities are left out of the development of PROMs .
Background  Patient-reported outcome measures ( PROMs ) are intended to reflect outcomes relevant to patients .
They are increasingly used for healthcare quality improvement .
To produce valid measures , patients should be involved in the development process but it is unclear whether this usually includes people with low literacy skills or learning disabilities .
Marital adjustment among patients with chronic obstructive pulmonary disease who are participating in pulmonary rehabilitation.
BACKGROUND Marital adjustment has been associated with morbidity and mortality across various chronic diseases but has been largely ignored among patients with chronic obstructive pulmonary disease ( COPD ) . PURPOSE This study was design ed to evaluate the relationship among marital adjustment , quality of life , psychologic functioning , and functional capacity among married patients with COPD who are participating in a 5-week exercise rehabilitation program and their spouses . SAMPLE A convenience sample of 31 patients with COPD and their partners was included . DESIGN A prospect i ve 1-group pretest-posttest study was conducted . RESULTS Marital adjustment scores indicated that patients and partners were , on average , satisfied with their marriages . Patient marital adjustment was associated with patient psychologic well-being , whereas partner marital adjustment was associated with patient physical functioning . In addition , patient and partner perceptions of marital adjustment predicted change in patient functioning after exercise rehabilitation . Patients who entered the program with poor marital adjustment experienced a greater magnitude of improvement in mental health after rehabilitation than did well-adjusted patients . CONCLUSIONS These findings suggest that marital adjustment is associated with both psychologic well-being and physical functioning among patients with COPD , and that it may predict change among patients with COPD participating in exercise rehabilitation
Conclusion Our findings suggest that people with low literacy skills or learning disabilities are left out of the development of PROMs .
Background  Patient-reported outcome measures ( PROMs ) are intended to reflect outcomes relevant to patients .
They are increasingly used for healthcare quality improvement .
To produce valid measures , patients should be involved in the development process but it is unclear whether this usually includes people with low literacy skills or learning disabilities .