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 .
Effect of rollator use on health-related quality of life in individuals with COPD.
OBJECTIVE The purpose of this study was to evaluate the influence of rollator use on health-related quality of life in patients with COPD . DESIGN R and omized controlled trial . METHODS Thirty-one postrehabilitation patients with COPD were r and omized to receive a  rollator ( n = 18 ) or  usual care  ( n = 13 ) for 8 weeks and to record the frequency of rollator use . Outcome measures at baseline , 4 weeks , and 8 weeks included the Chronic Respiratory Question naire ( CRQ ) and the 6-min walk ( 6MW ) . RESULTS During acute testing , subjects consistently walked further when assisted ( baseline 6MW : 292 + /- 67 m vs 263 + /- 67 m ; 8 weeks : 283 + /- 65 m vs 259 + /- 68 m [ + /-SD ] ; p = 0.013 ) . However , provision of a rollator at home was not associated with group differences in the CRQ ( p > 0.08 ) or in the unassisted 6MW ( p = 0.4 ) or the assisted 6MW ( p = 0.5 ) . Eight of 18 subjects assigned to the rollator group used the rollator less than three times per week . Regular users demonstrated a consistent improvement in mastery compared with infrequent users ( 4 weeks : 4.7 + /- 0.6 vs 5.2 + /- 0.8 , respectively ; 8 weeks : 5.3 + /- 0.8 vs 4.7 + /- 0.4 ; p = 0.014 ) . CONCLUSIONS Despite evidence of effectiveness during acute testing , this study did not demonstrate a rollator effect on quality of life or exercise capacity when the rollator was provided at home , for a longer period . Actual use of a rollator may be an important determinant of its effect . Therefore , when prescribing a rollator , health-care professionals should attempt to identify those most likely to use it
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 .