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 .
Feasibility of distractive auditory stimuli on upper extremity training in persons with chronic obstructive pulmonary disease.
OBJECTIVE To determine the feasibility of distractive auditory stimuli ( DAS ) used during an upper extremity training ( UET ) program on perceived dyspnea , functional performance , and health-related quality of life . In addition , to determine the appropriate music tempo used during the UET . DESIGN Experimental , r and omized , 3-group design with testing at baseline and 4 weeks . SETTING Outpatient . PATIENTS Thirty patients ( 13 male and 17 female ) with moderate to severe chronic obstructive pulmonary disease ( FEV1 41.27 % + /- 18 % predicted ) . INTERVENTION Moderate DAS group ( n = 10 ) and slow DAS group ( n = 10 ) subjects were instructed to perform UET for up to 15 minutes 3 to 5 times a week using DAS ( walkman , audiocassettes ) . The control group ( n = 10 ) received the same instructions , but no DAS . MEASURES AND RESULTS Primary outcome measures were perceived dyspnea , functional performance using the 6-minute peg and ring board ( 6MRPB ) count and health-related quality of life . In addition , all subjects recorded the time of UET performance using self-report ( daily logs ) . A significant increase was seen in 6MRPB count ( P = .002 ) between groups . Moderate DAS subjects increased 6MPRB count 46 + /- 21 rings and slow DAS subjects increased 46 + /- 20 rings from baseline to 4 weeks whereas control subjects increased only 5 + /- 4 rings . No significant differences were noted for the remaining variables . CONCLUSION Subjects who used DAS ( music ) while performing UET improved functional performance whereas controls failed to continue improvement . The DAS is a feasible adjunct to UET that may have the potential to augment the effectiveness of pulmonary rehabilitation training
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 .