Open Access Correspondence

The COSMIN checklist for evaluating the methodological quality of studies on measurement properties: A clarification of its content

Lidwine B Mokkink1*, Caroline B Terwee1, Dirk L Knol1, Paul W Stratford2, Jordi Alonso34, Donald L Patrick5, Lex M Bouter16 and Henrica CW de Vet1

Author Affiliations

1 Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands

2 School of Rehabilitation Science and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada

3 Health Services Research Unit, Institute Municipal d'Investigació Mèdica (IMIM-Hospital del Mar), Barcelona, Spain

4 Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain

5 Department of Health Services, University of Washington, Seattle, USA

6 Executive Board of VU University Amsterdam, Amsterdam, the Netherlands

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BMC Medical Research Methodology 2010, 10:22  doi:10.1186/1471-2288-10-22

Published: 18 March 2010



The COSMIN checklist (COnsensus-based Standards for the selection of health status Measurement INstruments) was developed in an international Delphi study to evaluate the methodological quality of studies on measurement properties of health-related patient reported outcomes (HR-PROs). In this paper, we explain our choices for the design requirements and preferred statistical methods for which no evidence is available in the literature or on which the Delphi panel members had substantial discussion.


The issues described in this paper are a reflection of the Delphi process in which 43 panel members participated.


The topics discussed are internal consistency (relevance for reflective and formative models, and distinction with unidimensionality), content validity (judging relevance and comprehensiveness), hypotheses testing as an aspect of construct validity (specificity of hypotheses), criterion validity (relevance for PROs), and responsiveness (concept and relation to validity, and (in) appropriate measures).


We expect that this paper will contribute to a better understanding of the rationale behind the items, thereby enhancing the acceptance and use of the COSMIN checklist.