Table 4.

Inventory of revisions to the provisional PROM based on feedback from the cognitive testing session.

Categories	Revision
Comprehensibility
Phrasing of symptoms items	•Rephrased “Urge to have bowel movement” to “Recurrent urge to have bowel movement” to reflect the recurrent nature of the urgency. •Rephrased “Little amount of stool” to “Passing little amount of stool” to emphasise the rating of an event rather than quantity.
Phrasing of QoL items	•Rephrased “Medication is not helping my constipation symptoms” to “My current treatment is helping my constipation symptoms” to utilise a broader phrase (which includes probiotics and fibre) and to remove double negative when rating. •Rephrased “I am worried that my constipation will lead to other health problems” to “I am worried that my constipation is linked to more serious health problems” to reflect the worry of constipation being a sign or symptom of more severe health problems. •Rephrased “I avoid social activities due to my constipation problems” to “I have to limit my social activities due to my constipation problems” as participants have reported restriction rather than avoidance of social activities.
Phrasing of item scales	•Rephrased “Neutral” to “Neither agree nor disagree” for clarity purposes.
Comprehensiveness
Inclusion of new symptoms items	•Inclusion of “Seeing blood during bowel movement (e.g. due to haemorrhoids, anal fissure, etc.)”.
Inclusion of new outcome measure for symptoms	•Inclusion of a column to the symptoms domain for patients to indicate symptom items that they are most bothered by. Participants highlighted that it is importance for doctors to understand which symptoms are bothersome to patients; can help with personalisation of treatment.

PROM, patient-reported outcome measure; QoL, quality of life