Table 2.

Decision-making process for eliminating or modifying questions or terms in the rounds of cognitive interviews

	Round 1	Round 2	Round 3	Round 4	Round 5	E.R.	Round 6	Round 7
	(4 ppts)	(7 ppts)	(4 ppts)	(4 ppts)	(9 ppts)		“Think-Aloud” trial + probes	“Think-Aloud” trial + probes
							(11 ppts)	(4 ppts)
	2) Expect	2) Realistically expect	2) Hope	2) Hope	2) Hope		2) Hope
	3) Personally expect	3) Hope	3) Realistically Expect	3) Realistically Expect	3) Realistically Expect		3) Think is likely to Occur
	4) Realistically expect	4) Think/feel/believe	4) Successful	4) How likely (particular outcomes)
	5) Hopeful		5) Substantially reduce	5) Substantially reduce VS reduce VS meaningfully
	6) Confident		VS reduce
				reduce
	7) Think/Feel/Believe
	8) Really think
Back pain terms	1) Back condition	1) Back pain	1) Back pain	1) Back pain	1) Back pain		1) Back Pain	1) Back pain
	2) Back pain problems		2) Average/current/ worst pain
	3) Back pain
Back dysfunction and global effects terms + outcomes domains	1) Limitations due to back pain	1) Limitations due to back pain	1) Impact of back pain on life	1) Impact of back pain on life	1) Impact of back pain on life		1) Physical limitations due to back pain	1) Impact of back pain on life
	2) Impact of back pain on life	2) Impact of back pain on life	2) Impact on work; social and recreational activities; daily activities; interactions with family & friends	2) Impact on work; social and recreational activities; daily activities; interactions with family & friends	2) Impact on work; social and recreational activities; daily activities; interactions with family & friends		2) Impact of back pain on life
	3) How BP interferes with life	3) Impact on work; social and recreational activities; daily activities; interactions with family	3) Sleep problems	3) Mood/Irritability	3) Mood/irritability		3) Impact on work; social and recreational activities; daily activities; interactions with family & friends
		4) Sleep problems			4) Energy		4) Back-related sleep problems
							5) Mood
							6) Energy
Coping					1) Coping		1) Coping
Timeframe		1) End of Tx period		1) End of Tx period 2) 1 year after			1) End of Tx period 2) One year from now	1) One year from now (with additional instructions)
Response options	1) words VS numbers	1) Ppt defined scales	1) 0-10	1) 0-10	1) 0-10		1) 0-10	1) 0-10
	2) Percent	2) Word set (a little worse- better than ever)	2) 0-100
	3) Likert scale (Strongly agree – strongly disagree)	3) 0-10	3) Percent
		4) Likert scale (Strongly agree – strongly disagree)	4) Negative numbers
		5) Middle Anchors
		6) 1-9
Word Anchors		1) 0 = a little worse, 10 = better than it’s ever been	1) 0 = No change, 10 = completely cured/no pain/pain-free	1) 0 = No change, 10 = no back pain	1) 0 = no change, 10 = no back pain		1) 0= no change/worse, 10 = complete relief
			2) Midpoint Anchor - somewhat	2) 0 = No change, 10 = back pain does not affect my mood	2) 0 = no change, 10 = back pain no longer impacts my life
				3) 0 = not at all likely, 10 = very likely	3) Cope VS really cope VS cope well		2) 10 = back pain no longer impacts my : (life) (sleep) (mood/irritability) (energy) (work) (Social and recreational activities) (daily activities) (relationships)
					4) NA
							3) 10 = Limitations completely resolved
Decisions/Rationale		1) Acupuncture Expectancy Scale eliminated – inconsistent meanings of questions	1) Upper anchor changed to “no back pain”	1) “How likely (specific outcomes)” was changed to questions of “how much change is expected”	1) Tested Cherkin/Sherman question “how helpful…”		1) Eliminated: Think is likely to occur – not as consistent as realistically expect	1) Use order suggested by survey design expert for self-care questions
		2) “Limitations due to back pain” kept for later, not tested in all rounds due to clarity of concept	2) Ppts prefer same scale throughout questionnaire		2) Work on Energy as a domain – test “energy level”

*Key.

Italicized text = eliminated.

Bold italicized text = selected for use in final questionnaire.

E.R. = Expert Review (prior to round 6).