Table 2.

Sub-steps in selecting the PROM (step 3 of the PROM-cycle)

Sub-step		Description
3a	Determine requirements of the PROM	Requirements may include the type of PROM (e.g. generic of specific), mode of administration (e.g. paper/pencil, web-based), measurement properties (see also 3d), applicability (see also step 3e).
3b	Identify potential PROMs	Identification of PROMs per selected PRO through a systematic search of the literature and existing databases.
3c	Initial selection of potential PROMs	Initial selection through content validity by evaluating the relevance, comprehensiveness, and comprehensibility of the items and domains of the PROM – does the PROM measure the selected PROs?
3d	Determine measurement properties of the PROM	Evaluate the reliability, validity and responsiveness of the potential PROMs. The COSMIN methodology may assist in the evaluation.
3e	Determine feasibility, interpretability and acceptability of the PROM	Feasibility is related to various aspects such as the time of administration (number of items), availability of translated version, and costs for using the PROM; interpretability is related to meaningful use of the scores on the PROM such as minimal clinical important difference; acceptability is related to support of patients and clinicians in using the PROM
3f	Select suitable PROM(s)	Selection of the PROM(s) based on the outcomes of step 3d and 3e, for which formal and informal consensus procedures can be used.
3g	Determine the next step	The next step could be testing of the selected PROM (step 4 in the PROM-cycle), adaptation of an existing PROM through further development and testing; or development of a new PROM if no existing PROMs meet the requirements.

PRO Patient Reported Outcome, PROM Patient Reported Outcome Measure, COSMIN COnsensus-based Standards for the selection of health Measurement Instruments [9]