The COSMIN checklist

VU medisch Centrum


EMGO institute for health and care research

The COSMIN checklist

The COSMIN checklist contains standards for design requirements and preferred statistical methods of studies on the measurement properties of health measurement instruments. The checklist can be used to determining if a study on measurement properties meets the standards for good methodological quality.

We recommend users of the COSMIN checklist to read the COSMIN manual before using the checklist. The manual contains user-friendly data extraction forms and detailed instructions for how to complete the COSMIN checklist. In addition, background information is provided on the development and validation of the checklist and the rationale behind all items. Also possible applications of the COSMIN checklist are described. 
In 2011 a COSMIN checklist with 4-point rating scale was developed which can be used to calculate total quality scores per measurement property, e.g. when using the checklist in a systematic review of measurement properties. Read more ...

Focus of the checklist
The focus of the checklist is on standards for studies on the measurement properties of Health-Realted Patient-Reported Outcomes (HR-PROs). However, the same measurement properties are likely to be relevant for other kind of health measurement instruments, such as performance-based instruments and clinical rating scales. Furthermore, the focus of the checklis is on HR-PROs used in an evaluative application, i.e. longitudinal applications assessing treatment effects or changes in health over time. To be used for discriminative or predictive purposes, the design requirements and standards for the measurement properties are the same, but the relative importance of the measurement properties may differ.

Content of the checklist
The checklist contains twelve boxes. Ten boxes can be used to assess whether a study meets the standard for good methodological quality. Nine of these boxes contain standards for studies on measurement properties (boxes A to I), and one box contains standards for studies on interpretability of HR-PRO instruments (boxes J). Interpretability is not considered a measurement property, but nevertheless an important characteristic of a HR-PRO instrument and is therefore included in the checklist.
In addition, two boxes are included in the checklist that contain general requirements for articles in which IRT methods are applied (IRT box), and general requirements for the generalisability of the results (Generalisability box), respectively.

We focus here on the application of the checklist to evalute the methodological quality of articles on measurement properties. Other possible applications of the checklist are discussed in the background document.

Instructions for using the COSMIN checklist
To complete the COSMIN checklist a 4-step procedure should be followed. 

click on the image for a larger view (pdf)

Step 1
is to determine which measurement properties are evaluated in an article.
Step 2 is to determine if the statistical methods used in the article are based on Classical Test Theory (CTT) or on Item Response Theory (IRT).
Step 3 is to evaluate the methodological quality of the studies on the properties identified in step 1.
Step 4 is to assess the generalisability of the results of the studies on the properties identified in step 1.

A detailed description of how to use the checklist, a rationale for each item, and suggestions for scoring the items, are provided in the COSMIN manual.