Open Access Highly Accessed Review

Validity of instruments to measure physical activity may be questionable due to a lack of conceptual frameworks: a systematic review

Elena Gimeno-Santos123, Anja Frei45, Fabienne Dobbels6, Katja Rüdell7, Milo A Puhan48, Judith Garcia-Aymerich1239* and the PROactive consortium

Author Affiliations

1 Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain

2 Hospital del Mar Research Institute (IMIM), Barcelona, Spain

3 CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain

4 Horten Centre for Patient-oriented Research, University Hospital of Zurich, Switzerland

5 Institute of General Practice and Health Services Research, University Hospital of Zurich, Switzerland

6 Centre for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium

7 Patient Reported Outcomes Centre of Excellence, Market Access, Primary Care Business Unit, Pfizer Ltd, Sandwich, Kent, UK

8 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore (MD), USA

9 Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain

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Health and Quality of Life Outcomes 2011, 9:86  doi:10.1186/1477-7525-9-86

Published: 3 October 2011



Guidance documents for the development and validation of patient-reported outcomes (PROs) advise the use of conceptual frameworks, which outline the structure of the concept that a PRO aims to measure. It is unknown whether currently available PROs are based on conceptual frameworks. This study, which was limited to a specific case, had the following aims: (i) to identify conceptual frameworks of physical activity in chronic respiratory patients or similar populations (chronic heart disease patients or the elderly) and (ii) to assess whether the development and validation of PROs to measure physical activity in these populations were based on a conceptual framework of physical activity.


Two systematic reviews were conducted through searches of the Medline, Embase, PsycINFO, and Cinahl databases prior to January 2010.


In the first review, only 2 out of 581 references pertaining to physical activity in the defined populations provided a conceptual framework of physical activity in COPD patients. In the second review, out of 103 studies developing PROs to measure physical activity or related constructs, none were based on a conceptual framework of physical activity.


These findings raise concerns about how the large body of evidence from studies that use physical activity PRO instruments should be evaluated by health care providers, guideline developers, and regulatory agencies.

Chronic heart disease; chronic respiratory disease; conceptual framework; elderly; patient reported outcomes; physical activity; questionnaire; systematic review