The PROactive innovative conceptual framework on physical activity

Fabienne Dobbels, Corina de Jong, Ellen Drost, Janneke Elberse, Chryssoula Feridou, Laura Jacobs, Roberto Rabinovich, Anja Frei, Milo A. Puhan, Willem I. de Boer, Thys van der Molen, Kate Williams, Hillary Pinnock, Thierry Troosters, Niklas Karlsson, Karoly Kulich, Katja Rüdell

Research output: Contribution to journalArticlepeer-review

32 Scopus citations


Although physical activity is considered an important therapeutic target in chronic obstructive pulmonary disease (COPD), what "physical activity" means to COPD patients and how their perspective is best measured is poorly understood. We designed a conceptual framework, guiding the development and content validation of two patient reported outcome (PRO) instruments on physical activity (PROactive PRO instruments). 116 patients from four European countries with diverse demographics and COPD phenotypes participated in three consecutive qualitative studies (63% male, age mean±sd 66±9 years, 35% Global Initiative for Chronic Obstructive Lung Disease stage III-IV). 23 interviews and eight focus groups (n = 54) identified the main themes and candidate items of the framework. 39 cognitive debriefings allowed the clarity of the items and instructions to be optimised. Three themes emerged, i.e. impact of COPD on amount of physical activity, symptoms experienced during physical activity, and adaptations made to facilitate physical activity. The themes were similar irrespective of country, demographic or disease characteristics. Iterative rounds of appraisal and refinement of candidate items resulted in 30 items with a daily recall period and 34 items with a 7-day recall period. For the first time, our approach provides comprehensive insight on physical activity from the COPD patients' perspective. The PROactive PRO instruments' content validity represents the pivotal basis for empirically based item reduction and validation.

Original languageEnglish (US)
Pages (from-to)1223-1233
Number of pages11
JournalEuropean Respiratory Journal
Issue number5
StatePublished - Nov 1 2014
Externally publishedYes

ASJC Scopus subject areas

  • Medicine(all)


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