@article {Dobbels1223, author = {Fabienne Dobbels and Corina de Jong and Ellen Drost and Janneke Elberse and Chryssoula Feridou and Laura Jacobs and Roberto Rabinovich and Anja Frei and Milo A. Puhan and Willem I. de Boer and Thys van der Molen and Kate Williams and Hillary Pinnock and Thierry Troosters and Niklas Karlsson and Karoly Kulich and Katja R{\"u}dell and the PROactive consortium}, editor = {Brindicci, Caterina and Higenbottam, Tim and Troosters, Thierry and Dobbels, Fabienne and Decramer, Marc and Tabberer, Margaret and Rabinovich, Roberto A and MacNee, William and Vogiatzis, Ioannis and Polkey, Michael and Hopkinson, Nick and Garcia-Aymerich, Judith and Puhan, Milo and Frei, Anja and van der Molen, Thys and de Jong, Corina and de Boer, Pim and Jarrod, Ian and McBride, Paul and Kamel, Nadia and Rudell, Katja and Wilson, Frederick J. and Ivanoff, Nathalie and Kulich, Karoly and Glendenning, Alistair and Karlsson, Niklas X. and Corriol-Rohou, Solange and Nikai, Enkeleida and Erzen, Damijan}, title = {The PROactive innovative conceptual framework on physical activity}, volume = {44}, number = {5}, pages = {1223--1233}, year = {2014}, doi = {10.1183/09031936.00004814}, publisher = {European Respiratory Society}, abstract = {Although physical activity is considered an important therapeutic target in chronic obstructive pulmonary disease (COPD), what {\textquotedblleft}physical activity{\textquotedblright} 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{\textpm}sd 66{\textpm}9 years, 35\% Global Initiative for Chronic Obstructive Lung Disease stage III{\textendash}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{\textquoteright} perspective. The PROactive PRO instruments{\textquoteright} content validity represents the pivotal basis for empirically based item reduction and validation. Conceptual framework as basis of PROactive PRO instruments to assess physical activity from COPD patient perspective http://ow.ly/ytJoS}, issn = {0903-1936}, URL = {https://erj.ersjournals.com/content/44/5/1223}, eprint = {https://erj.ersjournals.com/content/44/5/1223.full.pdf}, journal = {European Respiratory Journal} }