COSMIN Risk of Bias tool to assess the quality of studies on reliability or measurement error of outcome measurement instruments: a Delphi study

L. B. Mokkink*, M. Boers, C. P. M. van der Vleuten, L. M. Bouter, J. Alonso, D. L. Patrick, H. C. W. de Vet, C. B. Terwee

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

131 Citations (Web of Science)


Background Scores on an outcome measurement instrument depend on the type and settings of the instrument used, how instructions are given to patients, how professionals administer and score the instrument, etc. The impact of all these sources of variation on scores can be assessed in studies on reliability and measurement error, if properly designed and analyzed. The aim of this study was to develop standards to assess the quality of studies on reliability and measurement error of clinician-reported outcome measurement instruments, performance-based outcome measurement instrument, and laboratory values. Methods We conducted a 3-round Delphi study involving 52 panelists. Results Consensus was reached on how a comprehensive research question can be deduced from the design of a reliability study to determine how the results of a study inform us about the quality of the outcome measurement instrument at issue. Consensus was reached on components of outcome measurement instruments, i.e. the potential sources of variation. Next, we reached consensus on standards on design requirements (n = 5), standards on preferred statistical methods for reliability (n = 3) and measurement error (n = 2), and their ratings on a four-point scale. There was one term for a component and one rating of one standard on which no consensus was reached, and therefore required a decision by the steering committee. Conclusion We developed a tool that enables researchers with and without thorough knowledge on measurement properties to assess the quality of a study on reliability and measurement error of outcome measurement instruments.

Original languageEnglish
Article number293
Number of pages13
JournalBMC Medical Research Methodology
Issue number1
Publication statusPublished - 3 Dec 2020


  • Delphi study
  • Measurement error
  • Outcome measurement instruments
  • Quality assessment
  • Reliability
  • Risk of Bias

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