title: [Questions about questions: cognitive survey of questionnaire development].
abstract: OBJECTIVE
  Traditional pretests are used in the development of survey items to identify technical and comprehension problems. Cognitive processes involved in answering survey questions are not the object of this kind of test.
  
  
  METHODS
  Cognitive survey methods were used here to test a questionnaire screening for rehabilitation needs in people suffering from back pain. Essential techniques of cognitive testing (think-aloud, probing, confidence ratings) are outlined. We applied these techniques to 20 patients suffering from either acute or chronic back pain in order to test the survey.
  
  
  RESULTS
  The main goal, i.e., identifying problems in item formulation by means of cognitive testing, was achieved. Almost one third of the survey questions were rephrased according to the results of the study. Some of the improvements of the questionnaire are illustrated.
  
  
  CONCLUSIONS
  The increased effort required to perform cognitive testing as compared to traditional pretesting pays off. The two methods have specific pros and cons and cannot replace one another.
authors.affiliation: Institut für Sozialmedizin, Lübeck. oskar.mittag@sozmed.mu-luebeck.de
authors.forename: Oskar
authors.initials: O
authors.lastname: Mittag
authors.forename: Sonja
authors.initials: S
authors.lastname: Böhmer
authors.forename: Ruth
authors.initials: R
authors.lastname: Deck
authors.forename: Monika
authors.initials: M
authors.lastname: Ekkernkamp
authors.forename: Angelika
authors.initials: A
authors.lastname: Hüppe
authors.forename: Hildegard
authors.initials: H
authors.lastname: Telbis-Kankainen
authors.forename: Angelica
authors.initials: A
authors.lastname: Raspe
authors.forename: Heiner
authors.initials: H
authors.lastname: Raspe
mesh_terms: D000328:Adult; D003071:Cognition; D003210:Concept Formation / Q000145:classification; D016001:Confidence Intervals; D005260:Female; D005858:Germany; D006306:Health Surveys; D006801:Humans; D017116:Low Back Pain / Q000534:rehabilitation*; D008297:Male; D011939:Mental Recall / Q000145:classification; D008875:Middle Aged; D020380:Needs Assessment / Q000706:statistics & numerical data*; D010147:Pain Measurement / Q000706:statistics & numerical data; D012047:Rehabilitation Centers / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires / Q000592:standards; D013850:Thinking / Q000145:classification