title: Mindfulness: a systematic review of instruments to measure an emergent patient-reported outcome (PRO).
abstract: OBJECTIVE
  Mindfulness has emerged as an important health concept based on evidence that mindfulness interventions reduce symptoms and improve health-related quality of life. The objectives of this study were to systematically assess and compare the properties of instruments to measure self-reported mindfulness.
  
  
  METHODS
  Ovid Medline(®), CINAHL(®), and PsycINFO(®) were searched through May 2012, and articles were selected if their primary purpose was development or evaluation of the measurement properties (validity, reliability, responsiveness) of a self-report mindfulness scale. Two reviewers independently evaluated the methodological quality of the selected studies using the COnsensus-based Standards for the selection of health status Measurement INstruments checklist. Discrepancies were discussed with a third reviewer and scored by consensus. Finally, a level of evidence approach was used to synthesize the results and study quality.
  
  
  RESULTS
  Our search strategy identified a total of 2,588 articles. Forty-six articles, reporting 79 unique studies, met inclusion criteria. Ten instruments quantifying mindfulness as a unidimensional scale (n = 5) or as a set of 2-5 subscales (n = 5) were reviewed. The Mindful Attention Awareness Scale was evaluated by the most studies (n = 27) and had positive overall quality ratings for most of the psychometric properties reviewed. The Five Facet Mindfulness Questionnaire received the highest possible rating ("consistent findings in multiple studies of good methodological quality") for two properties, internal consistency and construct validation by hypothesis testing. However, none of the instruments had sufficient evidence of content validity. Comprehensiveness of construct coverage had not been assessed; qualitative methods to confirm understanding and relevance were absent. In addition, estimates of test-retest reliability, responsiveness, or measurement error to guide users in protocol development or interpretation of scores were lacking.
  
  
  CONCLUSIONS
  Current mindfulness scales have important conceptual differences, and none can be strongly recommended based solely on superior psychometric properties. Important limitations in the field are the absence of qualitative evaluations and accepted external referents to support construct validity. Investigators need to proceed cautiously before optimizing any mindfulness intervention based on the existing scales.
authors.affiliation: College of Pharmacy, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Taehwan
authors.initials: T
authors.lastname: Park
authors.forename: Maryanne
authors.initials: M
authors.lastname: Reilly-Spong
authors.forename: Cynthia R
authors.initials: CR
authors.lastname: Gross
mesh_terms: D057189:Checklist; D032921:Consensus; D005260:Female; D006304:Health Status; D006801:Humans; D064866:Mindfulness; D063868:Patient Outcome Assessment; D011594:Psychometrics / Q000295:instrumentation*; D011788:Quality of Life; D015203:Reproducibility of Results; D057566:Self Report; D011795:Surveys and Questionnaires
references.citation: JAMA. 2009 Sep 23;302(12):1284-93
references.pmid: 19773563
references.citation: Br J Clin Psychol. 2008 Nov;47(Pt 4):451-5
references.pmid: 18573227
references.citation: J Clin Epidemiol. 2009 Oct;62(10):1062-7
references.pmid: 19230609
references.citation: Soc Sci Med. 1999 Jun;48(11):1531-48
references.pmid: 10400255
references.citation: Assessment. 2004 Sep;11(3):191-206
references.pmid: 15358875
references.citation: Behav Ther. 2009 Jun;40(2):142-54
references.pmid: 19433145
references.citation: J Am Diet Assoc. 2009 Aug;109(8):1439-44
references.pmid: 19631053
references.citation: Subst Abus. 2009 Oct-Dec;30(4):328-37
references.pmid: 19904668
references.citation: Explore (NY). 2011 Sep-Oct;7(5):314-9
references.pmid: 21907154
references.citation: Cogn Behav Ther. 2006;35(3):148-58
references.pmid: 16952898
references.citation: Psychooncology. 2011 Jul;20(7):681-97
references.pmid: 20690112
references.citation: Assessment. 2011 Mar;18(1):11-26
references.pmid: 20980699
references.citation: J Couns Psychol. 2010 Jan;57(1):1-10
references.pmid: 21133556
references.citation: Psychol Assess. 2011 Dec;23(4):1034-40; discussion 1041-6
references.pmid: 22122674
references.citation: Psychother Res. 2010 Jul;20(4):388-97
references.pmid: 20204916
references.citation: Cogn Behav Ther. 2010;39(3):203-13
references.pmid: 20182933
references.citation: J Pers Soc Psychol. 2003 Apr;84(4):822-48
references.pmid: 12703651
references.citation: Qual Life Res. 2010 May;19(4):539-49
references.pmid: 20169472
references.citation: J Clin Psychol. 2006 Dec;62(12):1445-67
references.pmid: 17019673
references.citation: J Clin Epidemiol. 2010 Jul;63(7):737-45
references.pmid: 20494804
references.citation: Psychol Bull. 1990 Mar;107(2):238-46
references.pmid: 2320703
references.citation: J Psychosom Res. 2005 Jan;58(1):29-33
references.pmid: 15771867
references.citation: Assessment. 2010 Jun;17(2):220-9
references.pmid: 20040728
references.citation: Assessment. 2011 Mar;18(1):3-10
references.pmid: 21193491
references.citation: J Appl Meas. 2007;8(4):359-72
references.pmid: 18250523
references.citation: J Clin Psychol. 2011 Apr;67(4):404-24
references.pmid: 21254062
references.citation: Assessment. 2011 Sep;18(3):308-20
references.pmid: 21586480
references.citation: Pain. 2007 Sep;131(1-2):63-9
references.pmid: 17257755
references.citation: Perspect Psychol Sci. 2011 Nov;6(6):537-59
references.pmid: 26168376
references.citation: J Psychosom Res. 2010 Jun;68(6):539-44
references.pmid: 20488270
references.citation: J Anxiety Disord. 2009 Mar;23(2):297-303
references.pmid: 18834701
references.citation: J Consult Clin Psychol. 2007 Apr;75(2):336-43
references.pmid: 17469891
references.citation: Assessment. 2006 Mar;13(1):27-45
references.pmid: 16443717
references.citation: Cogn Behav Ther. 2011;40(3):174-82
references.pmid: 21660777
references.citation: Psychol Addict Behav. 2010 Dec;24(4):608-16
references.pmid: 21198223
references.citation: Emotion. 2010 Feb;10(1):83-91
references.pmid: 20141305
references.citation: Philos Ethics Humanit Med. 2011 May 17;6:10
references.pmid: 21586129
references.citation: J Clin Psychol. 2011 Jun;67(6):639-45
references.pmid: 21294117
references.citation: Altern Ther Health Med. 2010 Sep-Oct;16(5):30-8
references.pmid: 20882729
references.citation: Behav Res Ther. 2007 Jun;45(6):1393-400
references.pmid: 16949030
references.citation: J Consult Clin Psychol. 2010 Apr;78(2):169-83
references.pmid: 20350028
references.citation: Qual Life Res. 2012 May;21(4):651-7
references.pmid: 21732199
references.citation: Explore (NY). 2011 Mar-Apr;7(2):76-87
references.pmid: 21397868
references.citation: J Clin Epidemiol. 2007 Jan;60(1):34-42
references.pmid: 17161752
references.citation: Addict Behav. 2005 Aug;30(7):1335-41
references.pmid: 16022930
references.citation: Psychosom Med. 2003 Jul-Aug;65(4):564-70
references.pmid: 12883106
references.citation: Cogn Behav Ther. 2007;36(2):91-101
references.pmid: 17530495
references.citation: J Clin Psychol. 2009 Jun;65(6):590-612
references.pmid: 19358288
references.citation: Assessment. 2008 Jun;15(2):204-23
references.pmid: 18187399
references.citation: Psychiatry Res. 2011 May 30;187(3):441-53
references.pmid: 20846726
references.citation: Behav Ther. 2007 Sep;38(3):234-46
references.pmid: 17697849
references.citation: Spine (Phila Pa 1976). 2003 Jun 15;28(12):1290-9
references.pmid: 12811274
references.citation: Acta Psychiatr Scand. 2011 Aug;124(2):102-19
references.pmid: 21534932
references.citation: J Altern Complement Med. 2009 May;15(5):593-600
references.pmid: 19432513
references.citation: J Psychosom Res. 2008 Apr;64(4):405-8
references.pmid: 18374739
references.citation: Psychosom Med. 1998 Sep-Oct;60(5):625-32
references.pmid: 9773769
references.citation: Altern Ther Health Med. 2007 Sep-Oct;13(5):36-8
references.pmid: 17900040
references.citation: Assessment. 2008 Sep;15(3):329-42
references.pmid: 18310597