RHINO Scale: A Question about Content Validity

1 Anne F. Klassen, DPhil Hamilton, Ontario, Canada Stefan Cano, PhD Modus Outcomes Boston, Mass. Andrea Pusic, MD, MSc Memorial Sloan-Kettering Cancer Center New York, N.Y. Sir: W are writing in response to the article by Lee and Most1 describing a new patient-reported outcome (PRO) instrument for rhinoplasty patients, that is, the RHINO Scale. This 10-item scale purports to measure satisfaction after rhinoplasty performed for functional and/or aesthetic reasons. The authors evaluated their scale in a small sample (n = 22) of patients. We welcome the intention of surgeons taking seriously the need to capture the patient perception of outcomes of rhinoplasty. However, we are concerned that the authors do not describe any of the steps they took to develop their scale. Specifically, there is no information (nor citations pointing to other publications) about how the concepts measured by this scale were elicited. This makes its content validity, which is a core part of any new PRO instrument, at best, very difficult to judge. Content validity is the extent to which items in a PRO instrument are comprehensive