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Recent Abstracts

Dartmouth COOP Charts

Name of Questionnaire

Dartmouth COOP Charts. An international version is known as COOP/WONCA Charts. (WONCA = World Organization of National Colleges, Academies, and Academic Associations of General Practices/Family Physicians


Generic functional status measure designed for clinical use in primary care. Used subsequently in many different patient populations and settings.


E. Nelson et al., and the Dartmouth Primary Care Cooperative Information Project (COOP Project)


Dartmouth COOP Project
Dartmouth Medical School
Butler Building, HB 7265
Hanover, NH 03755
Phone: 603-650-1220
FAX: 603-650-1331


Cost & availability

$15.00 administration fee for comprehensive packet with camera-ready charts


Self or interviewer

Time to complete

1-2 minutes for 3 charts (Nelson, Wasson, Kirk et al.); 4.5 minutes for 6 charts (Landgraf et al.)

Number of items

6 to 9 single-item charts

Domains & categories (#)


Name of categories/domains

Adult COOP: physical function, emotional function, daily activities, social activities, social support, change in health, overall health, pain, quality of life (Nelson, Landgraf, et al.; Nelson, Wasson, Johnson et al.). Adolescent COOP: physical fitness, emotional feelings, school work, social support, family communication, health habits (Nelson, Wasson, Johnson et al.; Wasson, Kairys, Nelson et al.). COOP/WONCA: physical fitness, emotional feelings, daily activities, social activities, change in health, overall health, pain (optional) (Landgraf et al., Van Weel).

Scaling of items

5-point Likert-type scaling, with descriptors and cartoon illustrations of levels 1 through 5. Rating of "1" = no impairment, "5" = most impaired. Contribution of illustrations has been explored (Kempson et al., Larson et al.)


Each chart is a direct indicator of function in the domain, and summing for a total score is not encouraged. Scores can be summed for research purposes (Van Weel).


a. Test-Retest/Reproducibility Reported (Nelson, Landgraf et al.; Wasson, Kairys et al.)
b. Internal Consistency not applicable for single-item charts


Evidence for convergent and discriminant validity found for physical and emotional (but not role function) charts in multi-trait multi-method matrix with the Rand general health questionnaire (Nelson, Wasson, Kirk et al). Six COOP charts discriminated between levels of function in groups of patients, but were less precise than long-form (MOS), short-form (SF-36), and multi-item/global (General Health Survey) measures (McHorney et al.). Evidence for concurrent validity of COOP/WONCA charts with SF-36, EuroQol, and Nottingham Health Profile found through correlation and factor analysis; 4 of 6 charts discriminated between known groups (Essink-Bot et al.). Evidence for concurrent validity of adolescent COOP charts reported (Wasson, Kairys et al.)


Reported (Jenkinson et al.)

Research Use

Reported (modified version used for COPD [Smith et al] and LVRS [Appleton et al.]). Extensive bibliography posted on website through 1997.

Clinical Use



Original: English (US)

Translations: Chinese, Danish, Dutch, Finnish, French, German, Hebrew, Italian, Japanese, Korean, Norwegian, Portuguese, Spanish (3 dialects), Slovak, Swedish, Urdu


  1. Nelson E, Landgraf JM, Hays RD, Wasson JH, Kirk JW. The functional status of patients: How can it be measured in physicians' offices? Med Care 1990; 28:1111-1126.
  2. Nelson E, Wasson J, Kirk J, Keller A, Clark D, Dietrich A, Stewart A, Zubkoff. Assessment of function in routine clinical practice: Description of the COOP chart method and preliminary findings. J Chron Dis 1987; 40 (Suppl 1): 55S-63S.
  3. Wasson JH, Kairys SW, Nelson EC, Kalishman N, Baribeau P. A short survey for assessing health and social problems of adolescents. J Fam Pract 1994; 38:489-494.
  4. Landgraf JM, Nelson EC, Dartmouth COOP Primary Care Network. Summary of the WONCA/COOP International health assessment field trial. Aust Fam Physician 1992; 21:255-269.
  5. Nelson EC, Wasson JH, Johnson DJ, Hays RD. Dartmouth COOP Functional Health Assessment Charts: Brief measures for clinical practice.
  6. Van Weel C. Functional status in primary care: COOP/WONCA charts. Disabil Rehabil 1993; 15:96-101.
  7. Kempen GIJM, van Sonderen E, Sanderman R. Measuring health status with the Dartmouth COOP charts in low-functioning elderly. Do the illustrations affect the outcome? Qual Life Res 1997; 6:323-328.
  8. Larson CO, Hays RD, Nelson EC. Do the pictures influence scores on the Dartmouth COOP charts? Qual Life Res 1992; 1:247-249.
  9. McHorney CA, Ware JE, Roger W, Raczek AE, Lu JFR. The validity and relative precision of MOS short- and long-form health status scales and Dartmouth COOP charts. Med Care 1992; 30 (Suppl): MS253-265.
  10. Essink-Bot M-L, Krabbe PFM, Gonsel GJ, Aaronson NK. An empirical comparison of four generic health status measures: The Nottingham Health Profile, the Medical Outcomes Study 36-item Short-Form Health Survey, the COOP/WONCA charts, and the EuroQol instrument. Med Care 1997; 35:522-537.
  11. Jenkinson C, Lawrence K, McWhinnie D., Gordon J. Sensitivity to change of health status measures in a randomized controlled trial: Comparison of the COOP charts and the SF-36. Qual Life Res 1995; 4:47-52.
  12. Smith BJ, Appleton SL, Bennett PW, Roberts GC, Del Fante P, Adams R, Trott CM, Allan DP, Southcott AM, Ruffin RE. The effect of a respiratory home nurse intervention in patients with chronic obstructive pulmonary disease. Aust NZ J Med 1999; 29:718-725.
  13. Appleton S, Adams R, Porter S, Peacock M, Ruffin R. Sustained improvements in dyspnea and pulmonary function 3 to 5 years after lung volume reduction surgery. Chest 2003; 123:1838-1846.

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