Chapter 6 102 could be used in ways that are both effective (desired outcomes) and efficient (that do so with the least amount of effort and cost) [17]. Understanding who are adherent and who are non-adherent could be helpful to differentiate between patients who need more or less support during PR (effective and efficient). Therefore, accurate estimates of adherence in patients with COPD might be important to be able to support healthcare providers in their choices of support for the benefit of the individual patient. To predict patient’s probability of adherence to PR, a prediction model could be beneficial. Information from such a model can be used to manage the patient instead of managing the disease, as the traditional medical model does [13]. The model would aim to reduce unnecessary intervention and thus reduce pressure on the health system (patients who are adherent might need less support). By reducing the average number of consultations from 24.7, healthcare costs are directly saved and the pressure on healthcare providers will also be reduced. This person-centered care requires a patient-provider partnership involving collaborative care and education in chronic disease self-management to ensure the best possible health outcomes for the patient [13] and less pressure on the health system [10]. So far, no prediction models for (non-)adherence are available. Therefore, the aim of this study was to develop and validate a model to predict adherence to pulmonary rehabilitation in a cohort of patients with COPD in the Netherlands and Belgium. Methods The study is consistent with the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) reporting guidelines. Study design and population Participants of this prospective cohort study were Dutch/Flemish-speaking patients aged ³ 18 years from primary physiotherapy practices, and from the COPD patientorganizations from the Netherlands and Belgium. Recruitment commenced in January 2021, and 12-month follow-up assessments were completed in August 2022. Patients (³ 18 years) with COPD, with airflow limitation stage GOLD II-IV and having rehabilitation sessions for at least once a month, were potentially eligible for inclusion. The exclusion criteria were home-based rehabilitation and insufficient mastery of the Dutch/Flemish language to complete the questionnaires. Physiotherapy practices were approached by e-mail and social media for participation, and patients were recruited by their attending physiotherapist. Physiotherapy practices could receive a financial compensation of €20 per participating patient, at the time of study completion as a token of appreciation.
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