Chapter 1 12 Adherence measures To improve adherence, it must be measurable. Adherence in patients with chronic diseases entails a specific pattern of behavior (performing a behavior over a long period of time to manage the disease), this leads to one of the problems in studying adherence, namely obtaining accurate measures of adherence behaviors [19]. In addition, people with chronic diseases often have different treatments with different healthcare providers. These healthcare providers come from a wide variety of backgrounds and training e.g., doctors, pharmacists, psychologists, physiotherapists, dieticians, and will approach the problem of adherence from different perspectives [19]. The basis for these differences lies in the fact that there is no consensus on how adherence should be defined and measured [20]. Self-report diaries are the most commonly used measure of adherence, so far. However, there is no standardized diary that can be used across research studies, meaning results are not easily comparable between studies. In addition, poor completion rates for diaries, together with inaccurate recall and self-presentation bias, may further affect validity of these data [21]. More objective is the use of electronic devices such as accelerometers and pedometers [22]. However, these require the patient to use them systematically, and therefore they might only be successful for more adherent patients. Furthermore, electronic devices might not be able to register all prescribed exercises [23]. As there is no reference standard for measuring exercise adherence, no recommendations are currently made from the literature for a specific instrument to measure adherence [12]. So, the availability of a valid and reliable instrument to measure adherence is necessary to make it possible to use a patient-specific intervention and thereby improve the quality of life and health outcomes for patients with chronic diseases and reduce healthcare costs [7]. In addition, it becomes possible to compare results in different settings and under different circumstances [20]. In the literature several measures have been identified to objectify adherence in musculoskeletal disorders. These measures are all unidimensional instruments; they measure one part of a multi-dimensional concept [24]. Only one multidimensional instrument that captures the diverse behaviors that contribute to clinicbased adherence, has been described to measure adherence in a rehabilitation setting: the Rehabilitation Adherence Measure for Athletic Training [25]. The RAdMAT is considered to be reliable, valid, responsive and interpretable at an individual level, easy and simple to use, and low in financial costs [26] in patients with musculoskeletal complaints who are visiting a primary physiotherapy practice. A Dutch version of the RAdMAT could potentially be an appropriate measurement
RkJQdWJsaXNoZXIy MjY0ODMw