Chapter 8 144 lung attacks and worsening of the disease and increased healthcare utilization [12, 15]. In sum, self-management regarding PR in patients with COPD could be a manner to reduce healthcare costs, but in doing so, the effectiveness of PR should not be compromised by non-adherence [16]. Tools to better understand and describe levels of adherence of patients with COPD to PR, may help inform clinical decision-making to focus more on self-management and less on clinical supervision. A prediction tool was therefore developed to estimate the likelihood that a patient will adhere to PR recommendations [17]. PATCH The Predicting Adherence in paTients with CHronic diseases (PATCH) tool applies four predictors: patient’s exercise intention, depression, patient-therapist relation (alliance), and Medical Research Council (MRC) dyspnea score [17]. The model weighs and combines these predictors and gives the healthcare provider a probability that indicates the chance that the patient under evaluation is adherent. Narrow validation showed good discrimination, calibration, and net benefit. To make PATCH more feasible for use in practice, the tool is available online: https://derzis.nu/Calculator/. The effectiveness of phasing out supervised PR to be replaced by selfmanagement regarding PR (guideline recommendation), nor the predictive validity of the PATCH tool have been evaluated. First, it must be determined whether selfmanagement is as effective and safe as fully supervised PR. Since adherence is an important precondition for considering self-management as an effective approach for a given patient, it should be assessed whether low adherence (as assessed with the Dutch version of the Rehabilitation Adherence Measure for Athletic Training (RAdMAT-NL)) indeed is associated with suboptimal self-management. Such a measurement design can simultaneous be used to assess the predictive validity of the PATCH tool. If self-management is effective and safe, it can be explored how it can be implemented in clinical practice. Since implementation of new routines in healthcare is challenging and complex [18], it is wise to anticipate feasibility. There may be a variety of reasons (characteristics of the PATCH tool, characteristics of the physiotherapist, characteristics of the patient) that lead to neither the promotion of self-management, nor the PATCH tool being adopted in clinical practice. Objectives The primary aim of this study is to evaluate the safety and effectiveness of selfmanagement within pulmonary rehabilitation (PR) according to guideline recommendations as a partial replacement of supervised PR in patients with COPD who have already been participating in PR for at least six weeks, in a primary
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