Feasibility, effectiveness and safety of self-management in pulmonary rehabilitation 151 Perceived dyspnea Patients will report their perceived dyspnea at each measurement moment (T0-T4) using the Medical Research Council (MRC) dyspnea scale. The MRC scale is a practical and validated instrument to score the degree of dyspnea as experienced by a patient with COPD [25]. The list consists of 5 items in which the patient can indicate their own level of limitation: grade 1 ‘I only get breathless with strenuous exercise’; grade 2, ‘I get short of breath when hurrying on the level or up a slight hill’; grade 3, ‘I walk slower than people of the same age on the level because of breathlessness or have to stop for breath when walking at my own pace on the level’; grade 4, ‘I stop for breath after walking 100 yards or after a few minutes on the level’; grade 5, ‘I am too breathless to leave the house’ [25]. Lung attacks Patients will report at each measurement moment whether they have had a lung attack in the past three months, and if so, how many. Here, a lung attack is defined as a sudden worsening of lung symptoms for which the general practitioner or pulmonologist had to prescribe antibiotics or prednisolone [26]. Number of scheduled rehabilitation appointments At baseline (T0), physiotherapists will indicate how many appointments their patient had in the previous three months. If the patient has PR for less than three months, the number of appointments and duration of PR to that point will be noted. At each follow-up moment (T1-T4), physiotherapists will again record how many appointments their patient had during that period. Exercise adherence Exercise adherence will be assessed by the Dutch version of the Rehabilitation Adherence Measure for Athletic Training (RAdMAT-NL). The RAdMAT-NL has good psychometric properties with an internal consistency reliability of a = 0.91 [27]. The RAdMAT-NL is a 16-item questionnaire that uses a 4-point rating scale (never = 1, occasionally = 2, often = 3, always = 4) to evaluate clinic-based adherence [27]. The RAdMAT-NL consists of 2 subscales: Participation (items 1-5 and 9-16, range 13-52 points), Communication (items 6-8, range 3-12 points). The total scale range is 16-64, a higher score indicates a higher degree of adherence. According to the American College of Sports Medicine guidelines, a score of at least 85% must be achieved to be adherent to the rehabilitation program [28]. This means, a minimum total score of 54 or higher must be achieved on the RAdMAT-NL to be adherent. The RAdMAT-NL will be completed at baseline (T0) and all follow-up moments (T1T4) by the physiotherapist, independent of the patient and not in their presence. Perceived overall adherence Asking a single direct question is a strategy to assess patients’ adherence [29].
RkJQdWJsaXNoZXIy MjY0ODMw