Chapter 8 152 With a single question, patients will be asked to rate their perceived overall adherence (home-based and clinic-based adherence) considering the extent to which they succeed to attend appointments, to perform prescribed exercises, and the extent to which they ask questions and give feedback about their rehabilitation. Patients will report their perceived overall adherence at each measurement moment (T0-T4) on a five-point rating scale (did not succeed at all = 1, did succeed for less than half = 2, did succeed for about half = 3, did succeed for more than half = 4, totally succeeded = 5). Probability of adherence The probability of adherence over 12 months will be assessed by the physiotherapist using the PATCH tool at baseline (T0). The PATCH tool integrates predictors (intention, depression, MRC-score, alliance), and is intended for use in the population of COPD patients following PR for at least one month [17]. Internal validation showed good discrimination, calibration, and net benefit. The calculator provides a probability output that indicates the chance that the particular patient under evaluation is adherent (probability score ³ 53.5%) [17]. For example, a percentage of 75% indicates that there is a 75% chance that the patient is adherent (according to the criterion of engaging in at least of 85% of the prescribed exercise). Implementation Implementation outcomes will be defined by the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework, a framework designed to evaluate multiple dimensions of evidence-based intervention implementation in order to determine the public health impact and to shape scale-up processes [34]. Implementation outcome measures are specified by each component of RE-AIM and are summarized in table 2. Through these components, the impact of innovations can be assessed at both the individual (i.e., end-user; reach, effectiveness, maintenance) and organizational (i.e., delivery agent; adoption, implementation, maintenance) levels [35]. These implementation outcomes will be assessed at T4 by the researcher during interviews with physiotherapists and patients. Semi-structured interviews Interviews with physiotherapists and patients will be conducted by a trained researcher at T4. An interpretivist, constructivist, approach will be used to gain an in-depth understanding of participant’s views of more self-management and the PATCH tool. Interpretivism is an approach to social science that asserts that understanding the beliefs, motivations, and reasoning of individuals in a social situation is essential to decoding the meaning of the data that can be collected around a phenomenon. Table 2 will be used as a semi-structured interview topic guide to address the feasibility and acceptability of self-management and the
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