General discussion 173 provide direction for involving the right people in the inclusion of research participants and can potentially provide greater motivation among participants. Recommendations for practice and research Future research should focus on getting more results from electronic patient records. Physiotherapists nowadays work in the information technology environment and use computers and electronic health records in everyday clinical practice [20]. Good record-keeping is enhancing communication and mutual understanding between patients, physiotherapists and other healthcare providers. Additionally, the information content of a patient record may be used for other purposes such as monitoring the quality of treatment and the effectiveness of treatments [21]. Physiotherapists record the results of assessments and reassessments. In addition, most systems allow questionnaires to be sent to patients, which are automatically placed in the system after assessment. For this study physiotherapists had to register results twice: both in the electronic patient record and on the online registration form of this study. To reduce registration burden and require less time from physiotherapists, researchers may be able to extract results from the electronic patient records in the future. For generalizability of the results, it is recommended to conduct the study in a similar population, but in a situation without the restrictions caused by a COVID-19 pandemic. Possibly then some more variation in the results could be found. At this point, participants may have acted more out of fear; they may have been more adherent not to become infected or less adherent out of fear of going outside [13]. The population could also be expanded with including patients just starting pulmonary rehabilitation. In this way it could be assessed whether the results are generally valid for patients with COPD or only for patients who have been following pulmonary rehabilitation for some time. It is conceivable that patients who are just starting PR are more motivated to follow the treatment and thus have high adherence. It is possible that after a few months they find out that PR, for example, takes time, takes a lot of energy and does not ensure that they are cured of their COPD. Adherence may then decrease and stabilize to some extent [4]. Furthermore, it is important to make even clearer what is meant by homework exercises (as mentioned above, this was not clear to everyone). For example, some patients were required by their physiotherapist to do breathing exercises at home, however, the patients themselves did not see this as homework exercises.
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