Chapter 9 174 Development and validation of an exercise adherence measure Interpretation of the results The reliability of the Dutch version of the Rehabilitation Adherence Measure for Athletic Training (RAdMAT-NL) was assessed in the broad physiotherapy setting. Patients with musculoskeletal complaints and with chronic diseases were included. Physiotherapists reported that the RAdMAT-NL was easy to use and not timeconsuming to complete. Since the inter-rater reliability was excellent, the RAdMATNL could be used in a primary physiotherapy setting. This is consistent with results from previous studies [6, 22]. Physiotherapists indicated that the RAdMAT-NL would be easier to use in practice if a sum score of the total scale could be used. Previous validation of the original RAdMAT recommended the use of three subscales, but suggested that a single score for overall adherence also might be calculated [6]. Validation of the RAdMATNL (structural and construct) demonstrated that the RAdMAT-NL consisted of two subscales, Participation and Communication, and that the two domain scores can be used separately. The participation items of the RAdMAT-NL can also be used as a single measure of adherence in patients with COPD. In interpreting the results, it should be kept in mind that all 16 items of the RAdMAT-NL were used as sum score, rather than just the 13 items of Participation. Initially, the unidimensionality seemed to apply to the entire RAdMAT-NL, but after advice from reviewers on the study described in chapter 3 to also conduct a parallel analysis of the Rasch residuals, the unidimensionality was found to be interfered with by the communication items. The use of all items of the RAdMAT-NL as sum score may not be advised, however, the items of the two dimensions are correlated and both measure the same construct, exercise adherence, so this will hardly affect the results [23]. In addition, the Communication subscale has a relatively small share of the total score (explained only a small portion of the score variance, 7%). Thus, the Communication items add little to the total score but do not degrade the measurement. Low scores on the RAdMAT-NL may indicate the need for interventions to enhance patient’s 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 [24]. The physiotherapist can also decide to pay attention to one of the two domains when a patient scores much lower on this domain than on the other domain. The RAdMAT-NL can be included in the next reassessment, to evaluate if adherence increased. So, the RAdMAT-NL can be used as both an inventory and evaluation tool. Methodological considerations Inter-rater reliability was assessed in a heterogeneous population of patients (various musculoskeletal conditions and chronic diseases), but within one
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