Chapter 9 176 least 85% must be achieved to be adherent to the rehabilitation program (RAdMATNL score ³ 54 or Participation score ³ 45 ) [24]. The overall observed positive correlations between the RAdMAT-NL subscale Participation and the other adherence measures SIRAS, percentage change on Five Times Sit to Stand Test, self-reported home-based adherence, overall adherence and percentage attendance at scheduled rehabilitation appointments confirm that the RAdMAT-NL is associated with attendance to appointments, exercise skills and self-rated adherence which suggests the potential clinical relevance of the RAdMAT-NL. Since adherence has a significant impact on patient’s health outcomes [3, 27, 28], this tool should be widely used with patients with COPD in primary physiotherapy practices. Since adherence is a general problem within healthcare and specifically in chronic conditions (the longer the duration of a therapy, the greater the risk of nonadherence [3]), it will be interesting for follow-up research to see if the RAdMAT-NL can be used in other chronic diseases and in a different setting (general practice, secondary and tertiary care). Thereby, the current communication items of the RAdMAT-NL might be replaced by communication items that involve patienttherapist communication. Such items could potentially improve the RAdMAT-NL in terms of internal consistency reliability and unidimensionality. Prediction model Interpretation of the results An exercise adherence prediction model was developed and validated in patients with COPD following PR in a primary physiotherapy practice in the Netherlands and Belgium. The final model integrates four predictors (intention, depression, MRCscore, alliance), and is intended for use in the population of COPD patients following PR for at least one month. Values of the four predictors can be entered in a web-based prognostic tool (PATCH) (https://derzis.nu/Calculator/). PATCH's probability score can provide healthcare providers an indication of whether the patient has a reasonable chance of remaining adherent for a longer period. This probability score might assist the physiotherapist in deciding whether to reduce clinical supervision and increase self-management. Therefore, the added value of the prediction model compared to the RAdMAT-NL is that physiotherapists get an indication of their patient's adherence over a longer period of time and not just the adherence at the moment. Furthermore, the predictors of the PATCH tool help the physiotherapist to better estimate the probability that a patient will be capable of more self-management. With the PATCH tool, the physiotherapist gets much more information than just the answer to whether or not the patient in question is adherent. An additional added value of the PATCH tool is that it also gives the physiotherapist insight into what, if any, psychological interventions can be added to the rehabilitation sessions to increase adherence.
RkJQdWJsaXNoZXIy MjY0ODMw