Chapter 9 178 research does plan to examine whether these techniques can result in a better calibrated and predictive model, a sample size must be considered where there are sufficient degrees of freedom to use these techniques [33]. This thesis has focused primarily on predicting adherence. However, adherence must also be influenced, so that patients who are non-adherent can become adherent through psychosocial interventions. To also provide a first step in advising healthcare providers what intervention might be considered to increase their patient’s adherence, an analysis of determinants was performed in addition to the probabilistic approach [35]. Recommendations for practice and research PATCH can be used in practice in patients with COPD following PR for a prolonged time. It should be noted that healthcare providers always have to take into account specific patient characteristics which cannot be entered in calculators, for instance comorbidity. For example, a patient with COPD who receives a new hip is temporarily unable to exercise or less intensively. PATCH does not take this into account because comorbidities (in this case, a new hip) are not included as predictors of adherence in the model. So, the clinical judgement of the physiotherapist is very important here. Further, before PATCH can be used more broadly, it is recommended that follow-up research first focusses on broad validation and then on impact analysis [31]. It is not yet known how physiotherapists perceive the PATCH tool as a standard screening instrument, and it is not clear whether PATCH's current cut-off value (least misclassifications) is the most useful for practice. For example, in practice it might be better if no patients should be classified as false positive (a patient is classified as adherent but he or she is not). In that case, a patient would incorrectly receive less clinical supervision, at the risk of worsening his health outcomes. When the PATCH tool identifies patients effectively as adherent or non-adherent, PATCH can be implemented more broadly. These follow-up studies could take place in other physiotherapy practices, with other COPD patients, but possibly also within another setting (general practice) and with a different population (patients with another chronic disease, such as cardiovascular disease or cancer). To support this follow-up research, a feasibility and effectiveness protocol has been provided for a hybrid type 1 study; an effectiveness-implementation study, that gives its focus on evaluating the effects of more self-management and the use of the PATCH tool on relevant outcomes (adherence, exercise capacity, disease burden, health related quality of life, MRC dyspnea score, and lung attacks), while observing and gathering information on implementation [36].
RkJQdWJsaXNoZXIy MjY0ODMw