Addendum 186 Summary Chapter 1 As global aging increases, chronic diseases will place an increasing burden on society and healthcare systems. Focusing on more self-management may become an important strategy to reduce the disease burden of chronic diseases and healthcare costs. This is also an opportunity for pulmonary rehabilitation. However, one challenge that more self-management (within pulmonary rehabilitation) faces is long-term adherence; the long-term maintenance of a particular behavioral change to control a disease. Understanding the level of adherence to pulmonary rehabilitation can help in clinical decision making to focus more on selfmanagement and less on supervised treatment. The aim of this thesis was to expand existing knowledge about adherence with specific knowledge about exercise adherence in people with chronic (obstructive pulmonary) disease. This overarching aim was detailed in this thesis into three specific aims: 1. Development of a measurement, to validly and reliably measure exercise adherence in clinical practice, 2. Development of a prediction model to predict the probability of adherence in primary physiotherapy practices in patients with COPD already receiving pulmonary rehabilitation, and 3. Development of a protocol for a hybrid type-1 study to evaluate the safety and effectiveness of increased self-management in pulmonary rehabilitation, the predictive validity of the prediction model, and the feasibility and acceptability of increased selfmanagement and the prediction model by patients and physiotherapists. The first step in conducting this thesis was to determine what measurements of exercise adherence already exist, and which measurement might be appropriate for use in primary physiotherapy in patients with chronic diseases. The Rehabilitation Adherence Measure for Athletic Training (RAdMAT) seemed to be a promising instrument that rates several aspects related to adherence. Although the RAdMAT was developed in the athletic training setting, it has also been examined within the broader physiotherapy setting in patients with shoulder problems. Based on this, two research questions were formulated: ‘What is the reliability of a Dutch version of the RAdMAT in patients who are undertaking physiotherapeutic rehabilitation in a primary physiotherapy practice?’ (chapter 2) and ‘Wat is the validity of a Dutch version of the RAdMAT in patients with chronic obstructive pulmonary disease?’ (chapter 3). In chapters 2 and 3 the psychometric properties of the Dutch version of the Rehabilitation Adherence Measure for Athletic Training (RAdMAT-NL) are evaluated.
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