Addendum 188 undertaking pulmonary rehabilitation (PR) in 53 primary physiotherapy practices in The Netherlands and Belgium. Principal Axis Factoring (PAF) demonstrated that the RAdMAT-NL consists of two dimensions, Participation (Factor 1 with 13 items) and Communication (Factor 2 with 3 items) and which explained 50.8% of the total variance. Rasch analysis demonstrated that the participation items can be used as a single measure of adherence. Medium to large significant positive correlations between the RAdMAT-NL subscale Participation and different measures correlated with adherence supported the construct (convergent) validity of the RAdMAT-NL. Chapter 4 This chapter describes the results of a systematic review and meta-analysis of prognostic factors of adherence to home-based exercise therapy in patients with chronic diseases. A total of 57 studies were included. Within patient-related factors moderate- and high-quality evidence suggested that more self-efficacy, exercise history, motivation and perceived behavioral control predicted higher adherence. Within social-economic factors moderate-quality evidence suggested more education and physical health to be predictive of higher adherence and within condition-related factors moderate- and low-quality evidence suggested that less comorbidities, depression and fatigue predicted higher adherence. For the domains therapy-related and health-system factors there was not enough information to determine the quality evidence of the prognostic factors. Chapter 5 This chapter describes the results of a prospective cohort study in which 196 patients with COPD participated, who were undertaking pulmonary rehabilitation (PR), for at least one month, in 53 primary physiotherapy practices in The Netherlands and Belgium. The results showed that there was no significant change in exercise adherence over time (p = 0.89). Also, exercise capacity (p = 0.59) and health related quality of life (p = 0.24) remained stable. This means that a prediction model developed for this cohort can make a prediction about adherence covering a 12-month period. Chapter 6 This chapter describes the development and internal validation of a multivariable logistic regression model for exercise adherence; the Predicting Adherence in paTients with CHronic diseases (PATCH) tool. Eight candidate predictors, that were prespecified, were obtained in a prospective cohort study from 196 patients with COPD following PR in 53 primary physiotherapy practices in the Netherlands and Belgium. The final model included four predictors; intention, depression, MRCscore and alliance (patient-therapist relation). The optimism-corrected AUC after bootstrap internal validation was 0.79 (95% CI, 0.72-0.85). Calibration plots suggested good calibration and decision curve analysis showed great net benefit of using the prediction model in a wide range of risk thresholds.
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