Addendum 190 patients were involved in the inclusion of participants (other patients and physiotherapists). A diverse group of patients with COPD benefits the generalizability of the results. Limitations are the use of self-reports by patients (risk of recall bias), possible measurement bias due to physiotherapists not performing the measurements as standardized, and the restrictions of the COVID-19 pandemic that may have affected data collection. Regarding the development of a measurement instrument for adherence, it can be concluded that the RAdMAT-NL is a valid and reliable measurement to assess adherence in patients with COPD receiving pulmonary rehabilitation in primary physiotherapy practices. The participation items of the RAdMAT-NL can be used as a single measure of adherence. The communication items interfered with the unidimensionality of the RAdMAT-NL. These items assume communication from the patient themselves. It is possible that patient-therapist communication has more influence on adherence and does not interfere with unidimensionality. Follow-up research could further explore this dimension, as well as the applicability of the RAdMAT-NL in people with other chronic diseases, such as cardiovascular disease or cancer, for example. With only 16 items in a simple format, the RAdMAT-NL is relatively easy to use, both by healthcare providers in clinical practice and for research purposes. In addition to being able to provide an indication of the current level of adherence, the PATCH tool was developed in order to get an understanding of longer-term adherence and the factors that might affect patient adherence. The developed PATCH tool is easy to use in practice, because of an online calculator (https://derzis.nu/Calculator/). Users can enter the individual patient variables into the calculator to obtain adherence probabilities. PATCH can be used in practice in patients with COPD who are already receiving pulmonary rehabilitation (as opposed to patients who are about to start pulmonary rehabilitation). Before PATCH can be used more broadly, it is recommended that follow-up research first focusses on broad validation and then on impact analysis. To support this follow-up research, an evaluation and implementation protocol has been written for a hybrid type 1 study; an effectiveness-implementation study. Overall, the conclusion is that the products developed in this thesis might be able to contribute to better distribution of healthcare capacity, potentially reducing pressure on healthcare without compromising the effectiveness of PR for the individual patient.
RkJQdWJsaXNoZXIy MjY0ODMw