Chapter 2 22 Physiotherapists will also benefit from patients adhering more to their treatment. The environment, in which the physiotherapist works, is demanding for evidencebased work with a focus on reduction of healthcare costs. When patients adhere to evidence-based interventions, physiotherapists notice positive results and will not unnecessary change the intervention. This may result in more effective treatments and possibly a shorter treatment period. It will help physiotherapists work effectively, be more cost-efficient and contribute to the patient’s self-management [6, 7]. To increase adherence, it must be measurable. When an unexpected poor outcome is seen in patients, a reliable and valid measurement instrument to assess adherence should be available. That way, the physiotherapist can assess the diverse range of adherence attitudes and behaviors in the patient. The physiotherapist can engage in dialogue with the patient about the non-adherence and can implement strategies to target the attitudes and behaviors of nonadherence. Ultimately this may lead to better treatment outcomes. Because adherence is a multi-dimensional concept, a measurement of adherence also has to be multi-dimensional (measure more domains at the same time) [7, 10]. Currently there is no reference standard for measuring exercise adherence and a lot of measures have been identified in musculoskeletal disorders [11], but only one multi-dimensional instrument has been described to measure adherence in physiotherapy practice: The Rehabilitation Adherence Measure for Athletic Training [12, 13]. The RAdMAT is considered to be reliable, valid, responsive and interpretable at an individual level, easy and simple to use, and low financial cost [14] in patients with musculoskeletal complaints who are visiting a primary physiotherapy practice. Applicability of the RAdMAT in Dutch physiotherapy practices To date, the RAdMAT is available only in English. This original version shows promising psychometric properties. Internal consistency reliabilities range between 0.96 and 0.99 and Cronbach’s a for each level of adherence is acceptable to high [12]. Because a measurement also has to be simple and easy to use [14] a Dutch version of the RAdMAT should be available. For this study a Dutch version of the RAdMAT (RAdMAT-NL) was prepared by a native speaker based on the guidelines of translating questionnaires [15, 16]. This questionnaire, like the original version of the RAdMAT, is a 16-item questionnaire that uses a four-point rating scale (1 = never, 2 = occasionally, 3 = often, 4 = always) [12]. The conceptual meaning of the original measurement was maintained and the setting and the position of the raters were the same as used in the original version of the RAdMAT.
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