Measuring adherence in clinic-based physiotherapy 29 disease and partial paraplegia (ICC = 0.99). This is important for both clinical practice and further research, because a strong inter-rater reliability is necessary for interpreting change in the individual patient [19]. The results of this study are in accordance with the results of previous research [12, 13], which showed that the original version of the RAdMAT can reliably measure adherence in the physiotherapy practice in patients with musculoskeletal injuries and has an excellent inter-rater reliability (range ICC = 0.96-0.99). This study shows that the RAdMAT-NL also has an excellent inter-rater reliability. This study adds to previous research by showing that the RAdMAT-NL is also applicable in patients with chronic diseases. As such, the RAdMAT-NL meets almost all requirements of an appropriate measurement instrument: it is reliable, interpretable at an individual level, easy and simple to use, and low financial cost [14]. Because the measurement instrument is in Dutch, it is easy for Dutch people to complete and to analyze. Strengths and limitations The use of a diverse population was strength of this study, but the study also has weaknesses. First, the results of this study were obtained in one physiotherapy practice where the raters knew most of the participants. Although participants were blinded for the assessment, one of the raters might have recently worked with one or more of the participants. This would give the rater more information about the participant than the other rater, which would lead to information bias. If information bias occurred, then the inter-rater reliability could be underestimated. However, the inter-rater reliability was excellent, so probably information-bias did not occur. Second, raters had to assess participants independently, but whether this happened at all times could not be ensured. If mutual consultation occurred, then the inter-rater reliability could be overestimated. Nevertheless, the results are promising as the first step of the development of a Dutch instrument for measuring adherence in the physiotherapy practice. When an unexpected poor outcome is seen in patients, it is recommended to complete the RAdMAT-NL for this patient. That way, the physiotherapist can assess whether there is non-adherence in the patient and thus whether the intervention should be changed. Also, the physiotherapist can engage in dialogue with the patient about the non-adherence. Ultimately this may lead to better treatment outcomes [7, 10, 13]. To provide tailored interventions for each patient, reliable measurement instruments are needed. Using reliable measurement instruments has added value for patients, physiotherapists and society. Using reliable measurements can increase adherence in patients and adherence can in turn be a tool to achieve health gains in patients [7]. Better treatment results contribute to better quality of life and lower healthcare costs for patients and society [3, 7].
RkJQdWJsaXNoZXIy MjY0ODMw