Chapter 3 34 Abstract Introduction: When measuring exercise adherence in patients with chronic obstructive pulmonary disease (COPD), instruments covering all relevant aspects related to adherence should be used. The Rehabilitation Adherence Measure for Athletic Training (RAdMAT) seems a promising instrument. A Dutch version of this instrument (RAdMAT-NL) is available. The aim of this study was 1. to explore the dimensionality and construct validity of the RAdMAT-NL in patients with chronic obstructive pulmonary disease (COPD) and 2. to examine if the RAdMAT-NL could be used as a single measure of adherence. Methods: In this prospective study participated 193 patients with COPD, who were undertaking pulmonary rehabilitation (PR) in 53 primary physiotherapy practices in The Netherlands and Belgium. At one month, two and three months after inclusion, patients and their physiotherapist provided measures about the rehabilitation including the RAdMAT-NL. Principal Axis Factoring (PAF) was performed to explore the dimensionality of the RAdMAT-NL. Rasch analysis was used for testing unidimensionality of the RAdMAT-NL. Spearman’s correlations were calculated with other indicators of adherence, including SIRAS score, percentage attendance and change in exercise skills, to determine construct validity. Results: PAF demonstrated two dimensions of the RAdMAT-NL, Participation and Communication, explaining 50.8% of the total variance. Rasch analysis showed that without the communication items (Andersen LR-test, p-value < 0.001) the RAdMAT-NL can be used as a single score for adherence. Medium to large significant positive correlations between the RAdMAT-NL subscale Participation and different measures of adherence supported its validity. Conclusion: The RAdMAT-NL can be used as an interim assessment measure of exercise adherence for patients who are not progressing as expected. The 13 items of the Participation dimension can be used as a single score for adherence.
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