Adherence to pulmonary rehabilitation during a 12-month period 87 Baseline procedures After obtaining informed consent, patients provided baseline sociodemographic data, using an online (Qualtrics) or paper form, including age (years), gender (male/female), country (the Netherlands/Belgium), education (low/middle/higher), moderate (MPA) and vigorous physical activity (VPA) (days per week), exercise history (yes/no), physiotherapy history (yes/no), smoking status (never smoked/quit smoking/still smoking) and medication adherence (yes/no). Physiotherapists provided baseline data on the characteristics of the disease using an online form (Qualtrics), including classification of severity of airflow limitation (GOLD classification) (GOLD II/III/IV), degree of baseline functional disability due to dyspnea (MRC-score) (0/1/2/3/4/5), duration of COPD since diagnosis (years), and duration of physiotherapy (years). Follow up The outcome variables were assessed on four subsequent occasions: at baseline, and at 3, 6 and 12 months. All outcome variables were collected at each occasion. Patients reported the outcome data at home, and physiotherapists reported the outcome data at the physiotherapy practice when patients had an appointment. The Dutch version of the Rehabilitation Adherence Measure for Athletic Training (RAdMAT-NL) was completed by the physiotherapist, independent of the patient and not in their presence. Characteristics of the participating physiotherapists are summarized elsewhere [15]. Primary outcome variable Clinic-based adherence measured by the RAdMAT-NL was the primary outcome. The RAdMAT-NL is a 16-item questionnaire that uses a 4-point rating scale (never = 1, occasionally = 2, often = 3, always = 4) to evaluate clinic-based adherence [15]. The RAdMAT-NL consists of 3 subscales: Attendance/participation, Communication, and Attitude/effort. The total scale range is 16-64, a higher score indicates a higher degree of adherence. According to the American College of Sports Medicine (ACSM) guidelines, a score of at least 85% must be achieved to be adherent to the rehabilitation program [16]. This means, a minimum total score of 55 or higher must be achieved on the RAdMAT-NL to be adherent. Secondary outcome variables Exercise capacity was assessed by the 6-minute walk distance (6MWD). The change in 6MWD is a potential patient-centered outcome measure for therapies aimed at improving exercise capacity [17]. Patients had to try to cover as much distance as possible in six minutes; the physiotherapist measured the walking distance [18]. Since the 6MWD was used as an evaluative tool, this outcome evaluated the change in the patient's exercise capacity at each measurement time.
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