Measuring adherence to pulmonary rehabilitation: a prospective validation study of the Dutch version of the Rehabilitation Adherence Measure for Athletic Training (RAdMAT-NL)

doi:10.21203/rs.3.rs-2088726/v1

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Measuring adherence to pulmonary rehabilitation: a prospective validation study of the Dutch version of the Rehabilitation Adherence Measure for Athletic Training (RAdMAT-NL)

https://doi.org/10.21203/rs.3.rs-2088726/v1

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Introduction: Adherence is important in many aspects of healthcare as it is related to clinical outcomes. To date, there is a lack of simple, reliable and valid instruments to assess the level of exercise adherence. The Rehabilitation Adherence Measure for Athletic Training (RAdMAT) is a promising instrument.

Aims: The RAdMAT addresses different aspects of adherence to rehabilitation, grouped within three subscales. A Dutch version (RAdMAT-NL) is available. The aim of this study was to re-examine the validity of the RAdMAT-NL in patients with chronic obstructive pulmonary disease (COPD). In addition, we examined if the RAdMAT-NL could be used as a single score representative 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 between January 2021 and December 2021. At 1 month, 2 and 3 months after inclusion, patients and their physiotherapist provided measures about the rehabilitation including the RAdMAT-NL. Principal Component Analysis (PCA) was performed to assess whether the RAdMAT-NL has the same scale structure as the original RAdMAT. Rasch analysis was used for testing unidimensionality of the RAdMAT-NL. Spearman’s correlations were calculated with other indicators of adherence to determine construct validity.

Results: PCA supported the three purported dimensions of the RAdMAT-NL, explaining 63% of the total variance. Rasch analysis showed that the RAdMAT-NL can be used as a single score for adherence, which supports the practical application of the instrument. Large significant correlations between the RAdMAT-NL total and subscale scores and different measures of adherence supported its validity.

Conclusion: The RAdMAT-NL can be used as an interim assessment measure for patients who are not progressing as expected. Using three domain scores to assess progress is not necessary.

Adherence

Rehabilitation

Measurement

Validity

From a rehabilitation context, adherence has been defined as an ‘active, voluntary collaborative involvement of the patient in a mutually acceptable course of behaviour to produce a desired preventative or therapeutic result’ (Meichenbaum & Turk, 1987). The behaviours that constitute exercise adherence may vary, and largely depends on the type of injury or condition of presenting patients. These behaviours may include attendance at clinic appointments, the extent to which patients follow the prescribed treatment, and the communication with their healthcare provider about their recovery in order to receive feedback about their home-based rehabilitation activities (Clark et al., 2018). Rehabilitation more and more involves self-reliance, and requires effort from patients themselves in following prescribed exercises at home. This makes adherence increasingly important (Sabaté, 2003).

Adherence is important in many aspects of healthcare as it is related to clinical outcomes, and to the (economic) burden for healthcare providers (Vermeire et al., 2001). Patients who fail to adhere to the prescribed exercises, may experience prolonged duration of treatment and impaired therapeutic relationship, with less favourable treatment results (Pisters et al., 2010). Also, the increase in chronic diseases makes adherence increasingly important for all stakeholders in the healthcare system (Sabaté, 2003). To keep healthcare affordable and improving patient outcomes, attention must be paid to adherence. (Mold, 2017).

One chronic disease where non-adherence is of particular importance is chronic obstructive pulmonary disease (COPD). Fewer than half of treatments for COPD are taken as prescribed (Bender, 2014). The management of a disease like COPD is difficult because prescribed exercises largely take place at home, with patients and their caregivers making decisions as to whether treatments should be started or continued, often without consulting their healthcare provider (George, 2018). As a result, it is often not clear to professionals whether patients are adherent or not. Professionals tend to make their own judgements about the extent of the suspected non-adherence in patients by asking or by observing treatment progress (Bassett, 2012). These judgements may be incorrect; their validity is uncertain. Therefore, a standardised instrument is needed to quantify the extent and reasons for non-adherence (Bassett, 2012) as early as possible. On the basis of early signals, the treatment might be adapted to the specific needs of an individual patient or measures can be taken to improve adherence (Abbott et al., 1994).

To date, there is a lack of simple, reliable and valid instruments to assess the level of exercise adherence in rehabilitation practice (McLean et al., 2016). The Rehabilitation Adherence Measure for Athletic Training (RAdMAT) is a promising instrument that rates several aspects related to adherence. Although the RAdMAT was developed in the athletic training setting, it also has been examined within the broader physiotherapy setting in patients with shoulder problems (Clark et al., 2018). Previous validation of the RAdMAT recommended the use of three subscales, but suggested that a single score for overall adherence also might be calculated (Granquist et al., 2010). A Dutch version, the RAdMAT-NL, previously showed a high inter-rater reliability in a sample of patients in a primary physiotherapy setting (Ricke & Bakker, 2019). Therefore, the RAdMAT-NL seems to be appropriate for quantifying adherence in patients with COPD. However, the validity of the RAdMAT-NL, especially its dimensionality and construct validity, is not yet examined.

The aim of this study was to re-examine the dimensionality (structural validity) and construct validity of the RAdMAT-NL in patients with chronic obstructive pulmonary disease undertaking pulmonary rehabilitation in a primary physiotherapy practice. It is hypothesised that the RAdMAT-NL has the same dimensional structure as the original RAdMAT, and that it can also be used as a single measure of adherence. In addition, it is hypothesised that the RAdMAT-NL score is associated with other indicators of adherence.

Participants

Participants of this prospective study were Dutch/Flemish-speaking patients aged ≥ 18 years who were recruited between January 2021 and December 2021 from 53 primary physiotherapy practices, and from the COPD patient-organisations from the Netherlands and Belgium. Included were patients with COPD, with airflow limitation stage GOLD II-IV and having rehabilitation sessions for at least once a month, for at least 1 month. The exclusion criteria were home-based rehabilitation and insufficient mastery of the Dutch/Flemish language to complete the questionnaires.

Physiotherapy practices were approached by e-mail and social media for participation and patients were recruited by their attending physiotherapist. Patients who were willing to participate were contacted by the researcher per email for further information on their participation, and to obtain informed consent. For patients without an e-mail address, this was done by their physiotherapist at their visit to the physiotherapy practice.

Patients were also recruited via the COPD patient-organisation in the Netherlands and Belgium who, in turn, invited their physiotherapist for participation (Additional file 1). The study was approved by the Ethical Committee Psychology of the University of Groningen (PSY-1920-S-0504).

Procedures

After signing informed consent and inclusion, patients completed an online (Qualtrics) or paper form on their demographic characteristics. About simultaneously, the physiotherapist provided information on the characteristics of the disease, and administered a baseline Five Times Sit to Stand Test (FTSST) of the patient. The patients provided information at 1 month, 2 and 3 months after inclusion. After 3 months, the physiotherapist was also asked to provide information and measurements on the patient's rehabilitation. Characteristics of the participating physiotherapists are summarised in Additional file 2.

Assessment instruments

Five Times Sit to Stand Test (FTSST)

The FTSST is a test of lower limb function to assess the fastest time taken to stand five times from a chair with arms folded (Jones et al., 2013). The FTSST had a high intra-rater reliability (Mijnarends et al., 2013), is a practical functional outcome measure for use in clinic and at home (Jones et al., 2013), and is indicative of adherence (Babatunde et al., 2017). The FTSST was assessed by the physiotherapist during consultation two times, first after signing informed consent, and second after three months of rehabilitation.

Home-based adherence form

Patients completed a form to rate the extent they had performed their prescribed exercises the past month (Bassett, 2003) using a 5-point rating scale (as often as I had to = 1, more than half the number of times = 2, about half the number of times = 3, less than half the numbers of times = 4, not performed = 5).

The home-based adherence form (Additional file 3) was filled out by the patient at home after 1, 2 and 3 months of rehabilitation. Patients could also indicate whether or not they had experienced a COVID-19 infection or a lung attack in that month. If so, those data were excluded from the psychometric analysis of the RAdMAT-NL.

Perceived overall adherence

Overall perceived adherence (home-based and clinic-based adherence) including appointments, prescribed exercises and scheduled feedback meetings with the physiotherapist (Babatunde et al., 2017), was rated on a 5-point rating scale (did not succeed at all = 1, did succeed for less than half = 2, did succeed for about half = 3, did succeed for less than half = 4, totally succeeded = 5). The form was completed at home after three months of rehabilitation.

Percentage of attendance at scheduled rehabilitation appointments

After three months, the percentage of attendance was calculated for each patient by the number of appointments attended divided by the number of appointments scheduled, multiplied by 100 (Clark et al., 2018).

Sport Injury Rehabilitation Adherence Scale (SIRAS)

The SIRAS rates, on a 5-point scale, adherence to clinic-based rehabilitation, using three items on amount of effort taken, on extent of following instructions and advice, and on receptiveness to change in the rehabilitation program (Clark et al., 2018). Scores may range between 3 and 15 points (maximal adherence).

The SIRAS was completed by the physiotherapist after three months of rehabilitation independent of the patient, and not in their presence.

RAdMAT-NL

The RAdMAT-NL rates clinic-based adherence on a 4-point rating scale (never = 1, occasionally = 2, often = 3, always = 4) (Ricke & Bakker, 2019) and consists of three subscales: Attendance/participation, Communication and Attitude/effort (Granquist et al., 2010) (Additional file 4). The total scale range is 16–64 points (maximal adherence). Like the SIRAS, the RAdMAT-NL was completed by the physiotherapist after three months of rehabilitation, independent of the patient and not in their presence.

Statistical analysis

Data were analysed using R version 4.0.3. Baseline characteristics are presented with appropriate measures of central tendency and dispersion.

Principal component analysis (PCA) with Oblimin rotation was used to see if the same dimensions emerged for the RAdMAT-NL as for the original instrument, using a forced 3-factor solution. The absence of cross loading items was considered of evidence of structural validity of the RAdMAT-NL.

Prior to performing the PCA, the appropriateness of the data for factor analysis was assessed. The Kaiser-Meyer-Olkin (KMO) measure for sampling adequacy was 0.90, and all values for individual items were > 0.76, exceeding the recommended minimum value of 0.7. Bartlett’s test of sphericity was, χ² (120) = 1759.6, p < 0.001, below the needed p < 0.05 (Field, 2012).

After performing the forced 3-factor solution, this solution was evaluated by the number of cross-loaders (items loading higher, r > 0.40, on multiple factors (Hair et al., 1998)), the root mean square of the residuals (RMSR) (a value of 0.05 or lower is optimal), and the Fit based upon off diagonal values (values > 0.95 are good). PCA was performed followed by a parallel analysis and associated scree plots to explore how many factors the RAdMAT-NL consists of.

Rasch analysis was used for testing unidimensionality of the RAdMAT-NL. To perform the Rasch analysis, the item scores were first dichotomized according to their mean (item score < mean = 0; item score > mean = 1). Visual assessment using item-characteristic curves (ICC) plots and mean square infit and outfit effect sizes were used to examine the fit of the data to the unidimensional Rasch model (Streiner et al., 2015). Mean square infit and outfit effect sizes between 0.5 and 1.5 were considered acceptable (Linacre, 2002).

The internal consistency reliability of the scale or subscales was examined by calculating Cronbach's α.

Construct validity was examined by calculating Spearman’s correlations between 1. SIRAS and RAdMAT-NL and 2. between SIRAS and attitude/effort subscale (Clark et al., 2018; Granquist et al., 2010); 3. between RAdMAT-NL and percentage change on FTSST; 4. between RAdMAT-NL and self-reported home-based adherence; 5. between RAdMAT-NL and perceived overall adherence; 6. between percentage attendance at scheduled rehabilitation appointments and the attendance/participation subscale (Clark et al., 2018). The strength of correlations were interpreted based on the guidelines described by Cohen: small = 0.10–0.29, medium = 0.30–0.49 and large is 0.50-1.0 (Cohen, 1988).

Patients from 53 different physiotherapy practices participated in the study. Out of 199 patients who gave informed consent, data from 196 patients were analysed (Additional file 1). The most common reasons for exclusion were; the physiotherapists did not provide any information, or the patient left the study (died or diagnosed with cancer).

Table 1 summarises the demographic and clinical characteristics of the patients.

Table 1

Demographic and clinical characteristics patients (n = 196)
Male gender (%)	51.5%
Median age in years (IQR)	68.0 (64–73)
Education (%) - Low - Middle - Higher	21.4% 53.1% 25.5%
Smoking status (%) - Never smoked - Quit smoking - Still smoking	1.5% 85.2% 13.3%
Median time in years since diagnose (IQR)	10.5 (5–14)
GOLD classification (%) - GOLD I - GOLD II - GOLD III - GOLD IV	0.5% 27.1% 36.2% 36.2%
MRC-score (%) - 0 - 1 - 2 - 3 - 4 - 5	0.5% 5.1% 18.4% 36.7% 27.1% 12.2%
Years of physiotherapy (%) - 0–3 months - 3–6 months - 6–12 months - 1–5 years - > 5 years	14.8% 7.7% 6.6% 30.6% 40.3%
Note: GOLD: Global Initiative for Chronic Obstructive Lung Disease. The GOLD guidelines classify patients into four different categories: GOLD 1 (mild), GOLD 2 (moderate), GOLD 3 (severe), or GOLD 4 (very severe) based on their level of airflow limitation; MRC-score: Medical Research Council dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease.

Structural validity

Table 2 shows the factor loadings of the forced 3-factor PCA and the 1-factor solution. The 3-factor solution showed no cross-loaders, a RMSR of 0.07, a Fit based upon off diagonal of 0.98 and accounted for 63% of the total variance. Overall, the structure of the original RAdMAT was found in the RAdMAT-NL. However, the clusters slightly differ from the original clusters: item 11 (“gives 100% effort in rehabilitation sessions”) loaded on attendance/participation in our study, and attitude/effort in the original study, while item 16 (“shows interest in the rehabilitation process”) loaded on communication instead of the intended attitude/effort. The item clusters otherwise matched the original. All three subscales of the RAdMAT-NL had a Cronbach’s α > 0.78 (Table 2).

Table 2

Factor loadings of the 3- and 1-factor solution and fit statistics to the Rasch model for the RAdMAT-NL (n = 193)
	loadings 3-factor solution			loadings 1-factor solution	Infit / Outfit MnSq
Item	Attendance/ Participation (Factor 1: items 1–5, 11)	Communication (Factor 2: items 6–8, 16)	Attitude/ Effort (Factor 3: items 9, 10, 12–15)
1. Attends scheduled rehabilitation sessions	0.74			0.65	1.021 / 1.088
2. Arrives at rehabilitation on time	0.65			0.49	0.720 / 1.023
3. Follows the physiotherapists instructions during rehabilitation sessions	0.60			0.66	0.979 / 1.065
4. Follows the prescribed rehabilitation plan	0.74			0.78	0.639 / 0.784
5. Completes all tasks assigned by the physiotherapist	0.77			0.74	0.904 / 0.948
6. Asks questions about his rehabilitation		0.78		0.46	1.957 / 1.379
7. Communicates with the physiotherapist if there is a problem with the exercises		0.68	0.39	0.49	2.088 / 1.024
8. Provides the physiotherapist feedback about the rehabilitation program		0.88		0.44	1.624 / 1.360
9. Has a positive attitude during rehabilitation sessions			0.69	0.76	0.689 / 0.722
10. Has a positive attitude toward the rehabilitation process			0.58	0.80	0.612 / 0.741
11. Gives 100% effort in rehabilitation sessions	0.55			0.74	0.840 / 0.947
12. Is self-motivated in rehabilitation sessions			0.53	0.81	0.686 / 0.785
13. Is an active participant in the rehabilitation process			0.58	0.77	0.779 / 0.892
14. Stays focused while doing rehabilitation exercises			0.82	0.52	1.394 / 1.360
15. Is motivated to complete rehabilitation			0.53	0.82	0.513 / 0.660
16. Shows interest in the rehabilitation process	0.37	0.51		0.74	0.708 / 0.884
Eigenvalues	4.25	2.47	3.37	7.37
% of variance	27%	15%	21%	46%
RMSR	0.07			0.09
Fit based upon off diagonal values	0.98			0.95
α	0.84	0.78	0.89	0.91
Note: Only factor loadings over 0.40 are presented

The forced 1-factor solution showed that all items loaded on a single factor (all loadings > 0.44) although loadings for items 6, 7, and 8 were lower than for the other items (0.46, 0.49, 0.44 respectively). The RMSR of the model was 0.09, the Fit based upon off diagonal = 0.95, and the model accounted for 46% of the total variance (Table 2).

The unidimensionality of the 1-factor model was tested using the dichotomous Rasch model. The items 6, 7 and 8, and to a lesser extent item 14, showed a less good, but still acceptable fit to the unidimensional model. Mean square infit and outfit statistics showed higher values (> 1.5) for the items 6, 7 and 8, respectively 2.0, 2.1 and 1.6, indicating the scores on these items deviate from what is expected by the model (Table 3). The Cronbach’s α of the total RAdMAT-NL score was 0.91.

Figure 1 visualises the results of the parallel analysis scree plots indicating two factors. The figure shows that the eigen value of the second large factor is slightly above that obtained by chance.

Construct validity

The Spearman correlation coefficients between the RAdMAT-NL total and its subscales, SIRAS, change on FSST measures, adherence to homebased exercise, perceived overall adherence, and percentage attendance at scheduled rehabilitation appointments are presented in Table 3; showing large significant correlations between the RAdMAT-NL total and subscale scores on the one hand and different indicators of adherence including the SIRAS score, percentage attendance and change in exercise skills on the other hand.

Table 3

Construct validity of the RAdMAT-NL; Spearman correlation coefficients between adherence measures
		1	2	3	4	5	6	7	8
1	Percentage attendance
2	SIRAS	0.47
3	RAdMAT-NL	0.62	0.78
4	Subscale 1 attendance/participation	0.72	0.72	0.83
5	Subscale 2 communication	0.24	0.55	0.67	0.41
6	Subscale 3 attitude/effort	0.58	0.69	0.93	0.69	0.47
7	Perceived overall adherence	0.29	0.40	0.50	0.46	0.30	0.47
8	Homework exercises*	-0.25	-0.29	-0.37	-0.38	-0.32	-0.28	-0.51
9	Difference in FSST*	-0.42	-0.65	-0.76	-0.66	-0.52	-0.70	-0.39	0.27

SIRAS = Sports Injury Rehabilitation Adherence Scale, RAdMAT-NL = Rehabilitation Adherence Measure for Athletic Training the Dutch version, all correlations are significant p < 0.01

*Correlations are negative due to opposite direction of scoring

This study shows that the RAdMAT-NL has the same dimensional structure as the original RAdMAT, and that it can also be used as a single measure of adherence in patients with COPD undertaking pulmonary rehabilitation in a primary physiotherapy practice, although two items loaded differently from the original version.

Structural validity

With a forced 3-factor solution the structure of the original RAdMAT could be re-examined. So, this study was able to confirm the three factors of the original study, however, the clustering of items was slightly different compared to the original study (Granquist et al., 2010). The difference in these results may be due to the translation into a different language and different culture, a different patient group and a different setting. Despite this slight difference, the interpretation of the factors in this study is the same as in the original study. So, the subscales may be used to differentiate adherence levels like the original RAdMAT.

A forced 1-factor solution showed that all items strongly loaded on a single factor which is consistent with the study of Granquist et al (Granquist et al., 2010). Granquist et al suggested the RAdMAT could be used as a single score but did not statistically show this (Granquist et al., 2010). The Rasch analysis in this study showed that the RAdMAT-NL can be used as a single score for adherence, which enhances the practical application of the instrument. The results of the Rasch analysis showed that there was some interference with unidimensionality by the communication items. However, the values of the mean square infit and outfit statistics of those items were slightly higher then 1.5. Values between 1.5 and 2.0 do not degrade the scale but do not contribute to it either (Streiner et al., 2015). As visualised in Fig. 1, the misfit was small and also the internal consistency of the items was high (Table 2), so the 16-items can still be used as a single factor representative of adherence (Granquist et al., 2010). Granquist et al (Granquist et al., 2010) also made their own observation regarding the communication items. They described that two previous studies (Fisher & Hoisington, 1993; Fisher et al., 1993) addressed communication as an important factor for rehabilitation adherence, but that literature does not identify communication as a rehabilitation-adherence behaviour (Meichenbaum & Turk, 1987). Granquist et al (Granquist et al., 2010) concluded that athletic trainers likely use other cues/communication and that this should be kept in mind when interpreting the results of adherence. This may have caused the slight deviation from unidimensionality by the communication items.

Construct validity

Granquist et al (Granquist et al., 2010) used the SIRAS to examine construct validity and demonstrated strong correlations between the RAdMAT total scale and subscales, and the SIRAS, suggesting the RAdMAT is a valid measure of rehabilitation adherence for use in the context of rehabilitation for injured college athletes (Granquist et al., 2010). Clark et al confirmed these results and added the correlation between the RAdMAT and percentage attendance (Clark et al., 2018). The results of this study were similar to those of Granquist et al (Granquist et al., 2010) and of Clark et al (Clark et al., 2018) regarding the correlations. Furthermore, this study ratified construct validity by demonstrating correlations with other adherence measures, including perceived overall adherence, home-based adherence and the change on the FTSST.

Strengths and limitations

The strengths of this study are inclusion of patients from different physiotherapy practices and from patient-organisations in The Netherlands and Belgium. In this way, a representative sample of COPD patients attending a PR program participated in this study, which enhances the generalisability of the study results.

This study also has some limitations. This study was conducted during the COVID-19 pandemic and may have affected motivation of patients for physiotherapy and the way physiotherapists work. Counselling may not always have been able to take place physically, but also online. This may have influenced the evaluation of communication; another possible explanation for interference of the communication items with unidimensionality.

Implications

Up until now, no Dutch measure of exercise adherence was available. The RAdMAT-NL could be used as an interim assessment measure for patients who are not progressing as expected. Using three scores to assess progress is not necessary. Low scores on the RAdMAT-NL may indicate the need for interventions to enhance patient’s 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 (Medicine, 2021). The RAdMAT-NL may also be used or studied in relation to the patient psychological determinants of adherence, such as motivation and perceived control. That is, while the RAdMAT-NL provides the professional’s perspective on the patient’s adherence, the psychological determinants may provide the patient perspective, and together they may predict adherence even better.

The RAdMAT-NL showed good structural validity and construct validity in patients with COPD who were undertaking pulmonary rehabilitation in a primary physiotherapy practice in The Netherlands and Belgium. The factor structure and the psychometric properties of the original RAdMAT were confirmed, and the RAdMAT-NL can be used as a single measure of adherence. With only 16-items in a simple format, the RAdMAT-NL is also relatively easy to use, whether by healthcare providers in clinical practice or for research purposes.

COPD

Chronic Obstructive Pulmonary Disease

FSST

Five Times Sit to Stand Test

KMO

Kaiser-Meyer-Olkin measure

PCA

Principal Component Analysis

Pulmonary Rehabilitation

RAdMAT-NL

Dutch version of the Rehabilitation Adherence Measure for Athletic Training

RMSR

Root mean square of the residuals

SIRAS

Sport Injury Rehabilitation Adherence Scale

Acknowledgements

The authors wish to acknowledge the contributions of the patients and physiotherapists involved in this study.

Author contributions

E.R., E.B., R.L. and A.D. designed the study. E.R. performed data collection and analyses. E.B., R.L. and A.D. contributed to the interpretation of the results. E.R. took the lead in writing the manuscript. All authors provided critical feedback and helped shape the research, analysis and manuscript.

Competing interests

The authors declare that they have no competing interests.

Availability of data and materials

Data are available on reasonable request. Data are available on reasonable request through the corresponding author Ellen Ricke, [email protected]

Ethics approval and consent to participate

This study is registered with the number METc 2020/392. The METc UMCG has concluded that the study is not clinical research with human subjects as meant in the Medical Research Involving Human Subjects Act (WMO). Also, the study was approved by the Ethical Committee Psychology of the University of Groningen (PSY-1920-S-0504).

Consent for publication

Not applicable.

Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

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Additionalfile1Flowchart.pdf
Additional file 1: Flow chart
Additionalfile2Characteristicsphysiotherapists.docx
Additional file 2: Characteristics physiotherapists
Additionalfile3Homebasedadherenceform.docx
Additional file 3: Home-based adherence form and perceived overall adherence (Dutch)
Additionalfile4RAdMATNL.docx
Additional file 4: Dutch version of the Rehabilitation Adherence Measure for Athletic Training (RAdMAT-NL) (Dutch)

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Measuring adherence to pulmonary rehabilitation: a prospective validation study of the Dutch version of the Rehabilitation Adherence Measure for Athletic Training (RAdMAT-NL)

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Version 1

Abstract

Figures

Introduction

Methods

Participants

Procedures

Assessment instruments

Five Times Sit to Stand Test (FTSST)

Home-based adherence form

Perceived overall adherence

Percentage of attendance at scheduled rehabilitation appointments

Sport Injury Rehabilitation Adherence Scale (SIRAS)

RAdMAT-NL

Statistical analysis

Results

Structural validity

Construct validity

Discussion

Structural validity

Construct validity

Strengths and limitations

Implications

Conclusions

Abbreviations

Declarations

References

Supplementary Files

Status:

Version 1