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Ellen Ricke,1 Robert Lindeboom,2 Arie Dijkstra,1 Eric W Bakker2 1Department of Social Psychology, University of Groningen, Groningen, the Netherlands; 2Department of Epidemiology and Data Science | Division EBM, Academic Medical Centre, Amsterdam, the NetherlandsCorrespondence: Ellen Ricke, Department of Social Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 T, Groningen, the Netherlands, Tel +31 6 211 817 02, Email E.Ricke@rug.nlPurpose: Measuring exercise adherence is important in patients with chronic obstructive pulmonary disease (COPD). For this, the Rehabilitation Adherence Measure for Athletic Training (RAdMAT) seems to be a promising instrument, and a Dutch version (RAdMAT-NL) is available. The aim of this study was to explore the dimensionality and construct validity of the RAdMAT-NL in patients with COPD. Secondly, we examined whether the items of the RAdMAT-NL could be summed to a single score.Patients and Methods: This prospective study included 193 patients with COPD from 53 primary physiotherapy practices in The Netherlands and Belgium. Patients and their physiotherapist provided data including the RAdMAT-NL, at one, two, and three months after inclusion. Horn’s parallel analysis and exploratory factor analysis (EFA) were used to assess the dimensionality of the RAdMAT-NL. Fit to the dichotomous Rasch model for measurement was used to confirm the unidimensionality of the extracted RAdMAT-NL subscales and total scale. To evaluate construct validity, Spearman correlations with other indicators of adherence were calculated, including SIRAS score, percentage attendance and change in exercise skills.Results: EFA identified two dimensions of the RAdMAT-NL, “Participation” (13 items) and “Communication” (3 items), explaining 50.8% of the total variance. Rasch analysis confirmed the unidimensionality of the two dimensions. The unidimensional Rasch model was rejected for a summed score of all 16 RAdMAT-NL items. Medium to large signif

Attention to self-management in patients with chronic diseases is increasingly important for effective and efficient care. One crucial aspect of self-management is long-term adherence, which refers to the ability to maintain specific behavioral changes over time to control a disease. This research aimed to improve understanding of exercise adherence in people with chronic obstructive pulmonary disease (COPD). The researchers developed a measurement instrument to assess exercise adherence in primary physiotherapy. They also conducted a comprehensive review of the literature to identify factors that may predict exercise adherence. Based on these predictors and the measurement instrument, the researchers developed a prediction model which can be used to predict the probability that a patient will be adherent, in advance. The model includes four predictors: intention, depression, perceived dyspnea (difficulty in breathing), and the patient-therapist relationship (alliance). To facilitate its use in practice, a web-based calculator is available (https://www.derzis.nu/Calculator/) where healthcare providers can enter the values of the predictors and obtain the probability of adherence. The probability score obtained informs the healthcare provider about the individual patient to support personalized counseling. This tool can aid in decision-making and enable personalized interventions. Additionally, the researchers developed a protocol to evaluate the safety and effectiveness of increased self-management in patients with COPD, while also assessing the predictive validity of the prediction model. By implementing self-management strategies and utilizing the prediction model, healthcare providers can potentially improve patient outcomes and optimize the use of healthcare resources. The findings from this research have the potential to benefit both scientific research and practical applications in healthcare settings. The developed tools provide a p

Ellen Ricke,1 Eric W Bakker2 1Department of Social Psychology, University of Groningen, Groningen, the Netherlands; 2Department of Epidemiology and Data Science | Division EBM, Academic Medical Centre, Amsterdam, the NetherlandsCorrespondence: Ellen Ricke, Department of Social Psychology, University of Groningen, Grote Kruisstraat 2/1, Groningen, 9712 TS, the Netherlands, Tel +31 6 211 817 02, Email E.Ricke@rug.nlPurpose: Pulmonary rehabilitation (PR) is considered a cost-effective method of improving health-related quality of life in patients with chronic obstructive pulmonary disease (COPD). However, increasing demand and increasing costs of supply demands for sustainable and affordable care. One of the possible solutions to keep care affordable is self-management. A challenge here is non-adherence. Understanding who are adherent and who are non-adherent could be helpful to differentiate between patients who need more or less support. Therefore, the aim of this study was to develop and validate a model to predict adherence to PR in patients with COPD.Patients and methods: A multivariable logistic regression model for exercise adherence was developed. Eight candidate predictors, that were prespecified, were obtained in a prospective cohort study from 196 patients with COPD following PR in 53 primary physiotherapy practices in the Netherlands and Belgium, between January 2021 and August 2022. To create a parsimonious model, variable selection using backward selection was performed with a p-value of > 0.05 for elimination. Model performance was assessed by discrimination, calibration and clinical utility. Internal validation was assessed by bootstrapping (n = 500).Results: The final model included four predictors: intention, depression, MRC-score and alliance. The optimism-corrected AUC after bootstrap internal validation was 0.79 (95% CI, 0.72– 0.85). Calibration plots suggested good calibration and decision curve analysis showed great net benefit in a wide ran