Development and Validation of a Multivariable Exercise Adherence Prediction Model for Patients with COPD: A Prospective Cohort Study

Abstract

Purpose

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 range of risk thresholds.

Conclusion

The exercise adherence prediction model has potential for clinical utility to predict adherence in patients with COPD. Information from such a model can be used to manage the patient instead of managing the disease, and thereby to determine the treatment frequency for each individual patient. As a result, healthcare capacity might be better distributed, potentially reducing pressure on healthcare without compromising the effectiveness of PR for the individual patient.

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© 2023 Ricke and Bakker. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution - Non Commerical (unported, v3.0) License. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

Keywords:

• chronic obstructive pulmonary disease
• sustainable healthcare
• pulmonary rehabilitation
• self-management

Abbreviations

4DSQ, Four-Dimensional Symptom Questionnaire; AUC, Area Under the Curve; CI, Confidence Interval; COPD, Chronic Obstructive Pulmonary Disease; GOLD, Global Initiative for Chronic Obstructive Lung Disease; IQR, Inter Quartile Range; MRC-score, Medical Research Council dyspnea scale; PBC, Perceived Behavioral Control; PR, Pulmonary Rehabilitation; RAdMAT-NL, Dutch version of the Rehabilitation Adherence Measure for Athletic Training; TPB, Theory of Planned Behavior; WAI, Working Alliance Inventory.

Data Sharing Statement

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

Ethics Approval and Informed Consent

This study complies with the Declaration of Helsinki and 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).

Acknowledgments

The authors wish to acknowledge the contributions of the patients and physiotherapists involved in this study. Working Alliance Inventory used and reprinted by permission of the Society for Psychotherapy Research © 2016.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests.

Additional information

Funding

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