Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Penang, Malaysia.
Faculty of Pharmacy, Hamdard University, Karachi, 74400, Pakistan.
BMC Musculoskelet Disord. 2020 Feb 1;21(1):65. doi: 10.1186/s12891-020-3078-y.
Non-adherence to physical therapy ranges from 14 to 70%. This could adversely affect physical functioning and requires careful monitoring. Studies that describe designing and validation of adherence measuring scales are scant. There is a growing need to formulate adherence measures for this population. The aim was to develop and validate a novel tool named as the General Rehabilitation Adherence Scale (GRAS) to measure adherence to physical therapy treatment in Pakistani patients attending rehabilitation clinics for musculoskeletal disorders.
A month-long study was conducted in patients attending physical therapy sessions at clinics in two tertiary care hospitals in Karachi, Pakistan. It was done using block randomization technique. Sample size was calculated based on item-to-respondent ratio of 1:20. The GRAS was developed and validated using content validity, factor analyses, known group validity, and sensitivity analysis. Receiver operator curve analysis was used to determine cut-off value. Reliability and internal consistency were measured using test-retest method. Data was analyzed through IBM SPSS version 23. The study was ethically approved (IRB-NOV:15).
A total of 300 responses were gathered. The response rate was 92%. The final version of GRAS contained 8 items and had a content validity index of 0.89. Sampling adequacy was satisfactory, (KMO 0.7, Bartlett's test p-value< 0.01). Exploratory factor analysis revealed a 3-factor model that was fixed and confirmed at a 2-factor model. Incremental fit indices, i.e., normed fit index, comparative fit index and Tucker Lewis index, were reported > 0.95 while absolute fit index of root mean square of error of approximation was < 0.03. These values indicated a good model fit. The value for Cronbach (α) was 0.63 while it was 0.77 for McDonald's (ω), i.e., acceptable. Test-retest reliability coefficient was 0.88, p < 0.01. Education level was observed to affect adherence (p < 0.01). A cut-off value of 12 was identified. The sensitivity and accuracy of the scale was 95%, and its specificity was 91%.
The scale was validated in this study with satisfactory results. The availability of this tool would enhance monitoring for adherence as well as help clinicians and therapists address potential areas that may act as determinants of non-adherence.
物理治疗的不依从率在 14%到 70%之间。这可能会对身体功能产生不利影响，需要仔细监测。描述依从性测量量表设计和验证的研究很少。因此，非常有必要为这一人群制定依从性测量方法。本研究旨在开发和验证一种新的工具，即通用康复依从性量表（GRAS），以测量巴基斯坦骨骼肌疾病康复诊所接受物理治疗的患者的治疗依从性。
在巴基斯坦卡拉奇的两家三级护理医院的诊所接受物理治疗的患者中进行了为期一个月的研究。采用随机分组技术。根据每个项目的应答者比例为 1:20 计算样本量。使用内容有效性、因子分析、已知组有效性和敏感性分析来开发和验证 GRAS。采用接收者操作特征曲线分析确定截断值。使用重测法测量可靠性和内部一致性。使用 IBM SPSS 版本 23 分析数据。该研究获得了伦理批准（IRB-NOV：15）。
共收集了 300 份回复，回复率为 92%。GRAS 的最终版本包含 8 个项目，内容有效性指数为 0.89。采样充足，（KMO 0.7，Bartlett 检验 P 值<0.01）。探索性因子分析显示，在固定和确认 2 因子模型后，存在 3 因子模型。增量拟合指数，即标准化拟合指数、比较拟合指数和塔克刘易斯指数，均报告>0.95，而近似误差均方根的绝对拟合指数<0.03。这些值表明模型拟合良好。克朗巴赫（α）值为 0.63，麦克唐纳（ω）值为 0.77，即可接受。重测信度系数为 0.88，P<0.01。观察到教育水平会影响依从性（P<0.01）。确定了 12 分的截断值。该量表的灵敏度和准确度为 95%，特异性为 91%。
本研究验证了该量表，结果令人满意。该工具的可用性将增强对依从性的监测，并帮助临床医生和治疗师解决可能影响依从性的潜在问题。
