Liyanage I, Dasanayaka D A R K, Liyanage E, Ishara H K M, Rathnayake S
Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka.
Centre for Digital Innovations in Health and Social Care, Faculty of Health Studies, University of Bradford, Bradford, UK.
BMC Musculoskelet Disord. 2025 Sep 1;26(1):823. doi: 10.1186/s12891-025-09125-6.
Physiotherapy adherence can be defined as an active, voluntary patient involvement in a mutually agreed-upon course of action to achieve a desired preventive or therapeutic outcomes. Nonadherence may result in increased healthcare costs and poor recovery. Therefore, it is crucial to measure physiotherapy adherence to eliminate obstacles and promote adherence. No validated tool exists to measure physiotherapy adherence among Sinhala-speaking patients in Sri Lanka.
This study aimed to develop a Sinhala version of the General Rehabilitation Adherence Scale (GRAS-Sin). During the first phase, the original version of the GRAS was translated and culturally adapted to the Sinhala language. In the second phase, a cross-sectional survey was conducted among 200 patients who sought physiotherapy treatment for musculoskeletal issues at the National Hospital, Kandy and the Teaching Hospital, Peradeniya, Sri Lanka, to evaluate its psychometric properties. The pre-final version of the questionnaire developed in the first phase was used in the second phase.
The majority of the respondents were female (71.5%). Most patients (54.5%) showed a high level (20-24 total scores) of physiotherapy adherence. There was an acceptable level of internal consistency (Cronbach's alpha = 0.82) and test-retest reliability (intraclass correlation coefficient = 0.907, p < 0.05). The content validity index of the scale was 0.89. The sampling adequacy was satisfactory (KMO = 0.755, Bartlett's test p < 0.05). Construct validity was measured by exploratory factor analysis, which revealed a 2-factor model with a 73.4% variance. The incremental fit indices, i.e., the normed fit index, comparative fit index and Tucker-Lewis index, were reported to be > 0.95, whereas the absolute fit index of the root mean square of the approximation error was 0.065. These values indicated a good model fit. No floor and 27% ceiling effects were found. There was a significant (X = 17.46, p = 0.001) relationship between physiotherapy adherence and gender, whereas age, employment status, educational level, and economic status were not significant.
The GRAS-Sin questionnaire is a valid and reliable tool for assessing physiotherapy adherence among Sinhala-speaking patients in Sri Lanka. However, its ceiling effect may limit differentiation at higher adherence levels. Further studies are required to address the limitations of the ceiling effect in the present study.
物理治疗依从性可定义为患者积极、自愿地参与双方商定的行动方案，以实现预期的预防或治疗效果。不依从可能导致医疗成本增加和康复不佳。因此，测量物理治疗依从性以消除障碍并促进依从性至关重要。在斯里兰卡，尚无经过验证的工具来测量说僧伽罗语患者的物理治疗依从性。
本研究旨在开发僧伽罗语版的一般康复依从性量表（GRAS-Sin）。在第一阶段，将GRAS的原始版本翻译成僧伽罗语并进行文化调适。在第二阶段，对在斯里兰卡康提国立医院和佩拉德尼亚教学医院因肌肉骨骼问题寻求物理治疗的200名患者进行横断面调查，以评估其心理测量特性。第二阶段使用第一阶段编制的问卷预终版。
大多数受访者为女性（71.5%）。大多数患者（54.5%）表现出较高水平（总分20 - 24分）的物理治疗依从性。内部一致性处于可接受水平（克朗巴哈系数α = 0.82），重测信度良好（组内相关系数 = 0.907，p < 0.05）。该量表的内容效度指数为0.89。抽样适当性令人满意（KMO = 0.755，巴特利特检验p < 0.05）。通过探索性因素分析测量结构效度，结果显示为一个解释方差73.4%的双因素模型。报告的增量拟合指数，即规范拟合指数、比较拟合指数和塔克 - 刘易斯指数均 > 0.95，而近似误差均方根的绝对拟合指数为0.065。这些值表明模型拟合良好。未发现地板效应，天花板效应为27%。物理治疗依从性与性别之间存在显著关系（X = 17.46，p = 0.001），而年龄、就业状况、教育水平和经济状况则无显著关系。
GRAS-Sin问卷是评估斯里兰卡说僧伽罗语患者物理治疗依从性的有效且可靠的工具。然而，其天花板效应可能会限制在较高依从性水平上的区分度。需要进一步研究来解决本研究中天花板效应的局限性。
