28 Chapter 2 The quality of performance score depends on the physical therapist’s rating of the patient’s quality of performance of each exercise. Currently, there is no theoretical basis for the impact of the quality of performance on the effectiveness of adherence to HBE recommendations. Therefore, the authors used their clinical experience and experience with instrument development to determine the magnitude of the impact of the quality of performance. In this study, each point on the quality of performance scale reflects 20% effectiveness (Table 1). Table 1 Quality of performance score matrix. Excellent Good Reasonable Moderate Poor Score 1 Score 0.8 Score 0.6 Score 0.4 Score 0.2 All parts of the home-based exercise are performed perfectly according to the recommendations by the therapist. There is no room for improvement. It is certain the desired effect of the exercise has been achieved. Most parts of the exercise are performed well according to the recommendations by the therapist. Important parts of the exercise can be improved. The desired effect of the exercise is likely to have been achieved. The majority or all of the parts of the exercise are not performed according to the recommendations by the therapist. It is very unlikely that the desired effect of the exercise has been achieved. In the third and final step, the EXAS score is obtained by calculating the mean of the adherence scores for all individual exercises in the HBE program [3]. EXAS score = Adherence score exercise 1 + … + Adherence score exercise n n [3] In the clinimetric study, the construct validity and reliability of the EXAS were investigated. Intrarater reliability was assessed only for the quality of the performance rating scale of the EXAS. For both the construct validity and reliability assessments of the EXAS, the physical therapists using the instrument were provided information on the theoretical background of adherence to HBE programs, in addition to receiving training in scoring the EXAS and incorporating the EXAS in clinical practice. Training involved completing the EXAS using data from a test patient and discussing the process with one of the researchers (RA or RG).
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