31 Development of the Exercise Adherence Scale (EXAS) in patients with low back pain the patient, the physical therapist completed the EXAS together with the patient during a follow-up visit. Reliability Reliability is defined as “the extent to which scores for patients who have not changed are the same for repeated measurement under several conditions: for example, . . . by different persons on the same occasion (interrater) or by the same persons (i.e. raters or responders) on different occasions (intrarater)” (18). The EXAS is designed to be used by a physical therapist who both recommends the HBE program to the patient and rates the quality of performance during the patient’s follow-up visit. However, in clinical practice, it is not uncommon for patients to have more than one physical therapist during their treatment period. For this reason, both intrarater reliability and interrater reliability of the EXAS quality of performance were assessed. Participants and setting For the reliability study, two researchers included a convenience sample of healthy adults aged 18–65 years with sufficient command of the Dutch language to read and understand written or spoken instructions. Potential participants were excluded if they were unable to perform exercises due to physical or mental issues or if they experienced pain or discomfort when performing exercises. Recruitment took place at Fontys University of Applied Sciences in the Netherlands. MEASUREMENTS Quality of performance of the exercises by the participants was rated using the scoring matrix of the EXAS (Table 1). The following personal and demographic characteristics of the participants were measured: age (in years); gender; height (in centimeters); weight (in kilograms); and level of education (i.e. elementary school, high school, vocational school, college, or university). Procedures to test reliability All participants provided written informed consent prior to the start of the study. Subsequently, personal and demographic data were collected. Four different exercises commonly recommended by physical therapists in HBE programs for LBP were selected for reliability testing by a panel of physical therapists specialized in treating patients with LBP. The selected exercises were the squat, the deadlift using a broomstick, the lunge, and the bridge. For each exercise, participants were asked to watch an instructional video showing an actor performing the exercise; additional written instructions were also available. Participant performance of the exercise was recorded using two high-definition 2
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