Page 96 - Physical activity in recipients of solid organ transplantation - Edwin J. van Adrichem

Chapter 5
between organ transplant groups, revealed some signi

cant, but clinically small di

erences.
A trend was seen in which especially recipients of kidney transplantation of a deceased
donor tended to score higher on the barrier components and lower on two of the motivator
components. However, given the relatively small di

erences indicated between organ
transplant groups the choice for a single explorative component analysis seems legitimate.

speci
e components seem to be generic for transplant recipients rather than organ group

c.
A limitation of the present study is that the criterion validity of the Barriers and
Motivators Questionnaire has not been determined. Due to the lack of a gold standard for
measuring experienced barriers to and motivators of physical activity in the transplant or
general population, this could not be conducted. Likewise, the instruments content validity
is not determined. Although the content validity is likely limited, as it does not measure all
facets of this complex picture (i.e., individual, social, and environmental elements), several
essential aspects that can be addressed in rehabilitation are present. As the aim of the
current study was to explore the extension of the usability of this particular instrument
used in clinical practice, analysis of the component structure was considered useful and
relevant. In subsequent studies the construct validity could be studied further by validation
against more extensive questionnaires measuring the constructs indicated. Especially
questionnaires on personality traits and psychological constructs could be useful in this. For
instance, the barrier component ‘fear of negative e
minimally in

uence the conclusions of surveys.
Dutch cohort of recipients of solid organ transplantation. When transferring
29,30

ects’ could be validated with other
questionnaires on experienced fear. However, as the questionnaire is speci
constructs which are not likely to be easily validated with existing questionnaires, like
mail surveys (53%),
approach as was used in the current study.
yet, response rates up to 60% are reported when using a multimode

cally directed at
barriers to and motivators of physical activity the component structure also revealed new
‘physical limitations’ and ‘psychological outcomes’ of physical activity.

e response rate of
46% in the current study is in line with reported average response rates in email (35%) and
26

is potentially creates a non-responder bias.
However, recent studies have showed that there is not a necessary relationship between the
rate of non-response and the degree of bias
27,28
and greater participation was shown to only
25
Regarding generalizability of results it
should be noted that the multidimensional structure of the questionnaire was studied in a

ndings to
other settings or populations repetition of analyzes might be needed.
In conclusion, the Barriers and Motivators Questionnaire has a multidimensional structure
in which ‘Fear of negative e

ects’; ‘Physical limitations’; ‘Low expectations and self-
con

dence’; and ‘Lack of motivation or time’ are identi

ed as barrier components and
‘Health and Physical outcomes’; ‘External in

uences’; ‘Groups activities and

nancial
resources’; and ‘Psychological outcomes’ as motivator components.

ese components are
well interpretable and, as such, indicate speci
transplantation can experience barriers to or motivators for physical activity.

subscales can increase the applicability of the questionnaire in research as well as in clinical
c domains in which recipients of solid organ

e use of
settings and seems suitable for general assessment. Future studies should be focused on the
predictive validity of the speci

c components of the Barriers and Motivators Questionnaire
94.