Children with juvenile idiopathic arthritis are more likely to follow their medication and exercise regimens when their parents perceive that the treatments are helpful.
Adherence can be problematic in juvenile idiopathic arthritis (JIA) treatment, because therapy often is complicated, reported Debbie Ehrmann Feldman, Ph.D., of Montreal Children's Hospital, and her associates (Arthritis Rheum. 2007;57:226–33).
To evaluate the potential factors influencing patient adherence to JIA treatment over time, the investigators surveyed the parents of 175 children (mean age 10 years) with a mean disease duration of 4 years. The patients were receiving JIA treatment at two pediatric hospitals in Canada.
Several times over a 12-month period, parents completed questionnaires including the Parent Adherence Report Questionnaire; the Symptom Checklist-90-Revised; the Coping Health Inventory for Parents (CHIP); and the Child Health Assessment Questionnaire (CHAQ). The investigators also included clinical information obtained from each child's chart, and input from clinicians and physical therapists about prescribed treatment and opinions about patient adherence.
In terms of treatment adherence, the values for perceived adherence to medication were consistent between patients and physicians, whereas the perceived adherence to exercise was higher among parents than physical therapists. Parent-reported adherence to medication use ranged from 86 to 92 on a 100-mm visual analog scale in the PARQ, and the physician ratings for medication adherence ranged from 90 to 92. Perceived exercise adherence was substantially lower, with parent-reported values ranging from 54 to 64 and physical therapist ratings ranging from 35 to 50, the investigators stated.
“Adherence to medication was higher for participants who perceived exercise to be highly beneficial, as well as those who had children with lower disease severity [as measured by active joint count],” the authors wrote, commenting on findings from their generalized estimating equation analysis done to identify factors from all of the survey instruments associated with perceived treatment adherence. “Adherence to exercise was higher for participants who perceived exercise to be a highly beneficial treatment for JIA, for participants with younger children, and for participants with a child who was involved in the responsibility for his or her treatment.”
The findings underscore “the importance of patients' beliefs affecting adherence,” the authors wrote, noting that management strategies should incorporate explanations about the treatments, how they work, and why they are important.