Evidence-based Assessment of Adherence to Medical Treatments in Pediatric Psychology

Quittner, Alexandra L.; Modi, Avani C.; Lemanek, Kathleen L.; Ievers‐Landis, Carolyn E.; Rapoff, Michael A.

doi:10.1093/jpepsy/jsm064

Cited by 279 publications

(265 citation statements)

References 65 publications

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“…Combining self-report data with electronic data collection techniques may have resulted in a better estimate of adherence (45). Data from our study suggests a minimum adherence rate of 50% (calculated from supervised sessions), and it is likely that the true adherence rate falls between 50% and 72%, calculated from supervised and unsupervised sessions in this study.…”

Section: Discussionmentioning

confidence: 76%

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Feasibility and effectiveness of an aerobic exercise program in children with fibromyalgia: Results of a randomized controlled pilot trial

Stephens

Feldman

Bradley

et al. 2008

Arthritis & Rheumatism

106

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Objective. To determine the feasibility of conducting a randomized controlled trial of a 12-week exercise intervention in children with fibromyalgia (FM) and to explore the effectiveness of aerobic exercise on physical fitness, function, pain, FM symptoms, and quality of life (QOL). Methods. FM patients ages 8 -18 years were randomized to a 12-week exercise intervention of either aerobics or qigong. Both groups participated in 3 weekly training sessions. Program adherence and safety were monitored at each session. Data were collected at 3 testing sessions, 2 prior to and 1 after the intervention, and included FM symptoms, function, pain, QOL, and fitness measures. Results. Thirty patients participated in the trial. Twenty-four patients completed the program; 4 patients dropped out prior to training and 2 dropped out of the aerobics program. Better adherence was reported in the aerobics group than in the qigong group (67% versus 61%). Significant improvements in physical function, functional capacity, QOL, and fatigue were observed in the aerobics group. Anaerobic function, tender point count, pain, and symptom severity improved similarly in both groups. Conclusion. It is feasible to conduct an exercise intervention trial in children with FM. Children with FM tolerate moderate-intensity exercise without exacerbation of their disease. Significant improvements in physical function, FM symptoms, QOL, and pain were demonstrated in both exercise groups; the aerobics group performed better in several measures compared with the qigong group. Future studies may need larger sample sizes to confirm clinical improvement and to detect differences in fitness in childhood FM.

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Section: Discussionmentioning

confidence: 76%

“…Adherence with the exercise program may have been overestimated by self-report diaries (45). Combining self-report data with electronic data collection techniques may have resulted in a better estimate of adherence (45).…”

Section: Discussionmentioning

confidence: 99%

Feasibility and effectiveness of an aerobic exercise program in children with fibromyalgia: Results of a randomized controlled pilot trial

Stephens

Feldman

Bradley

et al. 2008

Arthritis & Rheumatism

106

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“…Every method of assessing medication adherence presents advantages and disadvantages [32], and there is no agreement on a single gold standard approach [1,[33][34][35]. Self-report measures present some specialized advantages and uses for medication adherence assessment.…”

Section: Advantages and Disadvantages Of Self-report Adherence Measuresmentioning

confidence: 99%

“…Until then, randomized controlled trials of adherence interventions would benefit from a more objective method of adherence assessment as the primary study outcome (e.g., EDM devices, prescription refill measures, or multiple measures with complementary properties, such as selfreport and adherence biomarkers). Use of multiple measures in adherence research can triangulate intervention effects [34,72] and advance measurement science through comparisons with one another.…”

Section: Contextual Considerations In Self-report Adherence Measuresmentioning

confidence: 99%

Self-report measures of medication adherence behavior: recommendations on optimal use

Stirratt

Dunbar‐Jacob

Crane

et al. 2015

Behav. Med. Pract. Policy Res.

605

528

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Medication adherence plays an important role in optimizing the outcomes of many treatment and preventive regimens in chronic illness. Self-report is the most common method for assessing adherence behavior in research and clinical care, but there are questions about its validity and precision. The NIH Adherence Network assembled a panel of adherence research experts working across various chronic illnesses to review selfreport medication adherence measures and research on their validity. Self-report medication adherence measures vary substantially in their question phrasing, recall periods, and response items. Self-reports tend to overestimate adherence behavior compared with other assessment methods and generally have high specificity but low sensitivity. Most evidence indicates that self-report adherence measures show moderate correspondence to other adherence measures and can significantly predict clinical outcomes. The quality of self-report adherence measures may be enhanced through efforts to use validated scales, assess the proper construct, improve estimation, facilitate recall, reduce social desirability bias, and employ technologic delivery. Self-report medication adherence measures can provide actionable information despite their limitations. They are preferred when speed, efficiency, and low-cost measures are required, as is often the case in clinical care. KeywordsAdherence, Compliance, Self-management, Medication, Self-report Valid measurement of medication adherence plays a crucial role in healthcare and health research. When a patient is not benefiting from a medication regimen, clinicians need sound adherence information to determine whether the medication is ineffective or not being taken as prescribed. Assessing medication adherence during routine clinical care can further ensure that individuals in need of adherence support interventions receive them, ideally before deleterious outcomes occur. In the context of clinical research, proper interpretation of proof-of-concept trials testing new pharmacologic regimens requires valid adherence data, because any null findings may stem from poor adherence rather than a lack of drug efficacy. Research designed to understand and promote medication adherence also requires precise methods of adherence assessment.Among many approaches to assessing medication adherence, patient self-report measures remain the most common method [1][2][3][4][5][6]. These measures are defined by asking respondents to characterize their medication adherence behavior. Self-report measures of medication adherence range from simple singleitem questions regarding missed doses to complex multi-item assessments that incorporate reasons for nonadherence [7]. The widespread use of self-report adherence measures in clinical care and research reflects their low cost and ease of implementation across a large variety of medication regimens.There are two primary challenges related to selfreport measures of medication adherence. ImplicationsPractice: Routine assessment of medication...

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“…1 Future studies should consider including an attention control or active comparison intervention and adherence assessments other than self-report. 23 The current results should be interpreted with several limitations in mind. This meta-analysis focused on the published literature across several specialties, including medicine, nursing, and nutrition.…”

Section: Discussionmentioning

confidence: 94%

Health Care Provider-Delivered Adherence Promotion Interventions: A Meta-Analysis

Pai

2014

Pediatrics

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BACKGROUND AND OBJECTIVE: Improving medical regimen adherence is essential for maximizing the therapeutic potential of treatments for pediatric chronic illness. Health care providers are uniquely positioned to deliver adherence promotion interventions. However, no studies have summarized the effectiveness of health care provider-delivered adherence interventions. The objective of this study was to describe the effectiveness of health care provider-delivered adherence promotion interventions in improving adherence among children who have chronic illness. Data sources include PubMed, PsycINFO, CINAHL, and Scopus. Studies were included if they were randomizedcontrolled trials of pediatric interventions aiming to increase adherence to the primary regimen for a chronic illness and at least 1 health care provider delivered the intervention.RESULTS: A total of 35 randomized-controlled studies including 4616 children were included. Greater improvements in adherence were observed immediately after health care provider-delivered interventions (d = 0.49; 95% confidence interval, 0.32 to 0.66) than at longer-term follow-up (d = 0.32; 95% confidence interval, 0.10 to 0.54). Treatment effect sizes differed across the adherence behaviors measured. There was significant heterogeneity in treatment effects; however, no moderators of treatment effectiveness were identified. This meta-analysis focused on the published literature. In addition, the majority of studies involved children who had asthma and younger children.CONCLUSIONS: Health care provider-delivered interventions for children who have chronic illness can be effective in improving adherence. Gains in adherence are highest immediately after intervention. Future interventions and studies should include multiple methods of assessing adherence, include active comparators, and address long-term maintenance of adherence gains.

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Evidence-based Assessment of Adherence to Medical Treatments in Pediatric Psychology

Cited by 279 publications

References 65 publications

Feasibility and effectiveness of an aerobic exercise program in children with fibromyalgia: Results of a randomized controlled pilot trial

Feasibility and effectiveness of an aerobic exercise program in children with fibromyalgia: Results of a randomized controlled pilot trial

Self-report measures of medication adherence behavior: recommendations on optimal use

Health Care Provider-Delivered Adherence Promotion Interventions: A Meta-Analysis

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