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Kirchner S, Klotsche J, Liedmann I, Niewerth M, Feldman D, Dressler F, Foeldvari I, Foell D, Haas JP, Horneff G, Hospach A, Kallinich T, Kuemmerle-Deschner JB, Moenkemoeller K, Weller-Heinemann F, Windschall D, Minden K, Sengler C. Adherence, helpfulness and barriers to treatment in juvenile idiopathic arthritis - data from a German Inception cohort. Pediatr Rheumatol Online J 2023; 21:31. [PMID: 37046303 PMCID: PMC10091650 DOI: 10.1186/s12969-023-00811-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/26/2023] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVES To develop and evaluate German versions of the Parent Adherence Report Questionnaire (PARQ) and Child Adherence Report Questionnaire (CARQ) and to evaluate adherence in patients with juvenile idiopathic arthritis (JIA). METHODS The PARQ and CARQ were translated into German, cross-culturally adapted and administered to patients (age ≥ 8 years) and their parents enrolled in the Inception Cohort Study of newly diagnosed JIA patients (ICON). The psychometric issues were explored by analyzing their test-retest reliability and construct validity. RESULTS Four hundred eighty-one parents and their children with JIA (n = 465) completed the PARQ and CARQ at the 4-year follow-up. Mean age and disease duration of patients were 10.1 ± 3.7 and 4.7 ± 0.8 years, respectively. The rate of missing values for PARQ/CARQ was generally satisfactory, test-retesting showed sufficient reliability. PARQ/CARQ mean child ability total scores (0-100, 100 = best) for medication were 73.1 ± 23.3/76.5 ± 24.2, for exercise: 85.6 ± 16.5/90.3 ± 15.0, for splints: 72.9 ± 24.2/82.9 ± 16.5. Construct validity was supported by PARQ and CARQ scores for medications, exercise and splints showing a fair to good correlation with the Global Adherence Assessment (GAA) and selected PedsQL scales. Adolescents showed poorer adherence than children. About one third of the parents and children reported medication errors. Perceived helpfulness was highest for medication, and adverse effects were reported the greatest barrier to treatment adherence. CONCLUSIONS The German versions of the PARQ and CARQ appear to have a good reliability and sufficient construct validity. These questionnaires are valuable tools for measuring treatment adherence, identifying potential barriers and evaluating helpfulness of treatments in patients with JIA.
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Affiliation(s)
- Sabine Kirchner
- Deutsches Rheuma-Forschungszentrum Berlin, Leibniz Institute, Epidemiology Unit, Pediatric Rheumatology, Charitéplatz 1, 10117, Berlin, Germany
| | - Jens Klotsche
- Deutsches Rheuma-Forschungszentrum Berlin, Leibniz Institute, Epidemiology Unit, Pediatric Rheumatology, Charitéplatz 1, 10117, Berlin, Germany
| | - Ina Liedmann
- Deutsches Rheuma-Forschungszentrum Berlin, Leibniz Institute, Epidemiology Unit, Pediatric Rheumatology, Charitéplatz 1, 10117, Berlin, Germany
| | - Martina Niewerth
- Deutsches Rheuma-Forschungszentrum Berlin, Leibniz Institute, Epidemiology Unit, Pediatric Rheumatology, Charitéplatz 1, 10117, Berlin, Germany
| | - Debbie Feldman
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, Montreal, QC, Canada
| | - Frank Dressler
- Clinic for Paediatric PneumologyAllergology and Neonatology, Children's Hospital, Medical School Hannover, Hannover, Germany
| | - Ivan Foeldvari
- Hamburg Centre for Pediatric and Adolescence Rheumatology, Paediatric Rheumatology, Hamburg, Germany
| | - Dirk Foell
- Department of Paediatric Rheumatology and Immunology, University Hospital Muenster, Muenster, Germany
| | - Johannes-Peter Haas
- German Centre for Child and Adolescent Rheumatology, Paediatric Rheumatology, Garmisch-Partenkirchen, Germany
| | - Gerd Horneff
- Asklepios Klinik St. Augustin, St. Augustin, Germany
- Department of Paediatric and Adolescent Medicine, University Hospital of Cologne, Cologne, Germany
| | - Anton Hospach
- Olga Hospital, Department of Pediatrics, Stuttgart, Germany
| | - Tilmann Kallinich
- Deutsches Rheuma-Forschungszentrum Berlin, Leibniz Institute, Epidemiology Unit, Pediatric Rheumatology, Charitéplatz 1, 10117, Berlin, Germany
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität Zu Berlin, Berlin, Germany
| | - J B Kuemmerle-Deschner
- Division of Pediatric Rheumatology and Autoinflammation Reference Center Tübingen, Department of Pediatrics, University Hospital Tübingen, Tübingen, Germany
| | - Kirsten Moenkemoeller
- Kliniken Köln - Kinderkrankenhaus Amsterdamer Str, Paediatric Rheumatology, Cologne, Germany
| | | | - Daniel Windschall
- Clinic for Paediatric and Adolescent Rheumatology, Northwest German Center for Rheumatology, St. Josef Stift Sendenhorst, Sendenhorst, Germany
- University of Halle-Wittenberg, Halle, Germany
| | - Kirsten Minden
- Deutsches Rheuma-Forschungszentrum Berlin, Leibniz Institute, Epidemiology Unit, Pediatric Rheumatology, Charitéplatz 1, 10117, Berlin, Germany
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität Zu Berlin, Berlin, Germany
| | - Claudia Sengler
- Deutsches Rheuma-Forschungszentrum Berlin, Leibniz Institute, Epidemiology Unit, Pediatric Rheumatology, Charitéplatz 1, 10117, Berlin, Germany.
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Lee J, Yoon JY. Development of a parent questionnaire to assess treatment adherence for a child or adolescent with epilepsy. Epilepsy Behav 2023; 140:109112. [PMID: 36780775 DOI: 10.1016/j.yebeh.2023.109112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 01/13/2023] [Accepted: 01/24/2023] [Indexed: 02/13/2023]
Abstract
PURPOSE This study aimed to develop a questionnaire to assess parents' treatment adherence for their child or adolescent with epilepsy (PQ-TAE). MATERIAL AND METHODS Seventy-one preliminary items were developed as a first draft and refined based on reviews from experts and cognitive interviews with parents. Then, an online survey was conducted from June 15 to July 15, 2020, to test the psychometric properties of the questionnaire and to modify it. Reliability and validity were additionally tested using exploratory factor analysis, internal consistency, and statistical relationships including parents' partnership with healthcare providers, educational attainment, and economic status. RESULTS The 4-factor model was adopted as the final factor structure of the PQ-TAE (CMIN/df = 2.15, RMSEA = 0.07, SRMR = 0.04, CFI = 0.93, TLI = 0.90). The reliability of the PQ-TAE was statistically acceptable (Cronbach's alpha = 0.93). The PQ-TAE score was statistically related to the partnership with healthcare providers (r = 0.58, p < 0.001), educational attainment (t = -2.12, p = 0.037), and economic status (t = -4.05, p < 0.001). CONCLUSIONS The PQ-TAE using a 5-point Likert scale consists of 25 items classified into four factors. The higher the score (Range 25-125), the better the treatment adherence of the parent of a child or adolescent with epilepsy.
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Affiliation(s)
- Juna Lee
- College of Nursing, Seoul National University, Seoul 03080, Republic of Korea
| | - Ju Young Yoon
- College of Nursing, Seoul National University, Seoul 03080, Republic of Korea; Center for Human-Caring Nurse Leaders for the Future by Brain Korea 21 (BK 21) Four Project, College of Nursing, Seoul National University, Seoul 03080, Republic of Korea.
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Brandelli YN, Tutelman PR, Chambers CT, Parker JA, Stinson JN, Huber AM, Stirling Cameron E, Wilson JP. "Every Little Furrow of Her Brow Makes Me Want To Stop": An Interpretative Phenomenologic Analysis of Mothers' Experiences With Juvenile Idiopathic Arthritis Treatments. Arthritis Care Res (Hoboken) 2022; 74:1761-1769. [PMID: 34151534 DOI: 10.1002/acr.24735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/29/2021] [Accepted: 06/17/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Children with juvenile idiopathic arthritis (JIA) are faced with a complex medical journey requiring consistent adherence to treatments to achieve disease management. Parents are intimately involved in JIA treatments; however, little is known about their experiences in this role. This is relevant as many treatments necessitate procedural pain (e.g., self-injections) or side effects (e.g., nausea), which may impact a parents' ability to follow treatment plans. The objective of this study was to explore the lived experiences of parents who identified challenges with their child's JIA treatments. METHODS Parents of children with JIA who identified challenges with their child's treatments were invited to take part in semistructured interviews. Data were analyzed using interpretative phenomenological analysis. RESULTS Ten mothers of children with JIA (60% female with a mean age of 11.83 years [range 4-16 years]) participated. Four superordinate themes were present in mothers' experiences: 1) treatments altered mothers' roles within the family, increasing their caregiver burden and advocacy; 2) treatments positively and negatively impacted their relationships (e.g., increased support from others, decreased time with others); 3) treatments elicited various emotional responses (e.g., frustration, grief), which affected their well-being; and 4) treatments were at times a source of internal conflict, affecting mothers' actions and adherence. CONCLUSION Mothers' experiences with their child's JIA treatments affects them in various ways that can subsequently impact treatment adherence. Results highlight the value of supporting parents through these complex treatment regimens and incorporating their experiences in treatment decisions to help promote optimal outcomes for children with JIA and their families.
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Affiliation(s)
- Yvonne N Brandelli
- Dalhousie University and IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Perri R Tutelman
- Dalhousie University and IWK Health Centre, Halifax, Nova Scotia, Canada
| | | | | | - Jennifer N Stinson
- University of Toronto and Hospital for Sick Children, Toronto, Ontario, Canada
| | - Adam M Huber
- Dalhousie University and IWK Health Centre, Halifax, Nova Scotia, Canada
| | | | - Jennifer P Wilson
- Cassie & Friends: A Society for Children With Juvenile Arthritis and Other Rheumatic Diseases, Vancouver, British Columbia, Canada
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Horton DB, Salas J, Wec A, Kohlheim M, Kapadia P, Beukelman T, Boneparth A, Haverkamp K, Mannion ML, Moorthy LN, Ringold S, Rosenthal M. Making Decisions About Stopping Medicines for Well-Controlled Juvenile Idiopathic Arthritis: A Mixed-Methods Study of Patients and Caregivers. Arthritis Care Res (Hoboken) 2019; 73:374-385. [PMID: 31880862 DOI: 10.1002/acr.24129] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 12/17/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Improved treatments for juvenile idiopathic arthritis (JIA) have increased remission rates. We conducted this study to investigate how patients and caregivers make decisions about stopping medications when JIA is inactive. METHODS We performed a mixed-methods study of caregivers and patients affected by JIA, recruited through social media and flyers, and selected by purposive sampling. Participants discussed their experiences with JIA, medications, and decision-making through recorded telephone interviews. Of 44 interviewees, 20 were patients (50% ages <18 years), and 24 were caregivers (50% caring for children ages ≤10 years). We evaluated characteristics associated with high levels of reported concerns about JIA or medicines using Fisher's exact testing. RESULTS Decisions about stopping medicines were informed by competing risks between disease activity and treatment. Participants who expressed more concerns about JIA were more likely to report disease-related complications (P = 0.002) and more motivated to continue treatment. However, participants expressing more concern about medicines were more likely to report treatment-related complications (P = 0.04) and felt more compelled to stop treatment. Additionally, participants considered how JIA or treatments facilitated or interfered with their sense of normalcy and safety, expressed feelings of guilt and regret about previous or potential adverse events, and reflected on uncertainty and unpredictability of future harms. Decision-making was also informed by trust in rheumatologists and other information sources (e.g., family and online support groups). CONCLUSION When deciding whether to stop medicines whenever JIA is inactive, patients and caregivers weigh competing risks between disease activity and treatment. Based on our results, we suggest specific approaches for clinicians to perform shared decision-making regarding stopping medicines for JIA.
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Affiliation(s)
- Daniel B Horton
- Rutgers Robert Wood Johnson Medical School and Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, New Brunswick, New Jersey, and Rutgers School of Public Health, Piscataway, New Jersey
| | | | | | - Melanie Kohlheim
- Pediatric Rheumatology Care and Outcomes Improvement Network, Cincinnati, Ohio
| | - Pooja Kapadia
- Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | | | | | - Ky Haverkamp
- University of Washington School of Medicine, Seattle
| | | | - L Nandini Moorthy
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | - Marsha Rosenthal
- Institute for Health, Health Care Policy and Aging Research, New Brunswick, New Jersey
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Brandelli YN, Chambers CT, Tutelman PR, Stinson JN, Huber AM, Wilson JP. Parent Pain Cognitions and Treatment Adherence in Juvenile Idiopathic Arthritis. J Pediatr Psychol 2019; 44:1111-1119. [PMID: 31509198 PMCID: PMC6761964 DOI: 10.1093/jpepsy/jsz067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE Given the high levels of pain and low rates of treatment adherence in children with juvenile idiopathic arthritis (JIA) and their families, this study sought to examine the relationship between parent pain cognitions (i.e., pain catastrophizing, fear of pain) and treatment adherence, and how barriers to treatment (e.g., forgetting treatments, children resisting injections) may be implicated in this relationship. METHODS Parents of children under 18 years of age who have been diagnosed with JIA were recruited to complete an online survey. In total, 221 parents (93% mothers) of children aged 2-17 years (M = 11.10, SD = 4.25) took part, completing questions regarding their pain cognitions, perceived barriers to treatment, and their child's arthritis treatment adherence ability. RESULTS Hierarchical regressions demonstrated that both pain cognitions (i.e., pain catastrophizing and fear of pain) were related to a decrease in parent-reported treatment adherence, however, pain catastrophizing was no longer significant when fear of pain was added to the model. The presence of treatment barriers partially mediated the relationship between fear of pain and treatment adherence, above and beyond the alternate model proposed. CONCLUSION These results suggest that parent pain catastrophizing and fears of pain are related to a greater difficulty following treatment plans, possibly in part because of barriers parents experience that preclude adherence. Given these findings, the identification and management of parent pain cognitions is critical to improving treatment adherence and outcomes for children with JIA and their families.
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Affiliation(s)
- Yvonne N Brandelli
- Department of Psychology and Neuroscience, Dalhousie University
- Centre for Pediatric Pain Research, IWK Health Centre
| | - Christine T Chambers
- Department of Psychology and Neuroscience, Dalhousie University
- Centre for Pediatric Pain Research, IWK Health Centre
- Department of Pediatrics, Dalhousie University
| | - Perri R Tutelman
- Department of Psychology and Neuroscience, Dalhousie University
- Centre for Pediatric Pain Research, IWK Health Centre
| | - Jennifer N Stinson
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children
| | - Adam M Huber
- Department of Pediatrics, Dalhousie University
- Division of Pediatric Rheumatology, IWK Health Centre
| | - Jennifer P Wilson
- Cassie and Friends: A Society for Children with Juvenile Arthritis and Other Rheumatic Diseases
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Silva VBME, Okamoto KYK, Ozaki LDS, Len CA, Terreri MTDSELRA. EARLY DETECTION OF POOR ADHERENCE TO TREATMENT OF PEDIATRIC RHEUMATIC DISEASES: PEDIATRIC RHEUMATOLOGY ADHERENCE QUESTIONNAIRE - A PILOT STUDY. ACTA ACUST UNITED AC 2019; 37:149-155. [PMID: 30892543 PMCID: PMC6651309 DOI: 10.1590/1984-0462/;2019;37;2;00015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 02/11/2018] [Indexed: 11/21/2022]
Abstract
Objective: To develop a questionnaire that allows the early detection of patients at risk for poor adherence to medical and non-medical treatment in children and adolescents with chronic rheumatic diseases. Methods: The Pediatric Rheumatology Adherence Questionnaire (PRAQ) was applied in recently diagnosed patients within a period of one to four months after confirmation of the rheumatic disease. After six months, the patients’ adherence to the medical and non-medical treatment was assessed. An internal consistency analysis was conducted to eliminate redundant questions in the PRAQ. Results: A total of 33 patients were included in the pilot study. Six months after the PRAQ had been applied, poor global adherence was observed in seven (21.2%) patients and poor adherence to medical treatment in eight (24.2%) patients. No correlation was observed between the PRAQ scores and the percentages of adherence, as well as the stratification for each index, except for a tendency to a correlation between socioeconomic index and poor adherence to medical treatment (p=0.08). A new PRAQ questionnaire with 25 of the 46 original questions was generated as a result of the reliability analysis. Conclusions: The usefulness of this questionnaire in clinical practice should be still evaluated. Due to the importance of a tool for the early detection of rheumatic patients at risk of poor adherence to treatment, the new PRAQ questionnaire should be reviewed and applied in a larger study to better define its validity and reliability.
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Affiliation(s)
| | | | | | - Claudio Arnaldo Len
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Favier LA, Ting TV, Modi AC. Feasibility of a musculoskeletal ultrasound intervention to improve adherence in juvenile idiopathic arthritis: a proof-of concept trial. Pediatr Rheumatol Online J 2018; 16:75. [PMID: 30466449 PMCID: PMC6251087 DOI: 10.1186/s12969-018-0292-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 11/12/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Non-adherence is a prevalent and modifiable issue in juvenile idiopathic arthritis (JIA) that currently lacks provider-based intervention. Education surrounding disease status is one way in which families remain engaged in their care. Musculoskeletal ultrasound is one such form of demonstrative, real-time education that may impact the way patients and caregivers self-manage their disease. The aims of this study are to 1) assess the feasibility, acceptability and perceived usefulness of musculoskeletal ultrasound as a non-adherence intervention tool and 2) to examine changes in methotrexate adherence in adolescents with JIA following the ultrasound. METHODS Eight adolescents with polyarticular or extended oligoarticular JIA and their caregivers completed this 12 week study. A within subject design was used to compare baseline and post-intervention adherence, quality of life and disease activity indices. Adherence measures included electronic measurement of methotrexate in addition to self-reported adherence questionnaires. The ultrasound intervention included a one-time, rheumatologist provided, educational examination of three or more currently or historically active joints. RESULTS The ultrasound intervention was found to be both feasible and acceptable. One hundred percent of eligible participants completed the ultrasound intervention. The ultrasound was well received by patients and caregivers, with most believing this to be a helpful tool. Baseline adherence was 75.3% among participants, with half of the participants being classified as non-adherent. Electronically measured and self-reported adherence measures did not show significant changes during the post-intervention period. Two participants improved, four participants maintained, and two participants decreased adherence. On ultrasound, 18/27 (66.7%) of the examined joints displayed abnormalities, with 63% being discrepant and additive to the rheumatologist's physical examination. CONCLUSIONS While our intervention did not show any changes in adherence, quality of life or disease activity indices in this proof-of-concept trial, the intervention does show promise in acceptability measures and merits future study in a more robust trial design. An additional study benefit was that the musculoskeletal ultrasound intervention was able to demonstrate subclinical disease, leading to clinically impactful therapeutic changes in several participants.
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Affiliation(s)
- Leslie A. Favier
- 0000 0000 9025 8099grid.239573.9Cincinnati Children’s Hospital Medical Center, Department of Pediatric Rheumatology, 3333 Burnet Ave, MLC 4010, Cincinnati, OH 45229 USA ,0000 0000 9025 8099grid.239573.9Cincinnati Children’s Hospital Medical Center, Behavioral Medicine and Clinical Psychology, Center for Adherence and Self-Management, 3333 Burnet Ave, MLC 7039, Cincinnati, OH 45229 USA
| | - Tracy V. Ting
- 0000 0000 9025 8099grid.239573.9Cincinnati Children’s Hospital Medical Center, Department of Pediatric Rheumatology, 3333 Burnet Ave, MLC 4010, Cincinnati, OH 45229 USA
| | - Avani C. Modi
- 0000 0000 9025 8099grid.239573.9Cincinnati Children’s Hospital Medical Center, Behavioral Medicine and Clinical Psychology, Center for Adherence and Self-Management, 3333 Burnet Ave, MLC 7039, Cincinnati, OH 45229 USA
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