Newsham D
Division of Orthoptics, Department of Allied Health Professions, University of Liverpool, Thompson Yates Building, Liverpool L69 3GB, UK.
Br J Ophthalmol. 2000 Sep;84(9):957-62. doi: 10.1136/bjo.84.9.957.
BACKGROUND/AIMS: Non-concordance has often been reported as a major contributor to the failure of occlusion therapy for amblyopia. In other fields of medicine the extent of a patient's understanding in areas of the disease and treatment has been shown to have both a direct and indirect effect on subsequent concordance. The aims of this study were to determine the extent of parental non-concordance, to assess their level of understanding in key areas of amblyopia, occlusion therapy, critical period and prognosis, and to discover the parent's own reasons for failing to concord.
Parents of children aged 2-7 years receiving a minimum of 1 hour of occlusion for unilateral amblyopia were recruited. Parental concordance was monitored using a diary and their understanding and reasons for non-concordance were assessed by a questionnaire. Concordance was analysed by calculating a concordance index, determining the proportion of non-concordance, and also by classifying the non-concordance on the basis of whether the behaviour was intentional or unintentional and whether the parents were adequately or inadequately informed.
Parental non-concordance was defined as failing to occlude less than 80% of the total prescribed time. The median concordance index was 0.75 and the proportion of non-concordant parents was 0.54 (95% CI 0.41 to 0.67) (n = 57). Parental knowledge was poor in areas of the critical period with 23% of parents unaware of an age limit to the treatment. Reasons for non-concordance given by 68% of parents demonstrated poor knowledge.
A substantial proportion of the non-concordant parents had poor understanding in areas such as the critical period and errors also occurred in implementing the treatment regimen. Increased parental awareness of the rationale and urgency of the treatment, with reinforcement of details of the regimen, would help to reduce non-concordance with occlusion therapy.
背景/目的：不依从常被认为是弱视遮盖治疗失败的主要原因。在医学的其他领域，患者对疾病及治疗方面的理解程度已被证明对后续的依从性有直接和间接影响。本研究的目的是确定家长不依从的程度，评估他们对弱视、遮盖治疗、关键期和预后等关键领域的理解水平，并找出家长不依从的自身原因。
招募2至7岁接受至少1小时单侧弱视遮盖治疗的儿童的家长。使用日记监测家长的依从性，并通过问卷评估他们的理解程度和不依从的原因。通过计算依从性指数、确定不依从的比例以及根据行为是有意还是无意以及家长是否得到充分或不充分的信息对不依从进行分类来分析依从性。
家长不依从被定义为遮盖时间少于规定总时间的80%。依从性指数中位数为0.75，不依从家长的比例为0.54（95%可信区间0.41至0.67）（n = 57）。家长在关键期方面的知识匮乏，23%的家长不知道治疗存在年龄限制。68%的家长给出的不依从原因显示出知识欠缺。
相当一部分不依从的家长在关键期等方面理解不足，并且在执行治疗方案时也出现错误。提高家长对治疗原理和紧迫性的认识，并强化治疗方案的细节，将有助于减少遮盖治疗的不依从情况。
