Hu Lu, Lingler Jennifer H, Sereika Susan M, Burke Lora E, Malchano Donna Kaltenbaugh, DeVito Dabbs Annette, Dew Mary Amanda
New York University School of Medicine, Center for Healthful Behavior Change, United States.
University of Pittsburgh School of Nursing, Department of Health and Community Systems, United States.
Heart Lung. 2017 May-Jun;46(3):178-186. doi: 10.1016/j.hrtlng.2017.01.006. Epub 2017 Feb 8.
This study reports on the first systematic review focused on lung transplant recipients (LTRs) and provides evidence regarding 1) prevalence of nonadherence to the post-transplant medical regimen; 2) risk factors for nonadherence; 3) impact of adherence-promoting interventions; and 4) transplant-related clinical outcomes of nonadherence in LTRs. Following the PRISMA guidelines, a literature search of 5 databases was conducted, yielding 30 relevant articles. Findings suggested that nonadherence rates varied greatly across regimen components and were not consistently associated with any single risk factor. Effect sizes in terms of correlation coefficients for adherence-promoting interventions ranged from .05 to .45. Mortality rates did not significantly differ by adherence levels. Major limitations across studies were weak methodologies for measuring nonadherence and small sample sizes. This review underscores the need for more rigorous and extensive studies of risk factors and clinical outcomes of nonadherence and for large-scaled theory-based trials to examine adherence-promoting interventions in LTRs.
本研究报告了首个聚焦于肺移植受者（LTRs）的系统评价，并提供了以下方面的证据：1）移植后医疗方案不依从的发生率；2）不依从的风险因素；3）促进依从性干预措施的影响；4）LTRs中不依从与移植相关的临床结局。按照PRISMA指南，对5个数据库进行了文献检索，共获得30篇相关文章。研究结果表明，不同方案组成部分的不依从率差异很大，且与任何单一风险因素均无一致关联。促进依从性干预措施的相关系数效应大小在0.05至0.45之间。死亡率在依从水平上无显著差异。各研究的主要局限性在于测量不依从的方法薄弱且样本量小。本综述强调需要对不依从的风险因素和临床结局进行更严格、广泛的研究，并开展大规模基于理论的试验，以检验促进LTRs依从性的干预措施。
