St Vincent's Clinical Campus, School of Clinical Medicine, UNSW, Sydney, NSW, Australia.
Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital Sydney, Victoria Street, Darlinghurst, NSW, 2010, Australia.
Clin Rheumatol. 2024 Sep;43(9):2943-2954. doi: 10.1007/s10067-024-07050-y. Epub 2024 Jul 15.
This study aimed to examine psychometric properties of the Adherence to Refills and Medications Scale (ARMS) in people with gout. We conducted exploratory factor analysis (EFA) and tested internal consistency (ordinal and Cronbach's alpha coefficients) and agreement (intraclass correlation coefficient (2,1)) in ARMS scores across three timepoints (baseline, 6, and 12 months) in 487 people with gout. The Kruskal-Wallis test, Spearman's rank, Kendall's tau-b correlations, and logistic regression were used to examine the criterion-related validity of the ARMS and factors associated with the ARMS. EFA suggested a one-factor structure, explaining 43.2% of total variance. High internal consistency (ordinal alpha = 0.902 at baseline) and moderate agreement in ARMS scores over time (ICCs > 0.5; p < 0.001) were observed. Lower ARMS scores (indicating better adherence) predicted achieving target serum urate (OR, 0.89; 95% CI, 0.83-0.95; p < 0.001), but not urate-lowering therapy (ULT) adherence (Proportion of Days Covered (PDC) ≥ 80%) (OR, 0.93; 95% CI, 0.81-1.05; p = 0.261). Negative correlations between ARMS and PDC were not statistically significant (Kendall's tau-b, r = - 0.126, p = 0.078; Spearman's rho = - 0.173, p < 0.073). Differences in median ARMS scores (IQR) of 16 (14-20), 13 (12-15), and 17.5 (15-21) in three groups of participants who reported (1) not taking ULT, (2) taking ULT and adherent, and (3) taking ULT but not adherent, respectively, were statistically significant (p < 0.001). Age was the only patient factor independently associated with optimal adherence (ARMS score = 12) (OR, 1.91; 95% CI, 1.50-2.43; p < 0.001). The ARMS is a reliable and valid measure of medication adherence behaviours in people with gout, justifying its use in gout medication adherence research.
这项研究旨在探讨在痛风患者中，“药物和剂量补充依从性量表（ARMS）”的心理测量特性。我们对 487 名痛风患者进行了探索性因素分析（EFA），并在三个时间点（基线、6 个月和 12 个月）测试了 ARMS 评分的内部一致性（等级和 Cronbach's alpha 系数）和一致性（组内相关系数 2,1）。Kruskal-Wallis 检验、Spearman 秩相关、Kendall's tau-b 相关和逻辑回归用于检验 ARMS 的效标关联效度及其与 ARMS 相关的因素。EFA 表明存在一个单因素结构，可解释总方差的 43.2%。ARMS 评分具有较高的内部一致性（基线时的等级 alpha 值为 0.902），并且在不同时间点的一致性较好（ICC>0.5；p<0.001）。较低的 ARMS 评分（表明依从性更好）预测了达到目标血清尿酸（OR，0.89；95%CI，0.83-0.95；p<0.001），但不能预测降尿酸治疗（ULT）的依从性（覆盖天数比例（PDC）≥80%）（OR，0.93；95%CI，0.81-1.05；p=0.261）。ARMS 与 PDC 之间的负相关关系无统计学意义（Kendall's tau-b，r=-0.126，p=0.078；Spearman's rho=-0.173，p<0.073）。报告（1）未服用 ULT、（2）服用 ULT 且依从、（3）服用 ULT 但不依从的三组参与者的 ARMS 评分中位数（IQR）分别为 16（14-20）、13（12-15）和 17.5（15-21），差异有统计学意义（p<0.001）。年龄是与最佳依从性（ARMS 评分=12）唯一相关的患者因素（OR，1.91；95%CI，1.50-2.43；p<0.001）。ARMS 是一种可靠且有效的痛风患者药物依从性行为测量工具，支持其在痛风药物依从性研究中的应用。
