Medical compliance in juvenile rheumatoid arthritis. Problems and perspectives

The purpose of this paper is to examine problems in medication and exercise compliance for children with juvenile rheumatoid arthritis (JRA) and to examine the inter‐rater reliability of multiple respondent (parent, child, physician, physical therapist) compliance assessment. Data on compliance, medication‐taking, and exercise were obtained from 93 parents of children with JRA. Self‐reports of compliance were obtained from 41 of the children with JRA. The physician and physical therapist also rated extent of compliance. Results showed that both parents and children reported significantly greater compliance with medication‐taking than with exercise performance. Older children (mean age 13.5 and 13.7 years for medication and exercise respectively) were more likely to report that they were responsible for assuring that recommendations were followed as compared to younger children (mean age 7.5 and 7.0 years). By parent report, locus of responsibility was significantly related to medication and exercise compliance (x 2 = 17.6, P < 0.002). For medication compliance, inter‐rater agreement between child, parent, and physician was high (91% to 98%). For exercise compliance, inter‐rater agreement between child, parent, and physical therapist was lower (63% to 73%). These data reinforce the need for individualized education to accompany treatment recommendations as a means for improving compliance and the need to give special attention to the problem of making and complying with exercise recommendations in JRA. Ratings from multiple perspectives are a useful method for assessing the reliability of reported compliance.