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S.E. Loudon, L. Chaker, S. de Vos, M. Fronius, C.W. N. Looman, B. Simonsz, R.A. Harrad, M. Awan, H.J. Simonsz; Electronic Recording of Patching for Amblyopia Group (ERPAG): Reasons and a Remedy for Non–Compliance? . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4312.
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To investigate predictors as well as a remedy for non–compliance with occlusion therapy for amblyopia.
In an RCT, compliance was measured with the Occlusion Dose Monitor (ODM) in all newly diagnosed amblyopic children in The Hague,1 week every 3 months. Additional children were recruited in Frankfurt and Leicester. All children received standard orthoptic care. They were randomized to receive a compliance–enhancing program (cartoon story, calendar with stickers and an information sheet for the parents) or a picture to color (control group). The compliance–enhancing program or picture to color and ODM were distributed via home–visits by the researchers. To identify predictors for non–compliance we assessed the socio–economic and ethnic factors of the family and the clinical factors of the child at the start of the study. Multivariate analysis was used. After 6 months reasons for failure or success of treatment were assessed using the Patching Success Questionnaire (PSQ). After completion of the study, the parents of the children who patched less than 20% of the prescribed occlusion time were interviewed. This semi–structured interview was based on differences in the PSQ between the compliant group and the group who patched less than 20%.
In the RCT, 310 children (74%) were eligible for analysis; mean age was 4.6 years (SD 2.0) and 56% were boys. Compliance was significantly better in the intervention group (78% versus 57%; P<0.001); this difference remained throughout the treatment period. Compliance was significantly influenced by the initial visual acuity of the child (P=0.031) and the country of origin of the family (P=0.035). However, the correlation between country of origin and fluency in the national language was too strong to be able to separate the effects of either variable. The concept that lack of good communication was responsible for compliance being less than 20%, was confirmed in the interviews: in this group there was an apparent lack of parental knowledge. 44 children patched less than 20%. Of these, 28 (5 intervention group; 23 control group) parents were interviewed.
The compliance–enhancing program that consisted of education aimed primarily at the child, improved compliance and reduced the number of children who did not occlude at all.
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