title: Adherence therapy improves medication adherence and quality of life in people with Parkinson's disease: a randomised controlled trial.
abstract: BACKGROUND
  Many factors are associated with medication non-adherence in Parkinson's disease (PD), including complex treatment regimens, mood disorders and impaired cognition. However, interventions to improve adherence which acknowledge such factors are lacking. A phase II randomised controlled trial was conducted investigating whether Adherence Therapy (AT) improves medication adherence and quality of life (QoL) compared with routine care (RC) in PD.
  
  
  METHODS
  Eligible PD patients and their spouse/carers were randomised to intervention (RC plus AT) or control (RC alone). Primary outcomes were change in adherence (Morisky Medication Adherence Scale) and QoL (Parkinson's Disease Questionnaire-39) from baseline to week-12 follow up. Secondary outcomes were MDS-UPDRS (part I, II, IV), Beliefs about Medication Questionnaire (BMQ), EuroQol (EQ-5D) and the Caregiving Distress Scale. Blinded data were analysed using logistic and linear regression models based on the intention-to-treat principle.
  
  
  RESULTS
  Seventy-six patients and 46 spouse/carers completed the study (intervention: n = 38 patients, n = 24 spouse/carers). At week-12 AT significantly improved adherence compared with RC (OR 8.2; 95% CI: 2.8, 24.3). Numbers needed to treat (NNT) were 2.2 (CI: 1.6, 3.9). Compared with RC, AT significantly improved PDQ-39 (-9.0 CI: -12.2, -5.8), BMQ general harm (-1.0 CI: -1.9, -0.2) and MDS-UPDRS part II (-4.8 CI: -8.1, -1.4). No significant interaction was observed between the presence of a spouse/carer and the effect of AT.
  
  
  CONCLUSIONS
  Adherence Therapy improved self-reported adherence and QoL in a PD sample. The small NNT suggests AT may be cost-effective. A larger pragmatic trial to test the efficacy and cost-effectiveness of AT by multiple therapists is required.
authors.affiliation: Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK; Norfolk & Norwich University Hospital NHS Foundation Trust, Norwich, UK.
authors.forename: D J
authors.initials: DJ
authors.lastname: Daley
authors.forename: K H O
authors.initials: KH
authors.lastname: Deane
authors.forename: R J
authors.initials: RJ
authors.lastname: Gray
authors.forename: A B
authors.initials: AB
authors.lastname: Clark
authors.forename: M
authors.initials: M
authors.lastname: Pfeil
authors.forename: K
authors.initials: K
authors.lastname: Sabanathan
authors.forename: P F
authors.initials: PF
authors.lastname: Worth
authors.forename: P K
authors.initials: PK
authors.lastname: Myint
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy* / Q000523:psychology; D011788:Quality of Life; D011795:Surveys and Questionnaires