Approaches to denote treatment outcome: Clinical significance and clinical global impression compared
Objectives The authors of a previous study proposed a statistically based approach to denote treatment outcome, translating pretest and posttest scores into clinically relevant categories, such as recovery and reliable improvement. We assessed the convergent validity of the Jacobson–Truax (JT) appro...
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Published in | International journal of methods in psychiatric research Vol. 28; no. 4; pp. e1797 - n/a |
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Main Authors | , , |
Format | Journal Article |
Language | English |
Published |
United States
John Wiley & Sons, Inc
01.12.2019
John Wiley and Sons Inc |
Subjects | |
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Abstract | Objectives
The authors of a previous study proposed a statistically based approach to denote treatment outcome, translating pretest and posttest scores into clinically relevant categories, such as recovery and reliable improvement. We assessed the convergent validity of the Jacobson–Truax (JT) approach, using T‐score based cutoff values, with ratings by an independent evaluator.
Methods
Pretest and retest scores on the Brief Symptom Inventory (BSI) and clinical global impression improvement (CGI‐I) ratings were collected repeatedly through routine outcome monitoring from 5,900 outpatients with common mental disorders. Data were collected in everyday practice in a large mental health care provider.
Results
Continuous pretest‐to‐retest BSI change scores had a stronger association with CGI‐I than the categorical variable based on JT. However, JT categorization and improvement according to CGI converged substantially with association indices (Somers' D) ranging from D = .50 to .56. Discordance was predominantly due to a more positive outcome according to JT than on CGI‐I ratings.
Conclusion
Converting continuous outcome variables into clinically meaningful categories comes at the price of somewhat diminished concurrent validity with CGI‐I. Nevertheless, support was found for the proposed threshold values for reliable change and recovery, and the outcome denoted in these terms corresponded with CGI improvement for most patients. |
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AbstractList | Objectives
The authors of a previous study proposed a statistically based approach to denote treatment outcome, translating pretest and posttest scores into clinically relevant categories, such as recovery and reliable improvement. We assessed the convergent validity of the Jacobson–Truax (JT) approach, using T‐score based cutoff values, with ratings by an independent evaluator.
Methods
Pretest and retest scores on the Brief Symptom Inventory (BSI) and clinical global impression improvement (CGI‐I) ratings were collected repeatedly through routine outcome monitoring from 5,900 outpatients with common mental disorders. Data were collected in everyday practice in a large mental health care provider.
Results
Continuous pretest‐to‐retest BSI change scores had a stronger association with CGI‐I than the categorical variable based on JT. However, JT categorization and improvement according to CGI converged substantially with association indices (Somers' D) ranging from D = .50 to .56. Discordance was predominantly due to a more positive outcome according to JT than on CGI‐I ratings.
Conclusion
Converting continuous outcome variables into clinically meaningful categories comes at the price of somewhat diminished concurrent validity with CGI‐I. Nevertheless, support was found for the proposed threshold values for reliable change and recovery, and the outcome denoted in these terms corresponded with CGI improvement for most patients. Abstract Objectives The authors of a previous study proposed a statistically based approach to denote treatment outcome, translating pretest and posttest scores into clinically relevant categories, such as recovery and reliable improvement. We assessed the convergent validity of the Jacobson–Truax (JT) approach, using T‐score based cutoff values, with ratings by an independent evaluator. Methods Pretest and retest scores on the Brief Symptom Inventory (BSI) and clinical global impression improvement (CGI‐I) ratings were collected repeatedly through routine outcome monitoring from 5,900 outpatients with common mental disorders. Data were collected in everyday practice in a large mental health care provider. Results Continuous pretest‐to‐retest BSI change scores had a stronger association with CGI‐I than the categorical variable based on JT. However, JT categorization and improvement according to CGI converged substantially with association indices (Somers' D ) ranging from D = .50 to .56. Discordance was predominantly due to a more positive outcome according to JT than on CGI‐I ratings. Conclusion Converting continuous outcome variables into clinically meaningful categories comes at the price of somewhat diminished concurrent validity with CGI‐I. Nevertheless, support was found for the proposed threshold values for reliable change and recovery, and the outcome denoted in these terms corresponded with CGI improvement for most patients. OBJECTIVESThe authors of a previous study proposed a statistically based approach to denote treatment outcome, translating pretest and posttest scores into clinically relevant categories, such as recovery and reliable improvement. We assessed the convergent validity of the Jacobson-Truax (JT) approach, using T-score based cutoff values, with ratings by an independent evaluator. METHODSPretest and retest scores on the Brief Symptom Inventory (BSI) and clinical global impression improvement (CGI-I) ratings were collected repeatedly through routine outcome monitoring from 5,900 outpatients with common mental disorders. Data were collected in everyday practice in a large mental health care provider. RESULTSContinuous pretest-to-retest BSI change scores had a stronger association with CGI-I than the categorical variable based on JT. However, JT categorization and improvement according to CGI converged substantially with association indices (Somers' D) ranging from D = .50 to .56. Discordance was predominantly due to a more positive outcome according to JT than on CGI-I ratings. CONCLUSIONConverting continuous outcome variables into clinically meaningful categories comes at the price of somewhat diminished concurrent validity with CGI-I. Nevertheless, support was found for the proposed threshold values for reliable change and recovery, and the outcome denoted in these terms corresponded with CGI improvement for most patients. The authors of a previous study proposed a statistically based approach to denote treatment outcome, translating pretest and posttest scores into clinically relevant categories, such as recovery and reliable improvement. We assessed the convergent validity of the Jacobson-Truax (JT) approach, using T-score based cutoff values, with ratings by an independent evaluator. Pretest and retest scores on the Brief Symptom Inventory (BSI) and clinical global impression improvement (CGI-I) ratings were collected repeatedly through routine outcome monitoring from 5,900 outpatients with common mental disorders. Data were collected in everyday practice in a large mental health care provider. Continuous pretest-to-retest BSI change scores had a stronger association with CGI-I than the categorical variable based on JT. However, JT categorization and improvement according to CGI converged substantially with association indices (Somers' D) ranging from D = .50 to .56. Discordance was predominantly due to a more positive outcome according to JT than on CGI-I ratings. Converting continuous outcome variables into clinically meaningful categories comes at the price of somewhat diminished concurrent validity with CGI-I. Nevertheless, support was found for the proposed threshold values for reliable change and recovery, and the outcome denoted in these terms corresponded with CGI improvement for most patients. |
Author | Hemert, Albert M. Carlier, Ingrid V.E. Beurs, Edwin |
AuthorAffiliation | 1 Section Clinical Psychology Leiden University Leiden The Netherlands 2 Department of Psychiatry Leiden University Medical Center Leiden The Netherlands |
AuthorAffiliation_xml | – name: 1 Section Clinical Psychology Leiden University Leiden The Netherlands – name: 2 Department of Psychiatry Leiden University Medical Center Leiden The Netherlands |
Author_xml | – sequence: 1 givenname: Edwin orcidid: 0000-0003-3832-8477 surname: Beurs fullname: Beurs, Edwin email: e.de.beurs@fsw.leidenuniv.nl organization: Leiden University – sequence: 2 givenname: Ingrid V.E. orcidid: 0000-0001-6237-1438 surname: Carlier fullname: Carlier, Ingrid V.E. organization: Leiden University Medical Center – sequence: 3 givenname: Albert M. surname: Hemert fullname: Hemert, Albert M. organization: Leiden University Medical Center |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/31597212$$D View this record in MEDLINE/PubMed |
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Keywords | clinical global impression Reliable Change Index clinical significance treatment outcome |
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The authors of a previous study proposed a statistically based approach to denote treatment outcome, translating pretest and posttest scores into... The authors of a previous study proposed a statistically based approach to denote treatment outcome, translating pretest and posttest scores into clinically... Abstract Objectives The authors of a previous study proposed a statistically based approach to denote treatment outcome, translating pretest and posttest... ObjectivesThe authors of a previous study proposed a statistically based approach to denote treatment outcome, translating pretest and posttest scores into... OBJECTIVESThe authors of a previous study proposed a statistically based approach to denote treatment outcome, translating pretest and posttest scores into... |
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SubjectTerms | Adult clinical global impression Clinical significance Discordance Female Humans Male Mental disorders Mental Disorders - diagnosis Mental Disorders - therapy Middle Aged Original Outcome Assessment, Health Care - standards Psychiatric Status Rating Scales - standards Psychometrics - standards Reliable Change Index treatment outcome |
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Title | Approaches to denote treatment outcome: Clinical significance and clinical global impression compared |
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