scholarly journals Evaluating a person-centred chronic pain service using indices of reliable and clinically significant change

2015 ◽  
Vol 3 (1) ◽  
pp. 19 ◽  
Author(s):  
Katherine Macey ◽  
Simon Clarke ◽  
Nima Golijani-Moghaddam ◽  
Roshan Das Nair
Keyword(s):  
Chronic Pain ◽  
Outcome Data ◽  
Service Planning ◽  
Published Data ◽  
Traditional Group ◽  
Reliable Change ◽  
Clinically Significant Change ◽  
Individual Level ◽  
Significant Change ◽  
Clinically Significant

Background: Psychological interventions for chronic pain often require substantial individualisation, which can undermine links with the research evidence on which treatment is based. To ensure clients receive effective therapy, evaluation is needed. This paper demonstrates the use of individual level change indices, which may be more appropriate for assessing effectiveness of person-centred treatment than traditional group-level statistics.Aims: To evaluate the efficacy of a psychological chronic pain service at individual level and to recommend improvements for future service evaluation.Method: Indices of reliable and clinically significant change were used to assess outcomes on the HADS, CORE-10, and PSEQ.Results: 56 out of 83 clients had usable outcome data. On the most widely administered outcome measure, the CORE-10, n=15 met reliable change and n=22 met clinically significant change criteria. 18 showed no reliable change. Only one person deteriorated.Conclusions: The person-centred treatment provided by this service was effective and achieved outcomes similar to published data from a structured group programme. However, missing data reduces the reliability of these conclusions and led to reduced usefulness of the evaluation for service planning. Recommendations for future evaluation are made.

scholarly journals My Therapist is a Student? The Impact of Therapist Experience and Client Severity on Cognitive Behavioural Therapy Outcomes for People with Anxiety Disorders

2015 ◽  
Vol 44 (2) ◽  
pp. 193-202 ◽  
Author(s):  
Liam Mason ◽  
Nick Grey ◽  
David Veale
Keyword(s):  
Anxiety Disorders ◽  
Behavioural Therapy ◽  
Outcome Data ◽  
Symptom Improvement ◽  
Therapist Experience ◽  
Clinically Significant Change ◽  
Trainee Therapists ◽  
Significant Change ◽  
Clinically Significant ◽  
The Impact

Background: Allocation of trainee therapist cases is often performed based on intuition and clinical circumstances, with lack of empirical evidence on the role of severity of presenting problem. This has the potential to be anxiety-provoking for supervisors, trainees and service users themselves. Aims: To determine how therapist experience interacts with symptom severity in predicting client outcomes. Method: An intention-to-treat analysis of annual outcome data for primary and secondary care clients seen by a specialist anxiety disorders service. 196 clients were stratified into mild, moderate and baseline severe symptoms of anxiety (GAD-7) and depression (PHQ-9). We measured percentage change on these measures, as well as number of sessions and therapy dropout. We also examined rates of reliable and clinically significant change on disorder-specific measures. We hypothesized that qualified therapists would achieve better outcomes than trainees, particularly for severe presentations. Results: Overall, outcomes were comparable between trainee and qualified therapists on all measures, and trainees additionally utilized fewer therapy sessions. There was however an interaction between anxiety severity (GAD-7) and therapist group, such that severely anxious clients achieved greater symptom improvement with qualified as compared to trainee therapists. Further, for trainee but not qualified therapists, baseline anxiety was negatively associated with rate of reliable and clinically significant change on disorder-specific measures. Conclusions: These findings indicate generally favourable outcomes for trainee therapists delivering manualized treatments for anxiety disorders. They additionally suggest that trainee therapists may benefit from additional support when working with clients that present with severe anxiety.

scholarly journals Feasibility of a virtual reality program to treat children with fear of darkness with nonexpert therapists

2020 ◽  
Vol 7 (2) ◽  
Author(s):  
Mateu Servera ◽  
Belén Sáez ◽  
Joan Miquel Gelabert Mir
Keyword(s):  
Experimental Study ◽  
Virtual Reality ◽  
Experimental Studies ◽  
The Other ◽  
Reliable Change Index ◽  
Reliable Change ◽  
Clinically Significant Change ◽  
Significant Change ◽  
Clinically Significant

Fear of darkness is highly prevalent and stable in children and often ends up becoming a specific situational phobia. The aim of this study is to analyze the feasibility of adapting and applying it through a Virtual Reality (VR) tool by nonexpert therapists. A pre-experimental study was carried out with six participants between the ages of 8 and 12 years old using pre- and posttreatment scales for assessing the fear of darkness. Statistically significant differences with large effects were found in all posttreatment measures: EMO (Roshenthal’s r = 0.64), WCDAN (r = 0.52), and Global item of current fear of darkness (r = 0.59). Using the Reliable Change Index (RCI) as a measure of clinically significant change, four participants improved satisfactorily, one acceptably, and the other did not improve. The results support the feasibility of using an adapted VR program to treat fear of darkness without being an expert therapist. However, more detailed experimental studies need to be carried out in order to analyze its efficacy.

Assessing Clinically Significant Change: Application to the SCL-90–R

2000 ◽  
Vol 86 (1) ◽  
pp. 263-274 ◽  
Author(s):  
Norbert Schmitz ◽  
Norbert Hartkamp ◽  
Gabriele H. Franke
Keyword(s):  
Clinical Significance ◽  
Psychotherapy Research ◽  
Outcome Data ◽  
Outcome Study ◽  
Symptom Checklist ◽  
Reliable Change ◽  
Psychotherapeutic Process ◽  
Clinically Significant Change ◽  
Process And Outcome ◽  
Clinically Significant

A Symptom Checklist (SCL-90–R) is a potentially useful measure of psychological distress; it is frequently used in psychotherapy research and clinical practice. The purpose of this study was to illustrate the use of the SCL-90–R for determining statistically reliable change and clinical significance outlined by Jacobson and Truax in 1991. This paper describes the concepts of statistical and clinical significance of change. A proposal for obtaining and characterizing samples is made. Then a clinician's perspective is taken. Reliable change estimates and cut-off scores are chosen based on outcome data. Selected data from a single psychotherapeutic process and outcome study then were used to test the estimates of change and cut-off scores.

scholarly journals Measuring clinically significant outcomes – LDQ, CORE-10 and SSQ as dimension measures of addiction

2014 ◽  
Vol 38 (3) ◽  
pp. 112-115 ◽  
Author(s):  
Duncan Raistrick ◽  
Gillian Tober ◽  
Jenny Sweetman ◽  
Sally Unsworth ◽  
Helen Crosby ◽  
...  
Keyword(s):  
Mental Health Problems ◽  
Clinical Implications ◽  
Three Dimension ◽  
Reliable Change ◽  
Clinically Significant Change ◽  
Social Satisfaction ◽  
The Core ◽  
Two Measures ◽  
Significant Change ◽  
Clinically Significant

Aims and methodTo determine values for reliable change and clinically significant change for the Leeds Dependence Questionnaire (LDQ) and Social Satisfaction Questionnaire (SSQ). The performance of these two measures with the Clinical Outcomes in Routine Evaluation (CORE-10) as three dimension measures of addiction was then explored.ResultsThe reliable change statistic for both LDQ and SSQ was ≥4; the cut-offs for clinically significant change were LDQ 410 males, ≤5 females, and SSQ ≥16. There was no overlap of 95% CIs for means by gender between ‘well-functioning’ and pre- and post-treatment populations.Clinical implicationsThese data enable the measurement of clinically significant change using the LDQ and SSQ and add to the evidence for the performance of the LDQ, CORE-10 and SSQ as dimension measures of addiction. The CORE-10 and SSQ can be used as treatment outcome measures for mental health problems other than addiction.

Assessing Reliable and Clinically Significant Change on Health of the Nation Outcome Scales: Method for Displaying Longitudinal Data

2005 ◽  
Vol 39 (8) ◽  
pp. 719-724 ◽  
Author(s):  
Alberto Parabiaghi ◽  
Angelo Barbato ◽  
Barbara D'avanzo ◽  
Arcadio Erlicher ◽  
Antonio Lora
Keyword(s):  
Clinical Improvement ◽  
Normative Data ◽  
Community Mental Health Services ◽  
Routine Data ◽  
Clinically Significant Change ◽  
Real Change ◽  
Significant Change ◽  
Clinically Significant ◽  
Routine Data Collection

Objective: Many authors recommended that reliable and clinically significant change (RCSC) should be calculated when reporting results of interventions. To test the reliability of the Health of the Nation Outcome Scales (HoNOS) in identifying RCSC, we applied the Jacobson and Truax model to two HoNOS assessments in a large group of people evaluated in 10 community mental health services in Lombardy, Italy, in 2000. Method: The HoNOS was administered to 9817 patients; of these, 4759 (48%) were re-assessed. Reliable change (RC) was calculated using Cronbach's alpha ( α), as a parameter of the reliability of the measure. Clinical significance cut-offs were calculated using a classification of severity based on HoNOS items. Results: In the whole sample, the clinical improvement cut-off was 11 and the remission cut-off was 5. Considering the severe patients, the clinical improvement cut-off was 12. The RC index calculated on the whole group and on the subgroup of severe patients indicated that eight-point and seven-point changes, respectively, were needed to be confident that a real change had occurred. Longitudinal changes were depicted on two-dimensional graphs as examples of reporting RCSC on HoNOS total scores in a routine data collection: 91.6% of the whole sample (4361) was stable, 5.6% (269) improved and 1.8% (129) worsened. Conclusion: Our study proposes a methodological framework for computing RCSC normative data on a widely used outcome scale and for identifying different degrees of clinical change.

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