Fontana A F, Dowds B N
J Nerv Ment Dis. 1975 Oct;161(4):221-30. doi: 10.1097/00005053-197510000-00001.
In recent years, the re-examination of treatment outcome has substantially advanced the sophistication with which the issues involved have been conceptualized. This study is directed toward the empirical elaboration of four of these issues as they relate to adjustment in the community. They may be stated briefly as the extent to which a) a common outcome pattern exists across different dimensions of adjustment; b) the vantage point of the observer influences adjustment ratings; c) judgments of overall improvement encompass the major dimensions of adjustment; and d) judgments of overall improvement represent changes in adjustment levels. With regard to the first issue, the data indicate that each major dimension of adjustment has a somewhat different pattern over time. Secondly, a substantial consensus exists between patients and their significant others concerning patients' adjustment relative to the adjustment of other patients as described by them and their significant others, although not in terms of the actual magnitude of their adjustment. Third, global improvement ratings are related to two dimensions of adjustment primarily (symptomatology and social involvement), and they are virtually unrelated to other major dimensions. Finally, global improvement ratings are highly reflective of the current level of adjustment. The relevance of these findings to outcome assessment is discussed and some suggestions are offered.
近年来，对治疗结果的重新审视极大地提升了对相关问题概念化的复杂程度。本研究旨在对其中四个与社区适应相关的问题进行实证阐述。它们可简要表述为：a）在不同适应维度上是否存在共同的结果模式；b）观察者的视角如何影响适应评分；c）整体改善的判断是否涵盖适应的主要维度；d）整体改善的判断是否代表适应水平的变化。关于第一个问题，数据表明每个主要适应维度随时间的模式略有不同。其次，患者与其重要他人之间在患者相对于其他患者的适应情况（如他们自己及重要他人所描述的）上存在相当程度的共识，尽管在实际适应程度方面并非如此。第三，整体改善评分主要与两个适应维度相关（症状学和社会参与），与其他主要维度几乎无关。最后，整体改善评分高度反映了当前的适应水平。讨论了这些发现与结果评估的相关性并提出了一些建议。
