van Os Jim, Delespaul Philippe, Barge Daniela, Bakker Roberto P
Department of Psychiatry and Psychology, Maastricht University Medical Centre, South Limburg Mental Health and Teaching Network, Maastricht, The Netherlands; King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, United Kingdom.
Department of Psychiatry and Psychology, Maastricht University Medical Centre, South Limburg Mental Health and Teaching Network, Maastricht, The Netherlands.
PLoS One. 2014 Dec 16;9(12):e115254. doi: 10.1371/journal.pone.0115254. eCollection 2014.
Routine Outcome Monitoring (ROM) is used as a means to enrich the process of treatment with feedback on patient outcomes, facilitating patient involvement and shared decision making. While traditional ROM measures focus on retrospective accounts of symptoms, novel mHealth technology makes it possible to collect real life, in-the-moment ambulatory data that allow for an ecologically valid assessment of personalized and contextualized emotional and behavioural adjustment in the flow daily life (mROM).
In a sample of 34 patients with major depressive disorder, treated with antidepressants, the combined effect of treatment and natural course was examined over a period of 18 weeks with Ecological Momentary Assessment (EMA). EMA consisted of repeated, within-subject, mini-measurements of experience (eg positive affect, negative affect, medication side effects) and context (eg stressors, situations, activities) at 10 unselected semi-random moments per day, for a period of six days, repeated three times over the 18-week period (baseline, week 6 and week 18).
EMA measures of emotional and behavioural adjustment were sensitive to the effects of treatment and natural course over the 18-week period, particularly EMA measures focussing on positive mood states and the ability to use natural rewards (impact of positive events on positive mood states), with standardized effect sizes of 0.4-0.5. EMA measures of activities, social interaction, stress-sensitivity and negative mood states were also sensitive to change over time.
This study supports the use of mROM as a means to involve the patient in the process of needs assessment and treatment. EMA data are meaningful to the patient, as they reflect daily life circumstances. Assessment of treatment response with mROM data allows for an interpretation of the effect of treatment at the level of daily life emotional and social adjustment--as an index of health, obviating the need for an exclusive focus on traditional measures of 'sickness'.
常规结果监测（ROM）被用作一种手段，通过提供有关患者结果的反馈来丰富治疗过程，促进患者参与和共同决策。虽然传统的ROM措施侧重于对症状的回顾性描述，但新型移动健康技术使得收集现实生活中即时的动态数据成为可能，从而能够对日常生活流程中个性化和情境化的情绪及行为调整进行生态效度评估（mROM）。
在34名接受抗抑郁药物治疗的重度抑郁症患者样本中，采用生态瞬时评估（EMA）在18周的时间内检查治疗和自然病程的综合效果。EMA包括在每天10个未选定的半随机时刻对体验（如积极情绪、消极情绪、药物副作用）和情境（如压力源、情况、活动）进行重复的、受试者内的微型测量，为期6天，在18周期间重复3次（基线、第6周和第18周）。
情绪和行为调整的EMA测量在18周期间对治疗和自然病程的影响敏感，特别是侧重于积极情绪状态以及利用自然奖励的能力（积极事件对积极情绪状态的影响）的EMA测量，标准化效应大小为0.4 - 0.5。活动、社交互动、压力敏感性和消极情绪状态的EMA测量也对随时间的变化敏感。
本研究支持使用mROM作为让患者参与需求评估和治疗过程的一种手段。EMA数据对患者有意义，因为它们反映了日常生活情况。用mROM数据评估治疗反应能够在日常生活情绪和社会调整层面解释治疗效果——作为健康指标，从而无需只专注于传统的“疾病”测量。
