Flinn Lucinda, Braham Louise, das Nair Roshan
Trent Doctorate in Clinical Psychology, Division of Psychiatry and Applied Psychology, University of Nottingham, UK.
Nottinghamshire Healthcare NHS Trust, Nottingham, UK.
Br J Clin Psychol. 2015 Sep;54(3):266-90. doi: 10.1111/bjc.12073. Epub 2014 Dec 16.
This systematic literature review investigated the inter-rater and test-retest reliability of case formulations. We considered the reliability of case formulations across a range of theoretical modalities and the general quality of the primary research studies.
A systematic search of five electronic databases was conducted in addition to reference list trawling to find studies that assessed the reliability of case formulation. This yielded 18 studies for review. A methodological quality assessment tool was developed to assess the quality of studies, which informed interpretation of the findings.
Results indicated inter-rater reliability mainly ranging from slight (.1-.4) to substantial (.81-1.0). Some studies highlighted that training and increased experience led to higher levels of agreement. In general, psychodynamic formulations appeared to generate somewhat increased levels of reliability than cognitive or behavioural formulations; however, these studies also included methods that may have served to inflate reliability, for example, pooling the scores of judges. Only one study investigated the test-retest reliability of case formulations yielding support for the stability of formulations over a 3-month period.
Reliability of case formulations is varied across a range of theoretical modalities, but can be improved; however, further research is required to strengthen our conclusions.
Clinical implications: The findings from the review evidence some support for case formulation being congruent with the scientist-practitioner approach. The reliability of case formulation is likely to be improved through training and clinical experience. Limitations: The broad inclusion criteria may have introduced heterogeneity into the sample, which may have affected the results. Studies reviewed were limited to peer-reviewed journal articles written in the English language, which may represent a source of publication and selection bias.
本系统文献综述调查了病例构想的评分者间信度和重测信度。我们考虑了一系列理论模式下病例构想的信度以及主要研究的总体质量。
除了检索参考文献列表外，还对五个电子数据库进行了系统检索，以查找评估病例构想信度的研究。这产生了18项可供综述的研究。开发了一种方法学质量评估工具来评估研究质量，这为研究结果的解释提供了依据。
结果表明评分者间信度主要在轻微（0.1 - 0.4）到高度（0.81 - 1.0）之间。一些研究强调培训和经验增加会导致更高程度的一致性。总体而言，心理动力学构想似乎比认知或行为构想产生的信度水平略高；然而，这些研究也包括了可能会夸大信度的方法，例如合并评判者的分数。只有一项研究调查了病例构想的重测信度，结果支持构想在3个月内的稳定性。
病例构想的信度在一系列理论模式中各不相同，但可以得到改善；然而，需要进一步研究来强化我们的结论。
临床意义：综述结果为病例构想与科学家 - 从业者方法相一致提供了一些支持证据。病例构想的信度可能通过培训和临床经验得到提高。局限性：广泛的纳入标准可能使样本引入了异质性，这可能影响了结果。所综述的研究仅限于用英语撰写的同行评审期刊文章，这可能是发表和选择偏倚的一个来源。
