a Department of Research and Monitoring , GGZ Noord-Holland-Noord , Heiloo , Netherlands.
b GGZ Ingeest and Department of Psychiatry , Amsterdam Public Health Research Institute, VU University Medical Center , Amsterdam , Netherlands.
Psychother Res. 2019 May;29(4):432-444. doi: 10.1080/10503307.2017.1408975. Epub 2017 Dec 3.
Progress feedback is often measured with generic instruments that measure common symptoms and generic aspects of functioning. The current study aims to explore the relative usefulness of disorder-specific measures. We hypothesized that disorder-specific instruments reveal more improvement than generic instruments and that the addition of disorder-specific instruments results in better treatment outcomes.
We used a cohort of 3419 patients with a depression. As generic measures, we used the BSI or the symptoms distress subscale of the OQ-45. In 946 patients, a specific instrument, the IDS-SR, was added. We compared mean change scores and percentages of clinical significant change. In a matched case control design, we analyzed whether the additional use of the IDS-SR resulted in better treatment outcomes.
Mean change scores of both types of instruments were comparable. When comparing clinical significant change, agreement was moderate. We found better outcomes on the generic instruments when both a generic and a disorder-specific instrument were used.
In individual treatment of depression, generic and disorder-specific instruments are not interchangeable. The additional use of disorder-specific instruments provides a more complete picture of the patient's progress than the use of a generic instrument alone. Clinical or methodological significance of this article: In outcome management often rather generic instruments are used, that do not address the specific symptoms of the primary diagnosis of patients. In daily practice clinicians do not always use the feedback on treatment progress, when they perceive the feedback as not specific or relevant enough. The current study aims to explore the relative usefulness of measures that focus on symptoms that characterize the primary diagnosis of patients with a depression compared to the generic measures. We used a large cohort of existing data of patients of several mental health care organizations that share an application for outcome measurement. First, we compared outcomes of generic instruments and a disorder-specific instrument of a subsample of patients with a depressive disorder that completed both kinds of instruments. Next, we applied a matched case control design to control for differences between patients and analyzed whether the additional use of disorder-specific instruments predicted better outcomes. With this methodology, we tried to optimize both the methodological quality as well as the clinical significance of our research.
进展反馈通常使用通用工具进行衡量，这些工具可以测量常见症状和通用功能方面。本研究旨在探讨特定疾病工具的相对有用性。我们假设特定疾病工具比通用工具更能揭示改善情况，并且添加特定疾病工具会带来更好的治疗结果。
我们使用了一个包含 3419 名抑郁症患者的队列。作为通用工具，我们使用了 BSI 或 OQ-45 的症状困扰子量表。在 946 名患者中，添加了特定的工具，即 IDS-SR。我们比较了均值变化分数和临床显著变化的百分比。在匹配病例对照设计中，我们分析了额外使用 IDS-SR 是否会导致更好的治疗结果。
两种类型工具的均值变化分数相当。在比较临床显著变化时，一致性为中度。当同时使用通用和特定疾病工具时，我们发现通用工具的结果更好。
在抑郁症的个体治疗中，通用和特定疾病工具不能互换。额外使用特定疾病工具可以提供比单独使用通用工具更完整的患者进展情况。
在结果管理中，通常使用的是通用工具，这些工具不能解决患者主要诊断的特定症状。在日常实践中，当临床医生认为反馈不够具体或相关时，他们并不总是使用治疗进展的反馈。本研究旨在探讨与通用测量相比，专注于描述抑郁症患者主要诊断特征的工具的相对有用性。我们使用了来自多个精神卫生保健组织的现有患者数据的大型队列，这些组织共享一个用于结果测量的应用程序。首先，我们比较了通用工具和特定疾病工具在完成这两种工具的抑郁障碍患者子样本的结果。接下来，我们应用了匹配病例对照设计来控制患者之间的差异，并分析了额外使用特定疾病工具是否可以预测更好的结果。通过这种方法，我们试图优化研究的方法学质量和临床意义。
