School of Lifespan Development and Educational Sciences, Kent State University, Kent, OH, USA.
Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, USA.
Aging Ment Health. 2022 Feb;26(2):250-262. doi: 10.1080/13607863.2020.1857688. Epub 2021 Jan 4.
It is increasingly recommended that hypothesis-generating studies be conducted after initial RCTs in order to identify moderators of differential treatment efficacy on individual outcomes. Such analyses are important because they help clarify the best inclusion and exclusion criteria or choice of stratification for maximizing power in subsequent RCTs, reduce the chances of discarding interventions that may appear to lack efficacy when only average treatment effects are taken into consideration, and facilitate the matching of individual clients to treatment alternatives. We identified predictors and moderators of treatment-related change in psychological distress among custodial grandmothers ( = 343) assigned within a prior RCT to behavior parent training (BPT), cognitive behavior therapy (CBT), or information only control (IOC) conditions. Latent change scores in psychological distress were estimated for each grandmother across pre-test to post-test and pre-test to six months, as indicated by self-reported and clinical ratings of depression and anxiety symptoms. These estimates served as outcomes in classification and regression tree analyses conducted separately within the CBT and BPT conditions to identify predictors of treatment efficacy. Matched groups based upon identified predictors were then formed across all RCT conditions, and Predictor × RCT Condition interactions were computed to test for moderation of differential treatment efficacy. Grandmother age was the only predictor and moderator of BPT efficacy at both measurement points, whereas multifaceted predictors and moderators emerged for CBT which varied by time since treatment.
越来越多的人建议，在初始 RCT 后进行产生假说的研究，以确定对个体结果的差异治疗效果的调节因素。此类分析很重要，因为它们有助于阐明最佳的纳入和排除标准，或选择最大程度提高后续 RCT 效力的分层，减少仅考虑平均治疗效果而丢弃可能缺乏疗效的干预措施的可能性，并促进将个体客户与治疗替代方案相匹配。我们确定了在先前的 RCT 中分配给行为家长培训 (BPT)、认知行为疗法 (CBT) 或仅信息对照 (IOC) 条件的监护祖母（n=343）心理困扰相关治疗变化的预测因素和调节因素。通过自我报告和抑郁和焦虑症状的临床评估，在每个祖母的预测试到后测试和预测试到六个月期间，估计心理困扰的潜在变化分数。这些估计值作为分类和回归树分析的结果，分别在 CBT 和 BPT 条件内进行，以确定治疗效果的预测因素。然后根据确定的预测因素在所有 RCT 条件下形成匹配组，并计算预测因素与 RCT 条件的相互作用，以检验差异治疗效果的调节作用。祖母年龄是 BPT 在两个测量点的唯一预测因素和调节因素，而多维预测因素和调节因素则因治疗后时间而异而出现于 CBT 中。
