Ash Green Specialist Learning Disability Service.
Clinical and Applied Psychology Unit.
J Consult Clin Psychol. 2022 May;90(5):427-445. doi: 10.1037/ccp0000736.
To provide a comprehensive assessment of the association between psychological treatment adherence/competence/integrity (ACI) and clinical outcomes.
The review protocol was preregistered (CRD42020193889). Studies that assessed ACI-outcome relationships for adult psychotherapy were searched across three databases (Scopus, PsycINFO, MEDLINE). Random effects meta-analyses were conducted on adherence-outcome, competence-outcome, and integrity-outcome relationships. Separate analyses were performed for studies with hierarchical (i.e., patients nested within therapist) versus nonhierarchical study designs. Moderator analyses were performed according to predefined clinical and methodological features. GRADE assessments rated the quality of each meta-analytic comparison.
The review identified 62 studies suitable for inclusion (45 adherence-outcome, 39 competence-outcome, and seven integrity-outcome effect sizes; N = 8,210 across all analyses). No significant adherence-outcome association was found. A small significant positive association was found only in nonhierarchical studies between competence and outcome, r = 0.17, 95% CI [0.07-0.26], p < .001, ∼d = .34, GRADE = moderate. Small-to-moderate significant positive associations between integrity and outcome were found for both nonhierarchical, r = 0.15, 95% CI [0.06-0.23], p < .001, ∼d = .30, GRADE = high, and hierarchical study designs, r = 0.23, 95% CI [0.01, 0.43], p < .044, ∼d = .47, GRADE = low. Diagnosis, treatment modality and year of publication significantly moderated the strength of ACI-outcome correlations.
Competence and integrity are significantly associated with clinical outcome, with a magnitude comparable to wider common factors. Further research is required to study these process-outcome associations with greater precision in routine-care settings and to understand the role of moderating variables. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
全面评估心理治疗依从性/能力/完整性（ACI）与临床结果之间的关系。
审查方案已预先注册（CRD42020193889）。在三个数据库（Scopus、PsycINFO、MEDLINE）中搜索评估成人心理治疗 ACI 结果关系的研究。对依从性结果、能力结果和完整性结果关系进行随机效应荟萃分析。对具有层次结构（即患者嵌套在治疗师内）和非层次结构研究设计的研究分别进行分析。根据预先确定的临床和方法学特征进行了调节分析。GRADE 评估对每项荟萃分析比较的质量进行了评级。
本综述确定了 62 项适合纳入的研究（45 项依从性结果、39 项能力结果和 7 项完整性结果效应量；所有分析中共有 8210 名患者）。未发现依从性结果存在显著相关性。仅在非层次结构研究中发现能力与结果之间存在较小但显著的正相关，r = 0.17，95% CI [0.07-0.26]，p <.001，d =.34，GRADE = 中等。在非层次结构研究中，发现完整性与结果之间存在较小到中等显著正相关，r = 0.15，95% CI [0.06-0.23]，p <.001，d =.30，GRADE = 高，在层次结构研究设计中，r = 0.23，95% CI [0.01，0.43]，p <.044，~d =.47，GRADE = 低。诊断、治疗方式和发表年份显著调节了 ACI 结果相关性的强度。
能力和完整性与临床结果显著相关，其程度与更广泛的共同因素相当。需要进一步的研究来更精确地研究这些过程-结果关联，并在常规护理环境中了解调节变量的作用。（APA，所有权利保留）。
