Paap Davy, Karel Yasmaine H J M, Verhagen Arianne P, Dijkstra Pieter U, Geertzen Jan H B, Pool Grieteke
Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
Front Psychol. 2022 Jul 15;13:945294. doi: 10.3389/fpsyg.2022.945294. eCollection 2022.
Measurement properties of the Working Alliance Inventory (WAI) and its various translations and adaptations for specific target groups have been investigated for over 30 years. No systematic review analyzing studies on measurement properties of the WAI has been conducted to date. COnsensus-based Standards for the selection of health Measurements INstruments (COSMIN) were developed for conducting high-quality systematic reviews on measurement properties in a transparent and standardized way. Aim of this study was to systematically review studies on measurement properties of the WAI, and its adapted versions, within psychotherapy, and other healthcare contexts using COSMIN criteria. PsycINFO, Medline, and EMBASE were searched (1989-2021). In all phases of the review procedure, study selection, data extraction, risk of bias assessment, rating of the quality of measurement properties, and rating of the quality of evidence for measurement properties, disagreement between reviewers was resolved by discussion. Results on validity, internal structure, reliability, construct validity, and responsiveness were analyzed. In total 66 studies were included. In most studies, evidence for measurement properties was according to COSMIN criteria, insufficient, lacking, or conflicting. Content validity was rated insufficient because neither patients nor healthcare professionals were involved in the development and validation process. Hence evidence for content validity of the WAI is unknown. Conflicting evidence was found for structural validity. Evidence for internal consistency could not be established. Limited evidence was found for inter-rater reliability and convergent validity. Conflicting evidence was also found for test-retest reliability and divergent validity. COSMIN criteria exposed persistent problems in validation studies of the WAI. These findings may indicate that measurement properties of the WAI are not up to current standards, or that COSMIN criteria may be less appropriate for assessing measurement properties of the WAI, or it could indicate both. The results of this systematic review suggest that WAI outcomes should be interpreted with caution and further research is needed regarding the content validity and hypotheses development. For the future, the theoretical framework underlying the measurement of the working alliance needs to be studied in psychotherapy and other health contexts, and tested in methodologically sound studies.
https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42019051428.
工作联盟量表（WAI）及其针对特定目标群体的各种翻译和改编版本的测量属性已被研究了30多年。迄今为止，尚未对WAI测量属性的研究进行系统评价。基于共识的健康测量工具选择标准（COSMIN）旨在以透明和标准化的方式对测量属性进行高质量的系统评价。本研究的目的是使用COSMIN标准，系统评价心理治疗及其他医疗环境中WAI及其改编版本测量属性的研究。检索了PsycINFO、Medline和EMBASE（1989 - 2021年）。在综述程序的所有阶段，即研究选择、数据提取、偏倚风险评估、测量属性质量评级以及测量属性证据质量评级中，评审员之间的分歧通过讨论解决。分析了效度、内部结构、信度、结构效度和反应度的结果。总共纳入了66项研究。在大多数研究中，根据COSMIN标准，测量属性的证据不足、缺乏或相互矛盾。内容效度被评为不足，因为患者和医疗专业人员均未参与开发和验证过程。因此，WAI内容效度的证据未知。在结构效度方面发现了相互矛盾的证据。无法确定内部一致性的证据。在评分者间信度和收敛效度方面发现的证据有限。在重测信度和区分效度方面也发现了相互矛盾的证据。COSMIN标准揭示了WAI验证研究中存在的持续性问题。这些发现可能表明WAI的测量属性未达到当前标准，或者COSMIN标准可能不太适合评估WAI的测量属性，或者两者皆有。本系统评价的结果表明，应谨慎解释WAI的结果，并且需要进一步研究其内容效度和假设发展。未来，需要在心理治疗和其他健康环境中研究工作联盟测量的理论框架，并在方法学合理的研究中进行检验。
