Evans Joanne, Tinch-Taylor Rose, Csipke Emese, Cella Matteo, Pickles Andrew, McCrone Paul, Stringer Dominic, Oliver Abigail, Reeder Clare, Birchwood Max, Fowler David, Greenwood Kathryn, Johnson Sonia, Perez Jesus, Ritunnano Rosa, Thompson Andrew, Upthegrove Rachel, Wilson Jon, Kenny Alex, Isok Iris, Joyce Eileen M, Wykes Til
Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
South London and Maudsley NHS Foundation Trust, London, UK.
Schizophrenia (Heidelb). 2023 Sep 30;9(1):67. doi: 10.1038/s41537-023-00390-9.
Cognitive Remediation (CR) improves cognition and functioning but is implemented in a variety of ways (independent, group and one-to-one). There is no information on whether service users find these implementation methods acceptable or if their satisfaction influences CR outcomes. We used mixed participatory methods, including focus groups, to co-develop a CR satisfaction scale. This was refined using three psychometric criteria (Cronbach's alpha, item discrimination, test-retest agreement) to select items. Factor analysis explored potential substructures. The refined measure was used in structural equation joint modelling to evaluate whether satisfaction with CR is affected by implementation method and treatment engagement or influences recovery outcome, using data from a randomised controlled trial. Four themes (therapy hours, therapist, treatment effects, computer use) generated a 31-item Cognitive Remediation Satisfaction scale (CRS) that reduced to 18 Likert items, 2 binary and 2 open-ended questions following psychometric assessment. CRS had good internal consistency (Alpha = 0.814), test-retest reliability (r= 0.763), and concurrent validity using the Working Alliance Inventory (r = 0.56). A 2-factor solution divided items into therapy engagement and therapy effects. Satisfaction was not related to implementation method but was significantly associated with CR engagement. Therapy hours were significantly associated with recovery, but there was no direct effect of satisfaction on outcome. Although satisfaction is important to therapy engagement, it has no direct effect on outcome. CR therapy hours directly affect outcome irrespective of which implementation model is used, so measuring satisfaction early might help to identify those who are likely to disengage. The study has mixed methods design.
认知修复（CR）可改善认知和功能，但实施方式多种多样（独立、小组和一对一）。目前尚无关于服务使用者是否认为这些实施方法可接受，或者他们的满意度是否会影响CR结果的信息。我们采用了包括焦点小组在内的混合参与式方法，共同开发了一种CR满意度量表。使用三个心理测量标准（克朗巴哈系数、项目区分度、重测一致性）对其进行优化以选择项目。因子分析探索了潜在的子结构。使用来自一项随机对照试验的数据，将优化后的测量方法用于结构方程联合建模，以评估对CR的满意度是否受实施方法和治疗参与度的影响，或者是否会影响康复结果。四个主题（治疗时长、治疗师、治疗效果、计算机使用）产生了一个包含31个条目的认知修复满意度量表（CRS），经过心理测量评估后，该量表简化为18个李克特条目、2个二元问题和2个开放式问题。CRS具有良好的内部一致性（α=0.814）、重测信度（r=0.763），以及与工作联盟量表的同时效度（r=0.56）。一个双因子解决方案将条目分为治疗参与度和治疗效果。满意度与实施方法无关，但与CR参与度显著相关。治疗时长与康复显著相关，但满意度对结果没有直接影响。尽管满意度对治疗参与度很重要，但它对结果没有直接影响。无论使用哪种实施模式，CR治疗时长都直接影响结果，因此早期测量满意度可能有助于识别那些可能退出治疗的人。该研究采用了混合方法设计。
