Treatment outcome
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In Quality of Health Care, Treatment outcome is defined as "Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series."[1]
Statistical methods
Note that the standard error of measurement (SEM) is different than the standard error of the mean (SE):
- standard error of measurement (SEM) is "It is estimated by the standard deviation of the instrument multiplied by the square root of one minus its reliability coefficient"[2]. If they reliability coefficient is not know, 0.5 can be an approximation.
- standard error of the mean (SE) is standard deviation (SD) divided by the square root of the population size
Options for estimating the MCID:
- 0.5 change per item on Likert scales[3]
- The minimal clinically important differences (MCID) has been proposed as >0.5 standard deviation improvement.[4]
- Copay et al used various methods to determine the optimal MCID[5].
- Receiver-operating characteristic curve derived MCID: " The optimal cut-off value for a ROC curve corresponds to the point of optimal trade-off between sensitivity and specificity "
- Half a standard deviation: Template:Sfrac \times {SD}
- Standard error of measurement SD \times \sqrt{1 - r}, "where SD is the standard deviation of the baseline scores and r is the test-retest reliability coefficient"
- Minimum detectable change: 1.96 \times \sqrt{2} \times{SEM}
- Effect size derived MCID: "multiplying the SD of the baseline scores by 0.2 (the small effect size)"
- Copay et al used various methods to determine the optimal MCID[5].
- A 30% reduction in a score[6].
- A 50% reduction in a score[7].
- Responsiveness statistic of Guyatt is the mean change divided by the square root of 2 x mean square error[8][9]
- The "response mean (difference of mean scores at 2 assessment points divided by standard deviation of score changes)...to compute the 95% confidence intervals of the standardized response means"[9][10]
- One standard error of measurement (SEM) of Wyrich[2][10]
- Jacobson has suggested[11]:
- "The level of functioning subsequent to therapy should fall outside the range of the dysfunctional population, where range is defined as extending to two standard deviations beyond (in the direction of functionality) the mean for that population."
- "The level of functioning subsequent to therapy should fall within the range of the functional or normal population, where range is defined as within two standard deviations of the mean of that population."
- "The level of functioning subsequent to therapy places that client closer to the mean of the functional population than it does to the mean of the dysfunctional population."[12]
See also
- Attention-deficit hyperactivity disorder monitoring response to therapy
- Back pain monitoring response to therapy
- Statistics
External links
References
- ↑ Anonymous (2025), Treatment outcome (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ 2.0 2.1 Wyrwich KW, Tierney WM, Wolinsky FD (1999). "Further evidence supporting an SEM-based criterion for identifying meaningful intra-individual changes in health-related quality of life". J Clin Epidemiol. 52 (9): 861–73. doi:10.1016/s0895-4356(99)00071-2. PMID 10529027.
- ↑ Wyrwich KW, Nienaber NA, Tierney WM, Wolinsky FD (1999). "Linking clinical relevance and statistical significance in evaluating intra-individual changes in health-related quality of life". Med Care. 37 (5): 469–78. doi:10.1097/00005650-199905000-00006. PMID 10335749.
- ↑ Delitto A, Piva SR, Moore CG, Fritz JM, Wisniewski SR, Josbeno DA; et al. (2015). "Surgery versus nonsurgical treatment of lumbar spinal stenosis: a randomized trial". Ann Intern Med. 162 (7): 465–73. doi:10.7326/M14-1420. PMC 6252248. PMID 25844995. Review in: Evid Based Med. 2016 Feb;21(1):31
- ↑ Copay AG, Glassman SD, Subach BR, Berven S, Schuler TC, Carreon LY (2008). "Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales". Spine J. 8 (6): 968–74. doi:10.1016/j.spinee.2007.11.006. PMID 18201937.
- ↑ Ramsay JR (2017). "Assessment and monitoring of treatment response in adult ADHD patients: current perspectives". Neuropsychiatr Dis Treat. 13: 221–232. doi:10.2147/NDT.S104706. PMC 5291336. PMID 28184164.
- ↑ Gaynes BN, Rush AJ, Trivedi MH, Wisniewski SR, Balasubramani GK, McGrath PJ; et al. (2008). "Primary versus specialty care outcomes for depressed outpatients managed with measurement-based care: results from STAR*D". J Gen Intern Med. 23 (5): 551–60. doi:10.1007/s11606-008-0522-3. PMC 2324144. PMID 18247097.
- ↑ Guyatt GH, Townsend M, Berman LB, Keller JL (1987). "A comparison of Likert and visual analogue scales for measuring change in function". J Chronic Dis. 40 (12): 1129–33. doi:10.1016/0021-9681(87)90080-4. PMID 3680471.
- ↑ 9.0 9.1 Wright JG, Young NL (1997). "A comparison of different indices of responsiveness". J Clin Epidemiol. 50 (3): 239–46. doi:10.1016/s0895-4356(96)00373-3. PMID 9120522.
- ↑ 10.0 10.1 Löwe B, Unützer J, Callahan CM, Perkins AJ, Kroenke K (2004). "Monitoring depression treatment outcomes with the patient health questionnaire-9". Med Care. 42 (12): 1194–201. doi:10.1097/00005650-200412000-00006. PMID 15550799.
- ↑ Jacobson NS, Truax P (1991). "Clinical significance: a statistical approach to defining meaningful change in psychotherapy research". J Consult Clin Psychol. 59 (1): 12–9. doi:10.1037//0022-006x.59.1.12. PMID 2002127.
- ↑ McMillan D, Gilbody S, Richards D (2010). "Defining successful treatment outcome in depression using the PHQ-9: a comparison of methods". J Affect Disord. 127 (1–3): 122–9. doi:10.1016/j.jad.2010.04.030. PMID 20569992.