How consistent are clinical significance classifications when calculation methods and outcome measures differ?

Ronk, Fiona R.; Hooke, Geoffrey R.; Page, Andrew C.

doi:10.1111/j.1468-2850.2012.01281.x

Cited by 19 publications

(25 citation statements)

References 29 publications

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“…As Ronk et al (2012) have argued, categorizations of clients following treatment can differ greatly across outcome measures, and therefore clinicians need to make explicit reference to the psychological construct that a measurement instrument purports to measure. That is, if a person is recovered in terms of anxiety, this does not mean they are recovered in an absolute sense.…”

Section: Discussionmentioning

confidence: 99%

“…The DASS-21 is a 21-item self-report scale that purports to measure levels of depression, stress, and anxiety in the population. Each seven-item scale has ' Other studies that have extracted data from a similar time period include Byrne, Hooke, and Page (2010); Newnham et al (2007); and Ronk et al (2012). four response options ranging from 0 (did not apply to me at all) to 3 (applied to me much, or most of the time). A maximum score of 42 (i.e., each scale is multiplied by 2 to make scores comparable to the DASS-42) on each scale indicates elevated depression, anxiety, or stress.…”

Section: Methodsmentioning

confidence: 99%

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Assessing clinical significance of treatment outcomes using the DASS-21.

Ronk

Korman

Hooke³

et al. 2013

Psychological Assessment

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Standard clinical significance classifications are based on movement between the "dysfunctional" and "functional" distributions; however, this dichotomy ignores heterogeneity within the "dysfunctional" population. Based on the methodology described by Tingey, Lambert, Burlingame, and Hansen (1996), the present study sought to present a 3-distribution clinical significance model for the 21-item version of the Depression Anxiety Stress Scales (DASS-21; P. F. Lovibond & Lovibond, 1995) using data from a normative sample (n = 2,914), an outpatient sample (n = 1,000), and an inpatient sample (n = 3,964). DASS-21 scores were collected at pre- and post-treatment for both clinical samples, and patients were classified into 1 of 5 categories based on whether they had made a reliable change and whether they had moved into a different functional range. Evidence supported the validity of the 3-distribution model for the DASS-21, since inpatients who were classified as making a clinically significant change showed lower symptom severity, higher perceived quality of life, and higher clinician-rated functioning than those who did not make a clinically significant change. Importantly, results suggest that the new category of recovering is an intermediate point between recovered and making no clinically significant change. Inpatients and outpatients have different treatment goals and therefore use of the concept of clinical significance needs to acknowledge differences in what constitutes a meaningful change.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Assessing clinical significance of treatment outcomes using the DASS-21.

Ronk

Korman

Hooke³

et al. 2013

Psychological Assessment

Self Cite

120

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show abstract

“…Ronk, Hooke and Page (2012) concluded that four of the five methods they compared (one of them was the original JT method) yielded similar outcome classifications with a mean agreement of 93.7%. Thus, there is general consensus regarding the appropriateness of the original JT method (Atkins et al, 2005;Ogles, Lunnen, & Bonesteel, 2001;Wise, 2004).…”

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confidence: 92%

Comparing Methods to Denote Treatment Outcome in Clinical Research and Benchmarking Mental Health Care

Beurs

Barendregt

Heer

et al. 2015

Clin Psychology and Psychoth

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When comparing various indicators or treatment outcome, statistical considerations designate continuous outcomes, such as the effect size of the pre-post change (effect size or ΔT) as the optimal choice. Expressing outcome in proportions of recovered, changed, unchanged or deteriorated patients has supplementary value, as it is more easily interpreted and appreciated by clinicians, managerial staff and, last but not the least, by patients. If categorical outcomes are used with small datasets, true differences in institutional performance may get obscured due to diminished power to detect differences. With sufficient data, outcome according to continuous and categorical indicators converge and lead to similar rankings of institutes' performance.

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“…The following information was extracted from the articles: 1) primary outcome variable; 2) type of intervention; 3) result of the statistical significance of the pre-post change (either raw or relative to a control group); 4) use or nonuse of the RCI statistic; 5) use or nonuse of a cutoff for moving closer to the functional population; 6) if a cutoff was adopted, which cutoff was applied; 7) method of summarizing the individual level statistics; and 8) inclusion/non-inclusion of an effect size if a summary statistic was utilized. Although Ronk, Hooke and Page (2012) highlight the importance of the selection of an appropriate outcome measure when conducting clinical significance analyses, given the wide variety of treatment outcomes and treatment outcome measures, we limited our investigation to only the primary outcome measure in each study.…”

Section: Literature Review 1: Jt Methodsmentioning

confidence: 99%

Group Level Clinical Significance: An Analysis of Current Practice

et al. 2014

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Measures of clinical significance offer important information about psychological interventions that cannot be garnered from tests of the statistical significance of the change from pretest to posttest. For example, post-intervention comparisons to a nonclinical group often offer valuable information about the practical value of the change that occurred. This study explored the manner in which researchers conduct clinical significance analyses in an effort to summarize the effectiveness of an intervention at the group level. The focus was on the use of the original Jacobson and Truax (Journal of Consulting and Clinical Psychology, 59, 12-19, 1991) method and the normative comparisons method due to Kendall et al. (Journal of Consulting and Clinical Psychology, 67, 285-299, 1999). The results highlight that although the Jacobson and Truax method is routinely adopted for summarizing group-level clinical significance, advanced strategies for summarizing the results are very infrequently applied. Further, the Kendall et al. method, which provides valuable and distinct information regarding how the treated group is performing relative to a normal comparison group, is rarely adopted and even when it is it is often not conducted appropriately. Recommendations are provided for conducting group-level clinical significance analyses.The past few decades have seen an upward trend in the importance placed on understanding the practical value of an intervention, leading to significant improvements in the appreciation of the relative benefit of different forms of intervention. The practical value of an intervention, namely its ability to reduce the symptoms being Curr Psychol

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How consistent are clinical significance classifications when calculation methods and outcome measures differ?

Cited by 19 publications

References 29 publications

Assessing clinical significance of treatment outcomes using the DASS-21.

Assessing clinical significance of treatment outcomes using the DASS-21.

Comparing Methods to Denote Treatment Outcome in Clinical Research and Benchmarking Mental Health Care

Group Level Clinical Significance: An Analysis of Current Practice

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