Use of outcome measurements in clinical practice: How specific should one be?

Abstract

In individual treatment of depression, generic and disorder-specific instruments are not interchangeable. The additional use of disorder-specific instruments provides a more complete picture of the patient's progress than the use of a generic instrument alone. Clinical or methodological significance of this article: In outcome management often rather generic instruments are used, that do not address the specific symptoms of the primary diagnosis of patients. In daily practice clinicians do not always use the feedback on treatment progress, when they perceive the feedback as not specific or relevant enough. The current study aims to explore the relative usefulness of measures that focus on symptoms that characterize the primary diagnosis of patients with a depression compared to the generic measures. We used a large cohort of existing data of patients of several mental health care organizations that share an application for outcome measurement. First, we compared outcomes of generic instruments and a disorder-specific instrument of a subsample of patients with a depressive disorder that completed both kinds of instruments. Next, we applied a matched case control design to control for differences between patients and analyzed whether the additional use of disorder-specific instruments predicted better outcomes. With this methodology, we tried to optimize both the methodological quality as well as the clinical significance of our research.

Extending the use of routine outcome monitoring: Predicting long-term outcomes in cognitive behavioral therapy for severe health anxiety

“…It is also possible that statistical power may have been lacking in this sample, given that there were trends towards greater improvements amongst sudden gainers on all outcomes and the original RCT sample-size was not powered for this purpose. Taken together, the current results suggest that sudden gains on the ORS may indicate improvements in some domains, but, as previously identified, supplementing the ORS with disorder-specific assessment is likely to help understand changes of particular interest (Nugter et al, 2017).…”

“…Nonetheless, current evidence suggests that disorder-specific feedback can enhance outcomes (Clark et al, 2018;Nugter et al, 2017). Therefore, given the similar predictive validity and the established benefit of disorder-specific feedback, this paper supports the use of both general and specific ROM.…”

Comparing disability between traumatic brain injury and spinal cord injury using the 12-item WHODAS 2.0 and the WHO minimal generic data set covering functioning and health

“…Even if separate health-condition-specific instruments may be useful in the follow-up of one patient or one group of patients, 9,10 they do not enable comparing patients with different diagnoses behind their disabilities. To unify the assessment of functioning around the world, and to enable comparisons between different diseases, the World Health Organization (WHO) has developed and validated International Classification of Functioning, Disability and Health (ICF)-based 11 generic assessment tools for these purposes.…”

Measures of clinically significant change.

“…For these reasons, the JT method has been the most commonly used method for most populations of therapy research over the past 30 years. 2 Some publications have also focused on the application of clinical significance in practice (e.g., Nugter et al, 2019;Speer, 1992). For example, Westbrook and Kirk (2005) and later Kelly (2010) both provide examples of using the JT method in routine clinical practice.…”

“…Tangentially, although the methods of calculation tend to produce roughly similar results, different outcome measures may produce large differences (e.g., Ronk et al, 2012). In particular, Nugter et al (2019) found differences in rates of clinical significance when comparing general symptom measures versus disorder specific measures and noted that disorder specific measures provided a more complete picture of change. In addition, Ogles et al (2001) found the JT method to be most common in the outcome literature, although the JT method is not applied uniformly across studies.…”