Dataset Information

Approaches to denote treatment outcome: Clinical significance and clinical global impression compared.

ABSTRACT:

Objectives

The authors of a previous study proposed a statistically based approach to denote treatment outcome, translating pretest and posttest scores into clinically relevant categories, such as recovery and reliable improvement. We assessed the convergent validity of the Jacobson-Truax (JT) approach, using T-score based cutoff values, with ratings by an independent evaluator.

Methods

Pretest and retest scores on the Brief Symptom Inventory (BSI) and clinical global impression improvement (CGI-I) ratings were collected repeatedly through routine outcome monitoring from 5,900 outpatients with common mental disorders. Data were collected in everyday practice in a large mental health care provider.

Results

Continuous pretest-to-retest BSI change scores had a stronger association with CGI-I than the categorical variable based on JT. However, JT categorization and improvement according to CGI converged substantially with association indices (Somers' D) ranging from D = .50 to .56. Discordance was predominantly due to a more positive outcome according to JT than on CGI-I ratings.

Conclusion

Converting continuous outcome variables into clinically meaningful categories comes at the price of somewhat diminished concurrent validity with CGI-I. Nevertheless, support was found for the proposed threshold values for reliable change and recovery, and the outcome denoted in these terms corresponded with CGI improvement for most patients.

SUBMITTER: de Beurs E

PROVIDER: S-EPMC7649961 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Publications

Approaches to denote treatment outcome: Clinical significance and clinical global impression compared.

de Beurs Edwin E Carlier Ingrid V E IVE van Hemert Albert M AM

International journal of methods in psychiatric research 20191009 4

<h4>Objectives</h4>The authors of a previous study proposed a statistically based approach to denote treatment outcome, translating pretest and posttest scores into clinically relevant categories, such as recovery and reliable improvement. We assessed the convergent validity of the Jacobson-Truax (JT) approach, using T-score based cutoff values, with ratings by an independent evaluator.<h4>Methods</h4>Pretest and retest scores on the Brief Symptom Inventory (BSI) and clinical global impression i ...[more]

PMID: 31597212

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Project description:Background and aimsOctogenarians are underrepresented in recently published studies that showed the benefit of endovascular stroke treatment (EST) for patients with acute basilar artery occlusion (BAO). We aimed to compare the clinical outcome of octogenarians with BAO and EST compared to younger patients (YPs) and identify independent outcome predictors.MethodsThis is a retrospective, single-center analysis of patients treated for BAO with EST from January 2013 until June 2021 in a tertiary stroke center. Octogenarians (80-89 years) were compared to YPs. A study endpoint was a favorable clinical outcome as per the modified Rankin Scale (mRS 0-3), 90 days after stroke onset. The study groups were compared using univariate analysis, and a multivariable logistic regression analysis was performed to define independent predictors for favorable and unfavorable (mRS 5-6) clinical outcomes.ResultsIn this study cohort, 74/191 (38.7%) octogenarians had a higher pre-stroke mRS [median, interquartile range (IQR): 2, 1-3 octogenarians vs. 0, 0-1 YP, p < 0.001] and a comparable National Institutes of Health Stroke Scale (NIHSS) before EST (median, IQR: 21, 10-38 vs. 20, 8-35 in YP, p = 0.487). They showed a comparable rate of favorable outcome (mRS 0-3, 90 days, 23.0 vs. 25.6% in YP, p = 0.725), but were less often functionally independent (mRS 0-2: 10.8% in octogenarians vs. 23.0% in YP, p = 0.049). The rate of unfavorable clinical outcome was comparable (mRS 5-6, n = 40, 54.1% in octogenarians vs. n = 64, 54.7% in YP, p = 0.831). A baseline NIHSS was an independent predictor for clinical outcome in YPs [e.g., for unfavorable clinical outcome: odds ratio (OR) 1.061, confidence interval (CI) 1.027-1.098, p = 0.005] and for favorable clinical outcome in octogenarians. Pre-stroke mRS predicted favorable outcomes in octogenarians (OR 0.54, CI 0.30-0.90, p = 0.0291), while age predicted unfavorable outcomes in YPs (OR 1.045, CI 1.011-1.086, p = 0.0137).ConclusionOctogenarians with acute BAO eligible for EST are as likely to achieve a favorable outcome as YPs, and the rate of death or severe disability is comparable. The admission NIHSS is an independent predictor for favorable and unfavorable outcomes in YP and for favorable outcomes in octogenarians. In this study cohort, pre-stroke mRS predicted favorable outcomes in octogenarians while age predicted an unfavorable outcome in YPs.

Dataset Information

Approaches to denote treatment outcome: Clinical significance and clinical global impression compared.

Objectives

Methods

Results

Conclusion

Publications

Approaches to denote treatment outcome: Clinical significance and clinical global impression compared.

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