試験方法論と実務に基づく実用的なエビデンスの間の関係をマッピングする:一般化可能性と研究勧告
Michael Barkham1, David Saxon1, Gillian E Hardy1
1School of Psychology, University of Sheffield, Sheffield, UK.
まとめ
臨床試験の結果を日常の実践に一般化する可能性を検討した. 研究結果は,より広範な患者とセラピストの参加により,セラピストの効果と治療の好み (認知行動療法対人中心体験療法) が変化することを示しています.
科学分野:
- 心理学
- 臨床心理学
- 医療サービス研究
背景:
- 臨床試験から得られたエビデンスベースの実践 (EBP) は,日常的な実践 (実践に基づくエビデンス) に一般化できない場合がある.
- セラピスト効果と異なる治療効果は,一般化に影響を与える重要な要因です.
- ルーティンケアに組み込まれた 実用的な試験は このギャップを研究する ユニークな機会を提供します
研究 の 目的:
- 実用的な試験から日常的な臨床実践への発見の汎用性を評価する.
- 患者とセラピストの 包摂性の増大に伴って セラピスト効果と治療結果の違いが どのように変化するかを調査する.
- 試験報告の透明性と一般化性を高めるための勧告を提供すること.
主な方法:
- 認知行動療法 (CBT) と人中心体験療法 (PCET) を比較した実用的な試験のデータを活用した.
- 臨床組織全体からの通常の結果データと統合された試験データ
- 4つのデータセットを構成し,次第に包括基準を広め,多層モデルを適用した.
主要な成果:
- 当初は非有意なセラピスト効果は,通常のデータセットにおける包括性の増加とともに有意になった.
- PCETを好む治療効果は,6ヶ月後にCBTを好むように変化した.
- 短い治療 (6〜8回) はPCETを好み,長い治療はすべてのデータセットでCBTを好む.
結論:
- 一貫した結果測定を用いた試験を日常の実践に組み込むことで,一般化可能性の直接的な評価が可能になります.
- 臨床試験の報告の透明性は 臨床試験の結果が現実の世界に 適用されるようにするために不可欠です
- 臨床試験の結果を解釈する際には 患者とセラピストの 包摂性を考慮することの重要性を強調しています
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