测试方法与实践证据在较小效应的现实世界之间的关系:可概括性和研究建议
Michael Barkham1, David Saxon1, Gillian E Hardy1
1School of Psychology, University of Sheffield, Sheffield, UK.
概括
研究了临床试验结果对常规实践的概括性. 结果显示治疗师效应和治疗偏好 (认知行为疗法与以人为中心的体验疗法) 随着更广泛的患者和治疗师包容而变化.
科学领域:
- 心理学
- 临床心理学
- 医疗服务研究
背景情况:
- 临床试验中的基于证据的实践 (EBP) 可能不适用于常规实践 (基于实践的证据).
- 治疗师效应和差异化治疗效应是影响概括性的关键因素.
- 嵌入常规护理中的实用试验为研究这一差距提供了独特的机会.
研究的目的:
- 评估从实用试验到常规临床实践中发现的概括性.
- 研究治疗效应和治疗结果的差异如何随着患者和治疗师的包容性增加而变化.
- 为提高试验报告的透明度和通用性提供建议.
主要方法:
- 使用实用试验数据比较认知行为疗法 (CBT) 和以人为中心的体验疗法 (PCET).
- 综合试验数据与整个临床组织的常规结果数据.
- 构建了四个数据集,包括越来越广泛的纳入标准,并应用多层次建模.
主要成果:
- 最初不显著的治疗效应随着常规数据集的增加而变得显著.
- 在试验数据中支持PCET的治疗效应在6个月后转向支持CBT的常规数据集.
- 较短的治疗 (6-8次) 支持PCET,而较长的治疗则支持所有数据集的CBT.
结论:
- 将试验嵌入常规实践中,使用一致的结果措施,可以直接评估可通用性.
- 试验报告的透明度对于确保试验结果适用于现实环境至关重要.
- 研究结果强调了在解释试验结果时考虑治疗师和患者的包容性的重要性.
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