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Assessing Change in Clinical Practice. Richard Bost, Ph.D., ABPP Frances Wen, Ph.D. Michael Basso, Ph.D. Oklahoma Psychological Association 11/6/04. Key issue…. How does one demonstrate statistically significant change in an individual patient?

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assessing change in clinical practice

Assessing Change in Clinical Practice

Richard Bost, Ph.D., ABPP

Frances Wen, Ph.D.

Michael Basso, Ph.D

Oklahoma Psychological Association 11/6/04

key issue
Key issue…

How does one demonstrate statistically significant change in an individual patient?

  • To document the clinical utility of an intervention
  • To document spontaneous recovery or deterioration
presenters
Presenters

Richard H. Bost, Ph.D., ABPP, BCIAC

  • Assoc Prof Behavioral Science at OSU-COM
  • Board certified in Rehabilitation Psychology (ABPP) and in Biofeedback (BCIAC)
  • Clinical experience in neurological impairment and physical health problems
  • Relative newcomer to research in computerized interventions in ABI
presenters7
Presenters

Frances Wen, Ph.D.

  • Asst Prof Family Medicine at OSU-COM
  • Focus on consulting with physicians on research regarding clinical health questions, grant writing
  • Clinical experience in physical and mental health problems
  • Researches physician competencies, assessment in medical education, availability/utilization of behavioral and health care services in rural areas
presenters8
Presenters

Michael Basso, Ph.D.

  • Assoc Prof of Psychology, Director of Clinical Training at TU
  • Teaches neuropsychology, cognitive psychology, and tests and measures
  • Researches cognitive function in psychiatric impairment, immune disorders, and MS
organization of presentation
Organization of Presentation
  • Independent but coordinated presentations:
    • Basic concepts (Bost)
    • Statistical foundations (Basso)
    • Application to emotional/behavioral medicine measures (Wen)
    • Application to cognitive measures (Bost)
  • Some content overlap; repetition of key points
  • Some review of familiar concepts; new application
  • Today’s slides and handouts are available at http://www.healthsciences.okstate.edu/bost.html
organization con t
Organization (con’t)

Software availability:

  • RCI Generator 2.0 (Devily, 2004)http://www.swin.edu.au/victims/resources/software/reliablechange/reliable_change_generator.html
  • SRB [Bivreg] (Crawford & Howell, 1998)http://www.abdn.ac.uk/~psy086/dept/Journal_urls_redirection.htm
  • Multiple Regression [Multreg] (Crawford & Howell, 1998)http://www.abdn.ac.uk/~psy086/dept/Journal_urls_redirection.htm
  • SRB Data Prep (Bost, 2004)http://www.healthsciences.okstate.edu/bost.html
key task
Key task

Distinguish error in measurement from clinically meaningful change

  • Specify random variation
  • Identify & minimize effects of bias
common sources of variance in serial assessment
Common Sources of Variance in Serial Assessment
  • Bias – → systematic change
    • Extraneous events (e.g. 9/11 ↑ anxiety)
    • Practice effects
      • Memory for content
      • Procedural learning
      • Familiarity with examiner & testing context
      • Performance anxiety
common sources of variance in serial assessment13
Common Sources of Variance in Serial Assessment

Bias (con’t)

  • Demographics
    • Pre-test abilities
    • Age
    • Education
    • Gender
    • Ethnicity
common sources of variance in serial assessment14
Common Sources of Variance in Serial Assessment
  • Error – sources of random change; statistical error
    • Measurement error (SEM)
    • Regression to the Mean (Seest)
guidelines for selecting tests
Guidelines for Selecting Tests
  • Determine examination goals
  • Determine type of data generated by each test considered: nominal, ordinal, interval, ratio.
      • Only interval and ratio can be used in RCI and SRB analyses
  • Appraise validity
  • Appraise reliability
  • Consider reading ability, time, costs
change assessment strategies
Change Assessment Strategies
  • Alternate forms
  • Reliable Change Index (RCI)
  • Adjusted RCI
  • Standardized Regression-Based change (SRB)
  • Multiple Regression
application to cognitive measures
Application to Cognitive Measures
  • Must have raw data from norm sample to use regression analysis
  • This info usually not in test manuals
  • Many clinicians will have this info in their clinical files
application to cognitive measures con t
Application to Cognitive Measures (con’t)
  • Guidelines for using raw data from clinical files:
    • Specify norm sample characteristics
    • Pull T1 and T2 test scores for 30+ patients
    • Apply to “SRB Data Prep” spreadsheet

(demo spreadsheet)

on line cognitive measure
On-line Cognitive Measure

Headminder Cognitive Stability Index (CSI)

  • Designed for serial measurement to document change over time
  • 10 subtests
  • Administration time—25-30 minutes
  • Four factors:
    • Processing speed
    • Response speed
    • Memory/learning
    • Attention
on line cognitive measure con t
On-line Cognitive Measure (con’t)

Headminder Cognitive Stability Index (CSI)

  • Displays results in standard scores
  • Displays RCIp with repeated administrations
  • Available at http://www.headminder.com

(demo CSI)