TREATMENT FIDELITY IN OUTCOME STUDIES
TREATMENT FIDELITY IN OUTCOME STUDIES
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DOI：
10.1016/0272-7358(91)90103-2
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发表时间：
1991-01-01
影响因子：
12.8
通讯作者：
PRINZ, RJ
中科院分区：
文献类型：
--
作者：
MONCHER, FJ;PRINZ, RJ
结果研究中治疗的保真度是指确认自变量的操纵是按计划进行的。需要验证保真度，以确保对可复制治疗进行公平、有力和有效的比较。本文的中心目的是评估1980年至1988年的结果研究，以确定研究者在多大程度上充分关注治疗忠实度问题。该评估涵盖了来自四个领域主要期刊的359项治疗结果研究：临床心理学、行为治疗、精神病学和婚姻与家庭治疗。对这些研究进行了评估：(a)治疗实施者的培训，(b)用于提高保真度的程序，(c)治疗验证的方面，(d)评估保真度的方法，以及(e)在解释结果时使用保真度评估。尽管在过去的十年中，检查治疗依从性并使用监督来提高保真度的研究比例显著增加，但大多数（55%）的研究基本上忽略了治疗保真度的问题。此外，在最近的一段时期（1986-1988）中，只有八分之一的研究结合了治疗手册的使用、治疗药物的监督和检查方案的遵守情况。最后，对上述保真度方面的关注在期刊领域之间没有显著差异。对现有实践进行审查的总体含义是，研究者、审稿人和期刊编辑需要更多地考虑与保真度相关的问题。提出了具体的建议，以改善促进和验证结果研究的治疗保真度。
Fidelity of treatment in outcome research refers to confirmation that the manipulation of the independent variable occurred as planned. Verification of fidelity is needed to ensure that fair, powerful, and valid comparisons of replicable treatments can be made. The central purpose of this article is the evaluation of outcome studies from 1980 to 1988 to determine the extent to which investigators are attending adequately to the issue of treatment fidelity. The evaluation covered 359 treatment outcome studies from major journals in four domains: clinical psychology, behavior therapy, psychiatry, and marital and family therapy. The studies were evaluated with respect to: (a) the training of treatment implementors, (b) the procedures used to promote fidelity, (c) the aspects of treatment verified, (d) the methods for assessing fidelity, and (e) the utilization of fidelity assessment in the interpretation of results. Although there were significant increases over the decade in the percentage of studies that checked adherence to treatment and used supervision to promote fidelity, the majority (55%) of the studies essentially ignored the issue of treatment fidelity. Furthermore, only one out of eight studies in the most recent period (1986–1988) combined the use of treatment manuals, supervision of treatment agents, and checking of adherence to protocol. Finally, attention given to the aforementioned aspects of fidelity did not differ significantly across journal domains. The overall implication of the review of existing practices is that investigators, reviewers, and journal editors need to give even greater consideration to the issues associated with fidelity. Specific recommendations for improving the promotion and verification of treatment fidelity in outcome studies were offered.