The clinical global impression scale and the influence of patient or staff perspective on outcome
The clinical global impression scale and the influence of patient or staff perspective on outcome
复制标题
DOI：
10.1186/1471-244x-11-83
复制
发表时间：
2011-05-14
期刊：
影响因子：
4.4
通讯作者：
Gauggel, Siegfried
中科院分区：
文献类型：
--
作者：
Forkmann, Thomas;Scherer, Anne;Gauggel, Siegfried
背景：自首次出版以来，临床整体印象量表（CGI）已成为精神病学中使用最广泛的评估工具之一。尽管出现了一些相互矛盾的数据，但迄今为止，调查CGI有效性的研究很少进行。目前尚不清楚改善指数CGI-I和严重指数CGI-S （dif）的差异评分在描述临床变化方面是否更有效。目前的研究检验了这两种方法的有效性，并调查了治疗师的CGI评分是否与患者自己对自己病情的看法相符。方法：德国某心理治疗医院住院的31例重度抑郁症患者（年龄M = 45.3, SD = 17.2，女性58.1%）。患者填写贝克抑郁量表（BDI）。CGI-S和CGI-I从三个角度进行评分：治疗治疗师（THER），参与患者治疗的治疗师团队（team）和患者（PAT）。入院和出院时分别填写BDI和CGI-S，出院时仅填写CGI-I。使用效应量、斯皮尔曼rho和类内相关性（ICC）对数据进行分析。结果：CGI-I和CGI-S （dif）评分之间的效应量在所有三个视角中都很大，CGI-I的变化得分明显高于CGI-S （dif）。BDI （dif）与PAT评分有中度相关性，但与TEAM或THER评分无显著相关性。从三个角度对CGI-S的评分一致性较低（dif） （ICC = .37；置信区间[CI]）。15至0.59；F-30,F-60 = 2.77, p < 0.001；平均rho = 0.36)，中度为CGI-I (ICC = 0.65。47 - 0.80；F-30,F-60 = 6.61, p < 0.001；平均rho = 0.59)。结论：由于没有强有力的证据证明两者的有效性，因此研究结果并没有明确建议是否使用CGI-I或CGI-S dif。由于从患者和工作人员的角度来看，CGI评分之间的一致性并不令人信服，因此不能假设CGI THER或TEAM评分完全代表了患者对其损伤严重程度的看法。因此，我们提倡在设计临床试验时，除CGI外，还应纳入多种自我和临床报告量表，以进一步了解CGI与患者视角的关系。
Background: Since its first publication, the Clinical Global Impression Scale (CGI) has become one of the most widely used assessment instruments in psychiatry. Although some conflicting data has been presented, studies investigating the CGI's validity have only rarely been conducted so far. It is unclear whether the improvement index CGI-I or a difference score of the severity index CGI-S (dif) is more valid in depicting clinical change. The current study examined the validity of these two measures and investigated whether therapists' CGI ratings correspond to the view the patients themselves have on their condition.Methods: Thirty-one inpatients of a German psychotherapeutic hospital suffering from a major depressive disorder (age M = 45.3, SD = 17.2; 58.1% women) participated. Patients filled in the Beck Depression Inventory (BDI). CGI-S and CGI-I were rated from three perspectives: the treating therapist (THER), the team of therapists involved in the patient's treatment (TEAM), and the patient (PAT). BDI and CGI-S were filled in at admission and discharge, CGI-I at discharge only. Data was analysed using effect sizes, Spearman's rho and intra-class correlations (ICC).Results: Effect sizes between CGI-I and CGI-S (dif) ratings were large for all three perspectives with substantially higher change scores on CGI-I than on CGI-S (dif). BDI (dif) correlated moderately with PAT ratings, but did not correlate significantly with TEAM or THER ratings. Congruence between CGI-ratings from the three perspectives was low for CGI-S (dif) (ICC = .37; Confidence Interval [CI] .15 to .59; F-30,F-60 = 2.77, p < .001; mean rho = 0.36) and moderate for CGI-I (ICC = .65 (CI .47 to .80; F-30,F-60 = 6.61, p < .001; mean rho = 0.59).Conclusions: Results do not suggest a definite recommendation for whether CGI-I or CGI-S dif should be used since no strong evidence for the validity of neither of them could be found. As congruence between CGI ratings from patients' and staff's perspective was not convincing it cannot be assumed that CGI THER or TEAM ratings fully represent the view of the patient on the severity of his impairment. Thus, we advocate for the incorporation of multiple self-and clinician-reported scales into the design of clinical trials in addition to CGI in order to gain further insight into CGI's relation to the patients' perspective.