Measuring clinically significant outcomes - LDQ, CORE-10 and SSQ as dimension measures of addiction.
TL;DR: Values for reliable change and clinically significant change for the Leeds Dependence Questionnaire and Social Satisfaction Questionnaire are determined and add to the evidence for the performance of the LDQ, CORE-10 and SSQ as dimension measures of addiction.
Abstract: Aims and method To determine values for reliable change and clinically significant change for the Leeds Dependence Questionnaire (LDQ) and Social Satisfaction Questionnaire (SSQ). The performance of these two measures with the Clinical Outcomes in Routine Evaluation (CORE-10) as three dimension measures of addiction was then explored. Results The reliable change statistic for both LDQ and SSQ was ⩾4; the cut-offs for clinically significant change were LDQ ⩽10 males, ⩽5 females, and SSQ ⩾16. There was no overlap of 95% CIs for means by gender between 'well-functioning' and pre- and post-treatment populations. Clinical implications These data enable the measurement of clinically significant change using the LDQ and SSQ and add to the evidence for the performance of the LDQ, CORE-10 and SSQ as dimension measures of addiction. The CORE-10 and SSQ can be used as treatment outcome measures for mental health problems other than addiction.
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TL;DR: The ICECAP-A and EuroQol five-dimensional questionnaire (EQ-5D-5L) have been used for the economic evaluation of treatments for substance use disorders.
35 citations
TL;DR: Investigation of the views of service users, family and friends on what constitutes a good outcome for the treatment of substance misuse problems found significant weight was placed, by both SUs and their family andFriends, on abstinence and ways of maintaining abstinence.
Abstract: Aims: The aim of this study was to investigate the views of service users (SUs), family and friends on what constitutes a good outcome for the treatment of substance misuse problems.Methods: Six focus groups were arranged to explore and identify important elements of good outcome. Transcripts of the focus groups were analysed using thematic analysis. The content of the main theme, good outcome, was cross checked with SUs and the four authors. The main theme was analysed further into sub-themes.Findings: Participants were 24 SUs and 12 family and friend members recruited from specialist drug and alcohol services. The participants represented a broad range of treatment journey experiences in a variety of treatment modalities. A total of 20 outcome elements were elicited and categorised into seven sub-themes: abstinence, health, activities, relationships, social circumstances, self-awareness and wellbeing of family and friends.Conclusions: The focus of this study was on the ideal outcome rather than intermed...
16 citations
Cites background from "Measuring clinically significant ou..."
...These approaches all have in common the idea that an individual’s wellbeing is defined by a number of constructs and outcome is, therefore, a compilation of related but independent measures (Raistrick et al., 2014)....
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TL;DR: Factor analysis of treatment outcomes from a UK specialist addiction service: Relationship between the Leeds Dependence Questionnaire, Social Satisfaction Questionnaire and 10-item Clinical Outcomes in Routine Evaluation found social satisfaction appears to be a unique construct of addiction.
Abstract: Introduction and Aims
To examine the relationship between three outcome measures used by a specialist addiction service (UK): the Leeds Dependence Questionnaire (LDQ), the Social Satisfaction Questionnaire (SSQ) and the 10-item Clinical Outcomes in Routine Evaluation (CORE-10).
Design and Method
A clinical sample of 715 service user records was extracted from a specialist addiction service (2011) database. The LDQ (dependence), SSQ (social satisfaction) and CORE-10 (psychological distress) were routinely administered at the start of treatment and again between 3 and 12 months post-treatment. A mixed pre/post-treatment dataset of 526 service users was subjected to exploratory factor analysis. Parallel Analysis and the Hull method were used to suggest the most parsimonious factor solution.
Results
Exploratory factor analysis with three factors accounted for 66.2% of the total variance but Parallel Analysis supported two factors as sufficient to account for observed correlations among items. In the two-factor solution, LDQ items and nine of the 10 CORE-10 items loaded on the first factor >0.41, and the SSQ items on factor 2 with loadings >0.63. A two dimensional summary appears sufficient and clinically meaningful.
Discussion and Conclusions
Among specialist addiction service users, social satisfaction appears to be a unique construct of addiction and is not the same as variation due to psychological distress or dependence. Our interpretation of the findings is that dependence is best thought of as a specific psychological condition subsumed under the construct psychological distress. [Fairhurst C, Bohnke JR, Gabe R, Croudace TJ, Tober G, Raistrick D. Factor analysis of treatment outcomes from a UK specialist addiction service: Relationship between the Leeds Dependence Questionnaire, Social Satisfaction Questionnaire and 10-item Clinical Outcomes in Routine Evaluation. Drug Alcohol Rev 2014;33:643–650]
9 citations
Cites background or methods from "Measuring clinically significant ou..."
...The scales described here are brief enough for routine use, can be embedded with other measures and they produce clinically meaningful data [17]....
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...The development of the scales as a package [16] and the measurement of outcomes in a large clinical sample [17] have been described elsewhere....
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TL;DR: This feasibility RCT aimed to test recruitment, randomisation, retention, and data collection methods, but recruited only 19 participants, illustrating the importance of undertaking feasibility studies prior to fully powered RCTs.
Abstract: The harmful use of alcohol is a causal factor in more than 200 disease and injury conditions and leads to over 3 million deaths every year worldwide. Relatively few problem alcohol users access treatment due to stigma and lack of services. Alcohol-specific digital health interventions (DHI) may help them, but trial data comparing DHI with face-to-face treatment are lacking. We conducted a feasibility RCT of an alcohol DHI, testing recruitment, online data-collection and randomisation processes, with an embedded process evaluation. Recruitment ran from October 2015 for 12 months. Participants were adults, drinking at hazardous and harmful levels, recruited from hospital emergency departments (ED) in London or recruited online. Participants were randomised to HeLP-Alcohol, a six module DHI with weekly reminder prompts (phone, email or text message), or to face-to-face treatment as usual (TAU). Participants were invited to take part in qualitative interviews after the trial. The trial website was accessed 1074 times: 420 people completed online eligibility questionnaires; 350 did not meet eligibility criteria, 51 declined to participate, and 19 were recruited and randomised. Follow-up data were collected from three participants (retention 3/19), and four agreed to be interviewed for the process evaluation. The main themes of the interviews were:
This feasibility RCT aimed to test recruitment, randomisation, retention, and data collection methods, but recruited only 19 participants. This illustrates the importance of undertaking feasibility studies prior to fully powered RCTs. From the qualitative interviews we found that potential recruits were not at equipoise for recruitment. An alternative methodology, for example a preference RCT recruiting from multiple locations, needs to be explored in future trials. International Standard Randomized Controlled Trial Number: ISRCTN31789096
5 citations
References
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TL;DR: To prevent relapse, treatment interventions should address multiple variables because no single variable strongly predicts continued drug use, although several variables display moderate longitudinal associations.
Abstract: Buts: de nombreuses personnes soignees pour la dependance aux opiaces continuent de consommer de la drogue pendant et apres le traitement. Il est possible d'ameliorer cette partie du probleme en s'interessant aux caracteristiques des patients qui predisent un usage continu de drogues. Cette etude utilise les techniques de la meta-analyse pour identifier les facteurs de risque de la poursuite de l'usage de drogue chez les patients soignes pour abus d'opiaces. Projet et Mesures: une recherche approfondie de la litterature publiee a partir de 69 etudes qui rapportaient des informations sur l'association bivariee entre une ou plusieurs variables independantes et l'usage continu de drogues illegales pendant et apres le traitement de la dependance aux opiaces. Resultats: les auteurs notent que la plupart des variables des patients ont de faibles relations longitudinales avec l'usage continuel de drogue, bien que quelques variables fassent preuve d'associations longitudinales moderees. Dix variables montrent des relations statistiquement significatives et longitudinalement predictives (moyenne > 0.1) avec l'usage ininterrompu, dont les suivantes: un niveau eleve d'usage de drogue/ opiaces avant le traitement, un traitement anterieur de la dependance aux opiaces, pas d'abstinence anterieure d'opiaces, l'abstinence d'une faible consommation d'alcool, la depression, un niveau eleve de stress, des problemes de chomage ou des difficultes au travail, des liens avec des camarades qui abusent des opiaces, la courte duree du traitement, et l'abandon du traitement avant la fin. Quelques autres variables peuvent etre potentiellement et longitudinalement predictives. Conclusions: pour prevenir les rechutes, les interventions therapeutiques doivent s'interesser a plusieurs variables parce qu'aucune variable seule ne peut predire vraiment un usage ininterrompu de drogue.
385 citations
TL;DR: While response biases favoring women, young physicians, and nonspecialty-fellow members were found across the 52-81 percent response rates examined in this study, the amount of bias was minimal for these factors that could be tested.
Abstract: A survey's response rate is a conventional proxy for the amount of response bias contained in that study. While there are more theoretical opportunities for bias when response rates are low rather than high, there is no necessary relationship between response rates and bias (O'Neill, Marsden, and Silman 1995; Asch, Jedrziewski, and Christakis 1997). A review of physician surveys published between 1985 and 1995 found an average response rate of 61 percent for all surveys of physicians and an average response rate of 52 percent for surveys with more than 1,000 observations (Cummings, Savitz, and Konrad 2001). There was no significant decline in response rates to published physician surveys across that time, but it is unclear whether that pattern has continued.
By definition, not much information is available about nonrespondents. It has been estimated that only 18 percent of physician survey articles perform any type of comparison between responders and nonresponders with the remainder having only response rates to serve as an indicator of bias (Cummings, Savitz, and Konrad 2001). Direct examinations of response bias for health care professional groups have generally found only minimal amounts of response bias in surveys (Barton et al. 1980; Hovland, Romberg, and Moreland 1980; Locker and Grushka 1988; McCarthy, Koval, and MacDonald 1997; Thomsen 2000; Kellerman and Herold 2001). Surveys of patients and the full population have consistently shown substantially more response bias (Sheikh and Mattingly 1981; Benfante et al. 1989; Brennan and Hoek 1992; Diehr et al. 1992; Vestbo and Rasmussen 1992; Prendergast, Beal, and Williams 1993; Walsh 1994; Blanker et al. 2000; Kotaniemi et al. 2001; Barchielli and Balzi 2002; Fowler et al. 2002; Mazor et al. 2002; Solberg et al. 2002; Partin et al. 2003; Van Loon et al. 2003). Substantial response bias greatly limits the generalizability of survey findings (Asch, Jedrziewski, and Christakis 1997; Cummings, Savitz, and Konrad 2001). Studies focused specifically on assessing response bias for physician surveys are lacking. It is important to determine if response rates for physicians are falling, and if decreasing response rates are associated with increasing response bias.
The American Academy of Pediatrics (AAP) has conducted many surveys of pediatricians through its Periodic Survey of Fellows and other programs. The AAP also maintains an administrative database that contains demographic information about its members. Using this database along with data from the American Board of Pediatrics administrative database, age, gender, membership type, and location data were merged with respondent/nonrespondent information for 50 surveys of pediatricians. The objectives in doing this were (1) to monitor response rates across time, (2) to examine systematic response bias for several different pediatrician characteristics, and (3) to explore response bias as a function of survey response rates.
377 citations
TL;DR: Links between social support and relapse were examined in a study of alcoholics, cigarette smokers, and opiate users completing treatment for drug use and found greater structural support predicted a lower risk of relapse.
359 citations
TL;DR: Few predictor variables were examined in more than a third of studies reviewed, and few variables were found to be significant predictors in a clear majority of studies, but a subset of variables was identified, which collectively could be considered to represent a consistent set of predictors.
316 citations
TL;DR: The Leeds Dependence Questionnaire is a 10-item, self completion questionnaire designed to measure dependence upon a variety of substances and has been shown to be understood by users of alcohol and opiates.
Abstract: The Leeds Dependence Questionnaire (LDQ) has been developed as part of a treatment evaluation package. The LDQ is a 10-item, self completion questionnaire designed to measure dependence upon a variety of substances; it has been shown to be understood by users of alcohol and opiates. The questionnaire was designed to be sensitive to change over time and to be sensitive through the range from mild to severe dependence; the follow-up data are insufficient to demonstrate change over time, but are encouraging. It is expected that both clinicians and researchers will find it useful to have a single measure relating to substance use, but not limited by specific substances. All items are scored 0-1-2-3; there are no normative data. The procedure for establishing content validity is described and estimates of concurrent, discriminant and convergent validities are reported; these validities are thought to be satisfactory. A principal components analysis produced a single factor accounting for 64% of the variance. Cronbach's alpha was 0.94. Test-retest reliability was found to be 0.95.
275 citations