Systematic review of practice-based research on psychological therapies in routine clinic settings.
OBJECTIVE
To review the published material on practice-based research and to compare results with benchmarks derived from efficacy studies.


METHODS
Electronic and manual searches were carried out up to and including 2008. Studies were screened for content relevance and selected according to specified inclusion criteria. Data were extracted from all studies that met criteria and were quality assessed using an adapted version of a checklist designed for the appraisal of both randomized and non-randomized studies of health care interventions. Studies were synthesized according to (1) the type of problem being treated and (2) study design using descriptive and meta-analytic methods where appropriate.


RESULTS
Psychological treatment conducted in routine clinic settings is effective for a range of client problems, particularly common mental health problems (uncontrolled effect size = 1.29; 95% CI = 1.26-1.33, N = 10,842). When benchmarked against data from efficacy studies, practice-based studies yielded effect sizes that fell short of the selected benchmark. In contrast, the practice-based studies achieved the benchmark for percentage of clients meeting a stringent criterion for recovery.


CONCLUSIONS
Clients receiving treatment as normally delivered within routine practice report significant relief of symptoms. However, the result of comparisons with efficacy benchmarks is dependent on the outcome index used. Notwithstanding this, substantive factors are also likely to contribute. Therefore, in addition to attending to methodological issues, further work is required to understand the relative contribution of these factors.
Cahill
Jane
J
School of Healthcare, University of Leeds, UK. j.l.cahill@leeds.ac.uk
Barkham
Michael
M
Stiles
William B
WB
D019985:Benchmarking / Q000592:standards*; D057189:Checklist; D006302:Health Services Research / Q000592:standards*; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D011613:Psychotherapy / Q000592:standards*; D016032:Randomized Controlled Trials as Topic; D013222:State Medicine; D016896:Treatment Outcome; D006113:United Kingdom