title: Feedback on patient progress and clinical support tools for therapists: improved outcome for patients at risk of treatment failure in psychosomatic in-patient therapy under the conditions of routine practice.
abstract: OBJECTIVE
  Although psychosomatic in-patient treatment is effective, 5-10% of the patients deteriorate. Providing patient progress feedback and clinical support tools to therapists improves the outcome for patients at risk of deterioration in counseling, outpatient psychotherapy, and substance abuse treatment. This study investigated the effects of feedback on psychosomatically treated in-patients at risk of treatment failure.
  
  
  METHODS
  At intake, all patients of two psychosomatic clinics were randomized either into the experimental group or the treatment-as-usual control group. Both groups were tracked weekly with the "Outcome Questionnaire" (OQ-45) measuring patient progress and with the clinical support tool "Assessment of Signal Cases" (ASC). Therapists received feedback from both instruments for all their experimental group patients. "Patients at risk" were defined as patients who deviated from expected recovery curves by at least one standard deviation. Of 252 patients, 43 patients were at risk: 23 belonged to the experimental group, 20 to the control group. The feedback effect was analyzed using a level-2-model for discontinuous change, effect size (d), reliable change index (RCI), and odds ratio for reliable deterioration.
  
  
  RESULTS
  For patients at risk, the experimental group showed an improved outcome on the OQ-45 total scale compared to the control group (p<0.05, d=0.54). By providing feedback, the rate of reliably deteriorated patients at risk was reduced from 25.0% (control group) to 8.7% (experimental group) - odds ratio=0.29. All reliably improved patients at risk belonged to the experimental group.
  
  
  CONCLUSIONS
  Feedback improves the outcome of patients at risk undergoing psychosomatic in-patient treatment.
authors: University Clinic of Regensburg, Department of Psychosomatics, Germany.
authors: Thomas
authors: T
authors: Probst
authors: Michael J
authors: MJ
authors: Lambert
authors: Thomas H
authors: TH
authors: Loew
authors: Reiner W
authors: RW
authors: Dahlbender
authors: Richard
authors: R
authors: Göllner
authors: Karin
authors: K
authors: Tritt
mesh_terms: D000328:Adult; D005246:Feedback; D005260:Female; D006282:Health Personnel; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D011602:Psychophysiologic Disorders / Q000523:psychology / Q000628:therapy*; D011613:Psychotherapy / Q000379:methods*; D011795:Surveys and Questionnaires; D017211:Treatment Failure; D016896:Treatment Outcome
keywords: Inpatient treatment; Outcome; Psychosomatics; Psychotherapy; Routine clinical care; Treatment failure