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Variability is common in language sample analysis (LSA), arising from personal factors such as age or level of education, or from factors within the text such as its length and purpose. Variability can affect interpretation of results in clinical practice and research studies, as well as the ability to detect change in individuals over time. This article focuses on sample length and time-based variability in the LSA literature and how it has been addressed through a scoping review. We then propose a method for estimating the effect of this common source of variability to allow determination of reliable change in individuals over time. Although some sources of variability are acknowledged in the research literature and clinical evidence-based practice, there has been no consistent method to account for these. The proposed method we present offers a means to address text length and time-based variability and materials and examples to facilitate its implementation in future studies and practice. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate whether the effect of physical activity on cognitive function in persons with dementia is moderated by patient characteristics as Apolipoprotein E and dementia type. We included 101 individuals with dementia and calculated the reliable change index to determine the change in global cognition, executive function, episodic memory, working memory, and processing speed before and after a 12-week exercise training. We found a higher treatment-related benefit in episodic memory in persons with non-Alzheimer's disease compared to persons with Alzheimer's disease, and in executive function in individuals with better baseline cognitive function. [ABSTRACT FROM AUTHOR]

Determining reliable and clinically significant change is central to evidence‐based practice yet rarely used in routine clinical settings. This paper illustrates these methods in the context of an evaluation of cognitive behaviour therapy for distressing auditory hallucinations ("voices"). We used data from a clinical sample attending Perth Voices Clinic, a transdiagnostic outpatient service for distressing voices, and a previously published reference sample of healthy voice hearers. Our outcomes on the primary measure of voice distress, derived from a previous factor analysis of the Psychotic Symptom Rating Scale‐Auditory Hallucinations subscale, showed that 62.9% of clients were classified as Recovered/Improved, 35.5% were classified as Unchanged, and 0.02% were classified as Deteriorated. Partial support for the validity of these classifications was obtained from the scores on the Depression, Anxiety, Stress Scales (Lovibond & Lovibond, 1995) but not on the Social and Occupational Functional Assessment Scale (Goldman et al., 1992). Clients classified as Recovered showed better emotional functioning on the Depression, Anxiety, Stress Scales compared with those who did not make a clinically significant change in voice distress. A tool is provided to assist practitioners to evaluate whether individual clients have benefited from therapy for distressing voices or not, which can be used to guide future treatment decisions (https://osf.io/gd9e5/). [ABSTRACT FROM AUTHOR]

Children treated for brain tumor show evidence of declines in general intellectual abilities (i.e., IQ). Group-level data indicate subtle declines over time on average, but no study has utilized a clinical criterion to identify and describe a reliable change in survivors of pediatric brain tumor (PBT). In this study, we discuss the utility of reliable change index (RCI) methodology to supplement group-level analysis (e.g., repeated measures ANOVA). This pilot sample consisted of 22 children (M age = 10.47 years) treated for PBT who completed initial and follow-up assessments (M interval = 23.58 months). Cognitive data included composite scores from the WISC-IV. An RCI z-score was calculated for each participant on each composite score based on two different test–retest reliability coefficients. As a group, survivors of PBT did not demonstrate a statistically significant change from initial to follow-up on any WISC-IV composite score. When RCI was calculated based on reliability coefficients with shorter test–retest intervals provided by the test publisher, 77% of survivors demonstrated a reliable change in performance on at least one measure. The frequency of RCI decreases in working memory was significantly higher than expected. In contrast, only 32% of survivors showed reliable changes on at least one measure when RCI was based on a reliability coefficient derived from a clinical sample with a longer retest interval. This study demonstrates that highly divergent results may be obtained with RCI and the importance of the source of reliability estimates. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the intra-individual variation of heart rate variability (HRV) and heart rate using an orthostatic challenge in elite male athletes during a training camp. Heart rate (variability) was measured upon waking. Log-transformed HRV metrics were evaluated in three segments (first min discarded for stabilization): 0–3 min supine, 3–6 min supine, and standing. Heart rate was assessed while supine, 15 s after standing and average final 30 s standing (Rusko protocol). A RM-ANOVA compared intra-individual means, standard deviations (SD) and coefficients of variation (CV%) for HRV and heart rate. The intraclass correlation coefficient (ICC) and standard error of measurement (SEmeas) were used for relative and absolute reliability, respectively. Time and frequency domain HRV metrics had low variation (CV% <8.5%; SEmeas% ≤4.0%) for 0–3 min supine which was not improved during 3–6 min. Standing HRV had lower ICC and higher SEmeas than supine values. Variability and reliability outcomes for heart rate were comparable to log-transformed HRV metrics. This study uniquely describes the intra-individual variation of HRV metrics during an orthostatic challenge and demonstrated low variability in this cohort of elite male athletes. These data can be helpful for identifying when true individual changes occur for the autonomic nervous system indices in supine and standing positions. [ABSTRACT FROM AUTHOR]

Abstract Background The role of non-infective inflammatory response (IR) in the aetiology of postoperative cognitive dysfunction (POCD) is still controversial. The aim of this controlled, prospective observational study was to assess the possible relationship between the grade of IR, defined by procalcitonin (PCT) changes, and development of POCD related to cardiac surgery. Methods Forty-two patients, who were ≥ 60 years of age and scheduled for elective cardiac surgery, were separated into the low inflammatory (LIR) and high inflammatory (HIR) response groups based on their PCT levels measured on the first postoperative day. A matched normative control group of 32 subjects was recruited from primary care practice. The PCT and C-reactive protein (CRP) levels were monitored daily during the first five postoperative days. The cognitive function and mood state were preoperatively tested with a set of five neurocognitive tests and two mood inventories and at the seventh postoperative day. The Reliable Change Index modified for practice (RCIp) using data from normative controls was applied to determine the significant decline in test performance. Results The LIR (n = 20) and HIR (n = 22) groups differed significantly in the PCT (p 0.05). Additionally, there was no difference in the mood states, anxiety levels and perioperative parameters known to influence the development of POCD. Conclusions In this study, the magnitude of the non-infective inflammatory response generated by on-pump cardiac surgery did not influence the development of POCD in the early postoperative period in elderly patients.

Internet Use Disorders (IUD) have a relevant effect on national economies. In the randomized, controlled, multicenter, prospective, and single-blinded OMPRIS study (pre-registration number DRKS00019925; Innovation Fund of the Joint Federal Committee of Germany, grant number 01VSF18043), a four-week online program to reduce media addiction symptoms, was evaluated for cost-effectiveness. The intervention group (IG) was compared to a waiting control group (WCG) from German statutory health insurance (SHI) and a societal perspective. Resource use, namely indirect and direct (non) medical costs, was assessed by a standardized questionnaire at baseline and after the intervention. Additionally, intervention costs were calculated. Determining the Reliable Change Index (RCI) based on the primary outcome, assessed by the "Scale for the Assessment of Internet and Computer Game Addiction" (AICA-S), individuals with and without reliable change (RC) were distinguished. The incremental cost-effectiveness ratio was calculated using the difference-in-difference approach. There were 169 (IG n = 81, WCG n = 88) persons included in the analysis. The mean age was 31.9 (SD 12.1) years. A total of 75.1% were male, and 1.8% diverse. A total of 65% (IG) and 27% (WCG) had an RC. The cost per person with RC was about EUR 860 (SHI) and EUR 1110 (society). The intervention leads to an improvement of media addiction symptoms at moderate additional costs.

Objectives: In the field of Parkinson disease (PD) research, many studies have shown that deep brain stimulation (DBS) can soften side effects, which arise during long-term medical therapy. This study focuses on the changes in depressive symptoms, quality of life (with the subdivisions physical and mental health), activities of daily living, and subjective memory functioning in PD patients testing the baseline and the outcome 1 year after DBS.Methods: For the first time, the reliable change index (RCI) methodology was applied to compare PD-DBS patients (n = 22) with best medically treated PD patients (PD-BMT; n = 28), subjects with mild cognitive impairment (MCI, n = 43) and healthy controls (n = 25) in the above-mentioned domains. The used questionnaires included the revised Beck Depression Inventory (BDI-II), the Short Form (36) Health Survey (SF-36), the Bayer Activities of Daily Living Scale (B-ADL), and the Forgetfulness Assessment Inventory (FAI).Results: The reliable change indices show high constant or improved results of the PD-DBS patients in the domains subjective memory (85.7%-100.0%), activities of daily living (60.0%-90.0%), physical health summary (77.8%), depressive symptoms (61.9%), and mental health summary (50.0%) in comparison with the PD-BMT, MCI, and control group.Conclusions: DBS is an established alternative to best medical treatment of PD. The comparisons between the PD-DBS and PD-BMT groups do suggest that the domains mental health, depressive symptoms, and physical health benefit most, while the domains activities of daily living and subjective memory functioning are rather constant. Nevertheless, further research is needed to identify mechanisms and predictors that lead to improvement in individual cases. [ABSTRACT FROM AUTHOR]

Since psychology emerged as an independent field of knowledge, there has been no consensus as to how it should develop, either, in the idiographic or nomothetic way. In the course of time, due to a commitment to what was seen as objectivity in science, the nomothetic approach came to dominate psychology. Thus, researchers used mostly quantitative psychometric methods to establish general rules of human behaviour. In doing so, the essence of nomothetic research is to be extremely careful when interpreting results not to make a reasoning mistake such as the ecological fallacy, as may happen when a researcher draws conclusions about nature of the individual in the group based on average results of the whole group. In the article, we presented two methods for longitudinal research designs which address this problem, and give more idiographic information about participants; via the Reliable Change Index and the Modified Brinley Plot. Finally, we provide a IBM SPSS Statistics syntax automatizing the whole process of computation for these new features. [ABSTRACT FROM AUTHOR]

Background: Some authors have pointed out the usefulness of the levels of substance use disorder (SUD) as a treatment outcome. However, in order to use this variable as an outcome measure, its impact needs to be addressed within a clinical context. The aim of this study was to analyze the sensitivity of SUD levels as a measure for detecting reliable changes and to make a comparison between the changes in SUD levels detected when using the number of criteria fulfilled and when using the reliable change index (RCI). Methods: The sample consisted of 206 (106 in follow‐up) patients diagnosed with abuse/dependence on alcohol and cocaine, according to DSM‐IV criteria. The Substance Dependence Severity Scale for DSM‐5 was used to determine current alcohol use disorder (AUD) and cocaine use disorder (CUD). Number of DSM‐5 criteria fulfilled and RCI were used to determine the change in SUD levels. Results: No association was found between adherence to/abandonment of treatment and AUD severity levels (χ2 = 7.029, p = 0.071) or CUD severity levels (χ2 = 2.044, p = 0.413). Statistical significant differences for levels of AUD (z = −3.870, p = 0.000) and CUD (z = −5.382, p = 0.000) were found between baseline assessment and follow‐up. According to the number of DSM‐5 criteria and RCI, the Kappa coefficient for the change in patient status (improved, worsened, or no change) was k = 0.61 for alcohol patients and k = 0.64 for cocaine patients. The "mild" category showed the greatest inconsistency between both procedures. Conclusions: Levels of SUD are sensitive to the impact of treatment as measured by the difference between the baseline assessment and 3‐month follow‐up. However, conclusions differ according to whether the DSM‐5 criteria or the RCI is applied. [ABSTRACT FROM AUTHOR]

Purpose: The efficacy of assertive community treatment for children and adolescents is proven in the United States, but remains controversial in Europe. Moreover, most studies showing positive outcomes of assertive community treatment are limited to statistically significant differences and do not consider whether the treatment is also subjectively clinically meaningful for the patient. Using a naturalistic sample, the present study aims to assess statistical and clinical significance of an assertive community treatment unit for adolescents in Europe.Methods: Linear mixed-effects models and reliable change indices were used to respectively assess the statistical and clinical significance of assertive community treatment in 179 adolescents (mean age = 15.76, SD = 1.76) with severe mental illnesses.Results: Difficulties related to mental health (measured by the Health of the Nation Outcome Scales for Children and Adolescents, HoNOSCA) and overall functioning (measured by the Global Assessment of Functioning scale) statistically improved (all ps < 0.001) from admission to discharge. Additionally, a considerable proportion of patients (from 14% to 21%) clinically recovered to functional levels.Conclusion: Our results support the fact that assertive community treatment can have convincing and positive clinical outcomes in European settings. [ABSTRACT FROM AUTHOR]

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Studying change is a critical part of psychology and science in general. Studies often treat fit as static and use between-person designs to assess change. Accordingly, potentially insightful within-person information is frequently overlooked. The current study aimed to establish the utility of reliable change methodology within the domain of organizational psychology, using needs-supplies fit as a guiding framework. When employee needs can be tracked with a fair degree of clarity, organizations can devise better strategies to routinely address discrepancies between desired employee needs and organizational offerings. This longitudinal study used secondary data from 258 secondary school teachers. The Needs-Supplies Fit Scale was administered. The study’s hypothesis was assessed through reliable change methodology. When considering all the participants that experienced at least some change across time intervals (n = 148), 23.65% (n = 35) of this change was meaningful. This declined to 17.33% meaningful change when factoring in the entire sample, including those who did not experience any change. When organizations are aware of the ever-evolving needs of employees, quicker action can be taken to avoid impending person-environment misfit. This study contributes to existing within-person studies that showcased the malleability of needs-supplies fit and emphasize the value of placing a more prominent focus on the individual. [ABSTRACT FROM AUTHOR]

Background: Although major depressive disorder is usually treated with antidepressants, only 50–70% of the patients respond to this treatment. This study applied Jacobson and Truax’s (1991) methodology (reliable change index, RCI) to a sample of depressive patients being treated with one of two antidepressants to evaluate their functioning and the effect of certain variables such as severity and age.Method: Seventy-three depressive patients medicated with Escitalopram (n = 37) or Duloxetine (n = 36) were assessed using the Hamilton depression rating scale over a 24-week period.Results: They indicate that the RCI stabilizes in an absolute way starting in week 16, and it is not until week 24 that all of the patients become part of the functional population. We found limited statistical significance with respect to the RCI and the external variables.Conclusion: Our study suggests the need to accompany the traditional statistical methodology with some other clinical estimation systems capable of going beyond a simple subtraction between pre and posttreatment values. Hence, it is concluded that RCI estimations could be stronger and more stable than the classical statistical techniques.

Midazolam is a widely used sedative agent during colonoscopy, with cognitive toxicity. However, the potential cognitive hazard of midazolam-based light sedation has not been sufficiently examined. We aimed to examine the cognitive safety and vulnerability profile under midazolam light sedation, with a particular focus on individual variations. Methods: We conducted a prospective case-controlled study in an academic hospital. In total, 30 patients undergoing sedative colonoscopy as part of a health check-up were recruited. Neuropsychological testing on the full cognitive spectrum was evaluated at 15 minutes and 120 minutes after low-dose midazolam administration. The modified reliable change index (RCI) was used for intrapersonal comparisons and controlling for practice effects. Results: Midazolam affected psychomotor speed (48%), memory (40%), learning (32%), working memory (17%), and sustained attention (11%), while sparing orientation and the fluency aspect of executive function at the acute stage. Residual memory (10%) and learning (10%) impairments at 2 hours after administration were evidenced in some patients. The three object recall and digit symbol coding tests can serve as useful screening tools. Conclusion: Midazolam-based light sedation induced selective cognitive impairments and prolonged cognitive impairments occurred in patients with advanced age. A longer observation time and further screening were recommended for patients due to their at risk state.

Individual changes over time in cognition in patients with psychotic disorders have been studied very little, especially in the case of first episode psychosis (FEP). We aimed to establish whether change in individual trajectories in cognition over 2 years of a sample of 159 FEP patients was reliable and clinically significant, using the reliable change index (RCI) and clinically significant change (CSC) methods. We also studied a sample of 151 matched healthy controls. Patients and controls were assessed with a set of neuropsychological tests, as well as premorbid, clinical and functionality measures. We analysed the course of cognitive measures over time, using analysis of variance, and the individual trajectories in the cognitive measures with the regression-based RCI (RCISRB) and the CSC. The RCISRB showed that between 5.4 and 31.2% of the patients showed deterioration patterns, and between 0.6 and 8.8% showed improvement patterns in these tests over time. Patients showing better cognitive profiles according to RCISRB (worsening in zero to two cognitive measures) showed better premorbid, clinical and functional profiles than patients showing deterioration patterns in more than three tests. When combining RCISRB and CSC values, we found that less than 10% of patients showed improvement or deterioration patterns in executive function and attention measures. These results support the view that cognitive impairments are stable over the first 2 years of illness, but also that the analysis of individual trajectories could help to identify a subgroup of patients with particular phenotypes, who may require specific interventions. [ABSTRACT FROM AUTHOR]

Background: Although major depressive disorder is usually treated with antidepressants, only 50–70% of the patients respond to this treatment. This study applied Jacobson and Truax’s (1991) methodology (reliable change index, RCI) to a sample of depressive patients being treated with one of two antidepressants to evaluate their functioning and the effect of certain variables such as severity and age. Method: Seventy-three depressive patients medicated with Escitalopram (n = 37) or Duloxetine (n = 36) were assessed using the Hamilton depression rating scale over a 24-week period. Results: They indicate that the RCI stabilizes in an absolute way starting in week 16, and it is not until week 24 that all of the patients become part of the functional population. We found limited statistical significance with respect to the RCI and the external variables. Conclusion: Our study suggests the need to accompany the traditional statistical methodology with some other clinical estimation systems capable of going beyond a simple subtraction between pre and posttreatment values. Hence, it is concluded that RCI estimations could be stronger and more stable than the classical statistical techniques. [ABSTRACT FROM AUTHOR]

Introduction: Primary prevention of mental disorders is a major issue in positive psychiatry. Adjustment disorder is one of the very few discrete mental disorders linked to an etiological factor, namely psychosocial stressors given rise to a maladaptive reaction with a course of symptoms vanishing with the removal of the stressor. We have focused on a measurement-based method to prevent the development of an adjustment disorder. Aim: The aim of this study has been to analyze from an ongoing Worklife Barometer Survey in which the World Health Organization Well-Being Scale (WHO-5) has been applied to prevent distress leading to an adjustment disorder. Methods: Persons identified with a decrease of 15 points in their repeatedly WHO-5 ratings over three months were through a brief psychological intervention by experienced psychologists. The Reliable Change Index (RCI) was used to determine the clinically meaningful change in the WHO-5 ratings. Results: Within the group who received the psychological intervention (N = 1338), 35% of the persons were identified by the RCI analysis to have developed a clinically reliable change in the WHO-5 at the time of the intervention. The remaining 65% of the persons obtained changes in the WHO-5 which might be considered as spontaneous fluctuations. In the month after the intervention, the persons with a clinically reliable change in the WHO-5 were restored. Conclusion: In this measurement-based pilot study, the repeatedly WHO-5 ratings identified a group of persons with a clinically reliable change in WHO-5 and a clinically significant improvement after a brief psychological intervention. [ABSTRACT FROM AUTHOR]

The stability of psychopathic personality disturbance (PPD) has important theoretical implications for developmental criminology and population heterogeneity perspective assertions that psychopathy is a key measure of criminal propensity. Data from the Pathways to Desistance Study (n = 1,354) were used to examine short-, moderate-, and long-term reliable change in symptoms of PPD measured via the Youth Psychopathic Traits Inventory (YPI). Youth scoring highest on the YPI at the baseline assessment were most likely to experience reliable decreases in test scores. Binomial regression analyses showed that a reliable decrease in YPI test score was associated with decreased odds of endorsing additional offenses. Findings contrasted the adolescent “fledgling” psychopathy perspective and indicated that individuals scoring high on the YPI are the group most likely to experience reliable decreases in test scores, especially over a longer follow-up period. [ABSTRACT FROM AUTHOR]

Introduction: Congenital central hypoventilation syndrome (CCHS) is a rare genetic disorder due to paired-like homeobox gene (PHOX2B) mutations. CCHS patients suffer from dysregulation of the autonomic nervous system characterized by the absence of or extremely reduced response to hypercapnia and hypoxia, with neuropsychological deficits. The aim of this exploratory study is to describe the longitudinal neuropsychological profile and its correlations with magnetic resonance imaging (MRI) of a child with CCHS with a PHOX2B mutation.Method: A comprehensive neuropsychological evaluation was conducted serially at age 7 years 4 months and 10 years 3 months, including assessment of intellectual functioning (IQ), motor functioning, perception, attention, executive functions, language, memory, social cognition, academic skills, and psychopathology. Reliable change index (RCI) scores were used to assess changes between assessments. We collected spin lattice relaxation time (T1)-weighted, fluid-attenuated inversion recovery (FLAIR), and spin spin lattice relaxation time (T2)-weighted images from the child at age 10 years 3 months using a 1.5-tesla MRI scanner.Results: IQ, processing speed index (PSI), social cognition (theory of mind and facial emotion recognition), selective attention, naming, academic skills (reading/comprehension), and manual speed with right hand declined in the second evaluation relative to the initial evaluation, while visuoconstructional praxis, receptive vocabulary, working memory, and arithmetic skill improved. The patient showed a remarkable global deterioration in executive functions (planning, task flexibility, behavioral regulation, and metacognition) as revealed by parental report and clinical evaluation. MRI revealed gliosis from the head to tail of the hippocampus and thinning of parahippocampal gyri.Conclusions: In a clinical case of CCHS, serial evaluation revealed deterioration of executive functions and social cognition over a 3-year interval. These changes corresponded to hippocampal damage as revealed in MRI, which may have affected social cognition through its role in the default mode network. Serial neuropsychological assessment is clinically useful in managing the needs of these patients. [ABSTRACT FROM PUBLISHER]

The purposes of this study were (a) to determine the reliable change in post-concussion-like symptoms reported following self-selected exercise or sports activities and (b) to explore the potential influence of gender and exercise parameters on post-concussion-like symptoms reported by a non-concussed cohort following exercise/training. A pre-to-post observational design was used. A convenience sample of students aged 18-30 years who visited a university recreation center to engage in their chosen exercise activity and a purposeful sample of men's and women's rugby union players engaged in their regular training sessions were included in the study. All participants reported their symptoms using the symptom scale of the Sport Concussion Assessment Tool 2. The reliable change index was used to determine the change in symptom scores reported from pre-to post-exercise/training. Multiple linear regression analysis was used to model the exercise variables to explain the impact on the reporting of symptoms. A total of 260 participants (146 males and 114 females) completed their self-selected exercise activity or rugby union training. Approximately two-thirds of all participants did not demonstrate a change (increase or decrease) in total symptom score (201/260, 77.9%) and/or symptom severity score (212/260, 81.9%) from pre-to post-exercise/training. The symptom response following exercise or sports training did not change in the majority of participants. Clinicians need to be aware of these findings to make informed decisions on return-to-play following a concussive brain injury. [ABSTRACT FROM AUTHOR]

Background: The role of non-infective inflammatory response (IR) in the aetiology of postoperative cognitive dysfunction (POCD) is still controversial. The aim of this controlled, prospective observational study was to assess the possible relationship between the grade of IR, defined by procalcitonin (PCT) changes, and development of POCD related to cardiac surgery. Methods: Forty-two patients, who were ≥ 60 years of age and scheduled for elective cardiac surgery, were separated into the low inflammatory (LIR) and high inflammatory (HIR) response groups based on their PCT levels measured on the first postoperative day. A matched normative control group of 32 subjects was recruited from primary care practice. The PCT and C-reactive protein (CRP) levels were monitored daily during the first five postoperative days. The cognitive function and mood state were preoperatively tested with a set of five neurocognitive tests and two mood inventories and at the seventh postoperative day. The Reliable Change Index modified for practice (RCIp) using data from normative controls was applied to determine the significant decline in test performance. Results: The LIR (n = 20) and HIR (n = 22) groups differed significantly in the PCT (p<0.001) but not in the CRP time courses. The incidence of POCD at the first postoperative week was 35.7% in the cohort. The LIR and HIR groups did not vary in the RCIp Z scores of neurocognitive tests and frequencies of POCD (7 vs 8 cases, respectively, p > 0.05). Additionally, there was no difference in the mood states, anxiety levels and perioperative parameters known to influence the development of POCD. Conclusions: In this study, the magnitude of the non-infective inflammatory response generated by on-pump cardiac surgery did not influence the development of POCD in the early postoperative period in elderly patients. [ABSTRACT FROM AUTHOR]

Background It is widely understood that statistical significance should not be equated with clinical significance, but the topic of clinical significance has not received much attention in the nursing literature. By contrast, interest in conceptualizing and operationalizing clinical significance has been a “hot topic” in other health care fields for several decades. Objectives The major purpose of this paper is to briefly describe recent advances in defining and quantifying clinical significance. The overview covers both group-level indicators of clinical significance (e.g., effect size indexes), and individual-level benchmarks (e.g., the minimal important change index). A secondary purpose is to describe the extent to which developments in clinical significance have penetrated the nursing literature. Methods A descriptive analysis of a sample of primary research articles published in three high-impact nursing research journals in 2016 was undertaken. A total of 362 articles were electronically searched for terms relating to statistical and clinical significance. Results Of the 362 articles, 261 were reports of quantitative studies, the vast majority of which (93%) included a formal evaluation of the statistical significance of the results. By contrast, the term “clinical significance” or related surrogate terms were found in only 33 papers, and most often the term was used informally, without explicit definition or assessment. Conclusions Raising consciousness about clinical significance should be an important priority among nurse researchers. Several recommendations are offered to improve the visibility and salience of clinical significance in nursing science. [ABSTRACT FROM AUTHOR]

Practice effects are improvements on cognitive tests as a result of repeated exposure to testing material. However, variability exists in the literature about whether patients with amnestic mild cognitive impairment (MCI) display practice effects, which may be partially due to the methods used to calculate these changes on repeated tests. The purpose of the current study was to examine multiple methods of assessing short-term practice effects in 58 older adults with MCI. The cognitive battery, which included tests of memory (Hopkins Verbal Learning Test–Revised and Brief Visuospatial Memory Test–Revised) and processing speed (Symbol Digit Modalities Test and Trail Making Test Parts A and B), was administered twice across one week. Dependentttests showed statistically significant improvement on memory scores (ps < .01,ds = 0.8–1.3), but not on processing speed scores. Despite this, the sample showed no clinically meaningful improvement on any cognitive scores using three different reliable change indices. Regression-based change scores did identify relatively large groups of participants who showed smaller than expected practice effects, which may indicate that this method is more sensitive in identifying individuals who may portend a declining trajectory. Practice effects remain a complex construct, worthy of continued investigation in diverse clinical conditions. [ABSTRACT FROM AUTHOR]

Objective:The aim was to examine the reliability and validity of two measures of learning and memory within the CogState Computerized Battery: the One Card Learning (OCL) and the Continuous Paired Associative Learning (CPAL). Comparison of various reliable change measures was also included to examine rate of correct cognitive change classification, in particular, when using the Within-Subject Standard Deviation (WSD).Method:The OCL and the CPAL tests were administered twice and compared to standard and experimental versions of conventional neuropsychological tests in patients with seizure disorders (Baselinen = 80, Follow-up = 54) and university students (Baselinen = 89, Follow-upn = 87). Calculations of Reliable Change Indices (RCIs) on individual performance were obtained to detect reliable change across time using published CogState and current study parameters.Results:Results showed low retest reliabilities in both OCL and CPAL tests (r’s = .49–.77). Small to medium convergent validity correlations with traditional tests of learning and working memory were also found. Discrepancies in RCIs methods on performance estimation were observed when different test parameters and reliabilities were used. In contrast to recent recommendations by publishers of the CogState tests, the WSD method was found to substantially increase the rate of Type-I error when tests reliabilities were low.Conclusions:Unsatisfactory reliability and validity estimates suggest caution regarding the CogState computerized measures of learning and memory as opposed to conventional tests. Caution should be used when interpreting OCL and CPAL test scores, as confidence intervals may be wide and encompass much of the population range. In line with previous recommendations, use of the WSD to detect change in performance over time should be avoided in neuropsychological testing, as this change measure is prone to elevated misclassification rates compared to other methods. Further independent research is needed to improve the psychometrics of CogState OCL and CPAL measures. [ABSTRACT FROM PUBLISHER]

Objective: In recent years, treatment of substance use disorder has rekindled emphasis on recovery which, being a gradual process, starts with remoralization. In this study, we examine the level of demoralization throughout the treatment process for patients with comorbid substance dependence and psychiatric disorders.Methods: 217 patients with co-occurring disorders and 179 community-based individuals participated in this study. Demoralization was measured twice over one month as inpatient treatment happened.Results: In contrast with the community sample, we found high levels of demoralization in the clinical cohort, with 86% of patients having demoralization scores above threshold. During the first month there was a statistically significant reduction in demoralization scores. However, clinically relevant change appeared limited, with only 3% of patients moving from dysfunctional to functional status in this naturalistic setting without targeted intervention aimed at remoralization.Conclusions: Although the level of demoralization is significantly improved during the first month of treatment, patients still remain strongly demoralized. Clinically relevant improvement is limited. It could be worthwhile to set up targeted interventions aimed at remoralization. Furthermore, we advocate for the assessment of demoralization in the clinical setting to monitor patients' treatment outcomes. [ABSTRACT FROM AUTHOR]

The objective of the study was to investigate change and predictors of change in health-related quality of life (HRQoL) in relatives of patients with severe traumatic brain injury (TBI) during rehabilitation, and to analyse associations between changes in HRQoL and symptoms of anxiety and depression. The Vitality (VT), Mental Health (MH), Social Function (SF) and the Role Emotional (RE) scales from the Short Form 36, and the anxiety and depression scales from the Symptom Checklist-90 – Revised were used. Of the 62 relatives, 24.6% experienced a reliable improvement on the VT scale, 53.2% on the MH scale, 27.4% on the SF scale and 16.1% on the RE scale. Of the relatives, 24.0% experienced clinically significant change (CSC) on the VT scale, 19.6% on the MH scale, 21.6% on the SF scale, and 19.2% on the RE scale. Relatives’ age and higher patient Glasgow Coma Scale score predicted the experience of CSC in RE, and change on the Functional Independence Measure in patients predicted CSC on the MH scale. Improvements in VT as well as MH were associated with improvement in symptoms of anxiety and depression, and improvement in SF was associated with improvement in symptoms of depression. About one-fifth of the sample experienced a CSC on one of the four HRQoL measures. Relatives experiencing CSC tended to be related to patients who showed more improvement during rehabilitation. Improvements in HRQoL were associated with improvements in symptoms of anxiety and depression. [ABSTRACT FROM PUBLISHER]

Background: Although a growing number of studies have demonstrated the efficacy of Acceptance and Commitment Therapy (ACT) for the treatment of psychological disorders, the effectiveness of transdiagnostic group ACT programmes in an applied clinical setting requires further evaluation. Methods: The current study examined the effectiveness of a 10‐week ACT transdiagnostic group programme delivered in a private psychiatric hospital. Pre‐ and post‐treatment outcomes were measured in 55 adults presenting with various psychiatric diagnoses. Treatment processes were also analysed. Results: At post‐intervention, participants demonstrated significantly greater valued living, cognitive defusion, and acceptance. No significant differences were evident in participants' mindfulness. Significant improvements were also evident on depression, anxiety, stress, functional disability, satisfaction with life, and personal well‐being. Reliable change indices were also calculated and revealed reliable improvements in a range of outcomes for 27% to 46% of participants. Participant attendance rates, clinician adherence to the manualised ACT content, and patient satisfaction were all high. Conclusions: Collectively, results provided support for the effectiveness of ACT in increasing psychological flexibility and improving psychological symptoms in a transdiagnostic population. However, the current study also showed that many patients did not respond to the intervention and further research is recommended to ascertain predictors of treatment response. [ABSTRACT FROM AUTHOR]

Context: A mobile application neurocognitive assessment has been used in place of equipment intensive computerized neurocognitive assessment protocol. A previous study reported high to very high test-retest reliability of neurocognitive assessment using the mobile application in healthy adults, but no studies have examined test-retest reliability, reliable change indices (RCIs), and sex effect in middle school and high school populations when conducted 1 year apart., Objective: The purpose of this study was to examine the test-retest reliability and RCIs of baseline data collected at 2-time points approximately 1 year apart using a mobile application neurocognitive rest in middle school and high school athletes. The secondary purpose of the study was to investigate the sex difference in neurocognitive measures., Design: Cross-sectional study., Setting: Institutional., Patients or Other Participants: 172 middle school and high school healthy student-athletes (mean age=13.78±1.59 years old)., Main Outcome Measure(s): Mobile application neurocognitive rest scores (reaction time, impulse control, inspection, and memory)., Results: The result from the study demonstrated that neurocognitive measures had low test-retest reliability across a 1-year time period in middle and high school settings. Upon retesting, reaction time and inspection time improved significantly in both middle and high school athletes, and impulse control showed significant improvement in middle school athletes. More athletes in middle school showed more RCI improvements compared to high school athletes. While both males and females demonstrated improvements in neurocognitive measures throughout adolescence, males outperformed females on reaction time and impulse control., Conclusions: Findings from the study indicate unacceptably low test-retest reliability of a mobile application neurocognitive test most likely due to cognitive development occurring throughout adolescence. Additionally, significant RCIs were noted. These naturally occurring improvements due to cognitive development could mask the post-concussion deficits. The findings warrant consideration of age and sex on the neurocognitive performance of middle and high school athletes.

Objective: The rate at which people obtain reliably improved or declined cognitive test scores when retested, in the absence of a change in clinical condition, is largely unknown. The purpose of this study was to illustrate the prevalence of statistically reliable change scores on memory test batteries in healthy adults and older adults. Method: Participants included three adult and older adult test-retest samples from memory test batteries. Reliable change scores (reliable change index with 90% confidence interval and practice effects) were calculated for the indexes and subtests of each battery. Multivariate analyses involved calculating the frequencies of healthy people obtaining one or more reliably declined or one or more reliably improved scores when considering all change scores simultaneously within each battery. Results: Across all batteries, having one or more reliably changed index or subtest score on retest was common. With most batteries, having two or more reliably changed scores was uncommon. Those with higher intellectual abilities were more likely to have a change on retest; however, no significant differences in base rates were found based on education level, sex, or ethnic minority status. Those older adults who did not have any low memory scores were more likely to improve than decline on retest. Conclusions: Having a single reliably changed score on retest is common when interpreting a battery of memory measures. This has implications for determining cognitive decline and cognitive recovery, suggesting that multivariate interpretation is necessary. [ABSTRACT FROM AUTHOR]