Outcomes Assessment: Reliable Change Index (RCI) in Assessing Health Outcomes in Clinical Practice

Abstract

Introduction

The assessment of therapeutic outcomes and the evaluation of treatment efficiency and effectiveness is an area of interest for clinicians and researchers. Scientific evidence demands randomized controlled trials and inter-groups comparisons with a minimum number of participants in each treatment modality, a requirement rarely feasible in clinical practice where the assessment of treatment outcomes, with regards to therapeutic goals, is crucial both in terms of statistical significance and clinical relevance.

Objective

The aim of this poster is to present an alternative methodology which permits to evaluate the individual's change.

Method

The reliable change index methodology allows for the estimation of statistical significance (statistically reliable change) and clinical relevance (calculation of cutoff points and its interpretation criteria). Two examples are presented: a group of patients with asthma in treatment and a female with major depression who underwent electroconvulsive therapy (ECT).

Results/discussion

Both cases were analyzed using standardized statistical analyses and the RCI method in order to estimate clinical change. The results illustrated the adequacy of both procedures for decision making in terms of effectiveness. However the RCI offered greater specificity with regards to individual changes. More specifically, RCI provided a more concrete estimation of the proportion of cases of asthma that showed change after the intervention, and also, indicated if such change were not only statistically significant, but also clinically relevant. Besides, when a single case was assessed (ex: ECT case) this methodology proved useful to estimate the efficacy of a continuation and maintenance program.

Disclosure of interest

The authors have not supplied their declaration of competing interest.