Measuring psychological outcomes after cognitive behaviour therapy in primary care: a comparison between a new patient-generated measure “PSYCHLOPS” (Psychological Outcome Profiles) and “HADS” (Hospital Anxiety and Depression Scale)

To assess the sensitivity to within person change over time of an outcome measure for practitioners in primary care that is applicable to a wide range of illness. Comparison of a new patient generated instrument, the measure yourself medical outcome profile (MYMOP), with the SF-36 health profile and a five point change score; all scales were completed during the consultation with' practitioners and repeated after four weeks. 103 patients were followed up for 16 weeks and their results charted; seven practitioners were interviewed. Established practice of the four NHS general practitioners and four of the private complementary practitioners working in one medical centre. Systematic sample of 218 patients from general practice and all 47 patients of complementary practitioners; patients had had symptoms for more than seven days. Standardised response mean and index of responsiveness; view of practitioners. The index of responsiveness, relating to the minimal clinically important difference, was high for MYMOP: 1.4 for the first symptom, 1.33 for activity, and 0.85 for the profile compared with < 0.45 for SF-36. MYMOP's validity was supported by significant correlation between the change score and the change in the MYMOP score and the ability of this instrument to detect more improvement in acute than in chronic conditions. Practitioners found that MYMOP was practical and applicable to all patients with symptoms and that its use increased their awareness of patients' priorities. MYMOP shows promise as an outcome measure for primary care and for complementary treatment. It is more sensitive to change than the SF-36 and has the added bonus of improving patient-practitioner communication.

The client-centred nature of occupational therapy acknowledges the individual as the central element of treatment. This philosophy, however, challenges the therapist to choose an outcome measure that is capable of reflecting this individualized perspective. Recent papers published in the rehabilitation literature have reported on the increased responsiveness of such measures over traditional self-report questionnaires. Although the need for a comprehensive review of individualized outcome measures has been identified in the literature, none exists to date. The purpose of this paper is to review six individualized outcome measures that have been identified in the rehabilitation and psychology literature. The measures include: the Canadian Occupational Performance Measure, the Assessment of Motor and Process Skills, McMaster (MAC) Toronto Arthritis, Goal Attainment Scaling, Target Complaints and the Patient Specific Functional Scale. The reliability, validity, responsiveness and clinical utility of each outcome measure was examined and critiqued. Each tool, to a varying degree, met the description of a standardized, client-centred outcome measure.