Would continuous feedback of patient's clinical outcomes to practitioners improve NHS psychological therapy services? Critical analysis and assessment of quality of existing studies

Abstract

Purpose: Continuous outcome monitoring studies have been conducted by one group of researchers in the United States, mainly in university counselling clinics. We completed a systematic review of continuous outcome monitoring and feedback during psychological therapy and assessed the quality and methodological rigour of existing studies to examine if the findings might be applicable to psychological therapy settings in the United Kingdom.

Methods: An electronic database literature search was carried out on studies on or after 1990 to June 2013 using strict research criteria. Independent ratings of the quality of existing studies were undertaken.

Results: Ten studies with original data met inclusion criteria and two meta-analyses. Feedback improves outcomes for clients who are at risk of treatment failure but effect sizes diminish with more severe psychiatric populations. No study has followed up patients to assess maintenance of gains. Study quality is highly variable. Few studies included diagnostic information and details of randomization. Clinical Support Tools are thought to be helpful but how these were used was not described.

Conclusions: Although research in continuous monitoring and feedback of clinical outcomes shows promising results in counselling settings, study quality, and methodological issues set limitations on the generalizability of the findings.

Practitioner points: Feedback improves the outcome of therapy for young people with mild problems for those who are at risk of not improving with therapy. Feedback improves outcomes for those with more severe mental health problems but with reduced effect sizes. We do not know if improved outcomes are sustained. The generalizability of the findings may be limited.

Keywords: Feedback; critical analysis; patient outcomes; psychological therapy.