Clinical Assessment Interview for Negative Symptoms (CAINS): A Systematic Review of Measurement Properties

Abstract

Background and hypothesis: Negative symptoms are very important for the overall loss of functioning observed in patients with schizophrenia. There is a need for valid tools to assess these symptoms.

Study design: We used the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) systematic review guideline to evaluate the quality of the clinical assessment interview for negative symptoms (CAINS) as a clinician-rated outcome measurement (ClinROM).

Study results: The search strategy resulted in the retrieval of 13 articles, 11 of which were included in this evaluation. In terms of risk of bias, most articles reported on measures of internal consistency and construct validity, which were overall of good quality. Structural validity, reliability, measurement error, and cross-cultural validity were reported with less than optimum quality. There was a risk of bias in ClinROM development. According to the updated criteria of good measurement properties, structural validity, internal consistency, and reliability showed good results. In contrast, hypothesis testing was somewhat poorer. Results for cross-cultural validity were indeterminate. According to the updated GRADE approach from the COSMIN group the scale received a moderate grade.

Conclusions: The COSMIN standard allows a judgment of the CAINS as an instrument with the potential to be recommended for use, but which requires further research to assess its quality, in particular in the domains of content validity, internal consistency, and cross-cultural validity.

Keywords: antipsychotic; negative symptom; scale; schizophrenia; validation.

Fig. 1.

Overview of the COSMIN methodology. Step 1: Risk of Bias Checklist. Step 2: Updated criteria for good measurement properties. *Portrayed criteria are not complete. For full version, please see COSMIN manual p. 28 table 4. Step 3: GRADE approach. Risk of Bias: as assessed with the RoB Checklist (see table 2 for instructions on downgrading). Inconsistency: valid explanation for inconsistent results. Imprecision: refers to total included sample size. Indirectness: refers to whether studies were performed in population or context of interest. Step 4: Formulate recommendations.