Inconsistent Application of the Reliable Change Index in Clinical Psychology Trials Undermines Comparability of Individual Change Estimates

IF 2.7 3区心理学 Q2 PSYCHOLOGY, CLINICAL

Journal of Clinical Psychology Pub Date : 2026-10-01 Epub Date: 2026-08-08 DOI:10.1002/jclp.70203

Alexander O. Crenshaw, Ameesha MacDonald, Kianan Carr, Alena Shull, Sophia Pope, Madison Blackmon

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引用次数: 0

Abstract

Objective

The reliable change index (RCI) is a valuable idiographic tool used by clinicians and researchers to evaluate whether individual clients experienced statistically detectable change on a given measure. However, numerous RCI methods exist, and the popular Jacobson and Truax (1991) method is underspecified, raising the potential for inconsistent operationalization across studies. The present study evaluated how the RCI is operationalized in psychology clinical trials and explored how RCI operationalization can influence numerical thresholds.

Methods

We conducted a methodological scoping review of four clinical psychology journals published from 2020 to 2023 and coded the operationalization of reliable change in psychology clinical trials. We then used descriptive data from a convenience sample of published psychometric studies to illustrate the impact of operationalization on reliable change thresholds.

Results

Among 226 clinical trials, 29 (13%) formally assessed reliable change. We identified at least seven distinct operationalizations of the RCI, including five distinct operationalizations of the same formula from Jacobson and Truax (1991). In illustrative examples, differences in the specific operationalization of this formula produced absolute RCI threshold discrepancies as large as 79%, or 1.02 standard deviation units.

Conclusion

Operationalization of reliable change is highly inconsistent in clinical trials, which can harm comparability of results across studies. We recommend improved reporting and that clinical trials compute two RCIs. First, the Jacobson & Truax method—using the baseline standard deviation and internal consistency—supports clinician use and improves between-study comparability, though other sources of non-comparability remain. Second, one of several modern methods provides improved within-study RCI evaluation.

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临床心理学试验中不一致的可靠变化指数应用削弱了个体变化估计的可比性。

目的：可靠变化指数（RCI）是临床医生和研究人员使用的一种有价值的具体工具，用于评估个体客户是否在给定的测量中经历了统计上可检测的变化。然而，存在许多RCI方法，而流行的Jacobson和Truax（1991）方法没有明确规定，这增加了在研究中操作不一致的可能性。本研究评估了RCI在心理学临床试验中的运作方式，并探讨了RCI运作如何影响数值阈值。方法：对2020 - 2023年出版的4种临床心理学期刊进行方法学范围综述，并对心理学临床试验中可靠变化的操作化进行编码。然后，我们使用来自已发表的心理测量学研究的便利样本的描述性数据来说明操作化对可靠变化阈值的影响。结果：226项临床试验中，29项（13%）正式评估了可靠变化。我们确定了至少七种不同的RCI操作方法，包括Jacobson和Truax（1991）对同一公式的五种不同操作方法。在说述性的例子中，该公式具体操作的差异产生的绝对RCI阈值差异高达79%，即1.02个标准差单位。结论：在临床试验中，可靠变化的操作化高度不一致，这可能会损害研究结果的可比性。我们建议改进报告和临床试验计算两个rci。首先，Jacobson & Truax方法——使用基线标准差和内部一致性——支持临床医生的使用，并提高了研究间的可比性，尽管其他来源的不可比较性仍然存在。其次，几种现代方法之一提供了改进的研究内部RCI评估。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Psychology PSYCHOLOGY, CLINICAL-

CiteScore

5.40

自引率

3.30%

发文量

177

期刊介绍： Founded in 1945, the Journal of Clinical Psychology is a peer-reviewed forum devoted to research, assessment, and practice. Published eight times a year, the Journal includes research studies; articles on contemporary professional issues, single case research; brief reports (including dissertations in brief); notes from the field; and news and notes. In addition to papers on psychopathology, psychodiagnostics, and the psychotherapeutic process, the journal welcomes articles focusing on psychotherapy effectiveness research, psychological assessment and treatment matching, clinical outcomes, clinical health psychology, and behavioral medicine.