Thursday, August 04, 2005

Quality stamp against evaluation

A lot of efforts are going into evaluating different therapies. As I have said before, evaluating the efficacy of a therapy is a very tricky business. And comparing therapies is even more difficult. There are many theoretical issues. Let me list a few. The profile of the clients might be different. The quality of therapist might influence the therapy. Can you punish a therapy where the clients did not follow the instructions. The enormous efforts needed to get a sample big enough for reliable statistics. Defining the correct outcome measures. The time period over which the clients need to be monitored. These are a few of the issues from the top of my head. I agree that criticizing is always much easier than making constructive suggestion for improvement! But let me just re-emphasize that I myself had done a statistical study on patients' data of the KST.

Due to the enormous difficulties to have a controlled environment to do measure therapy efficacy, I believe that national associations must be realistic and go the route of quality control rather than evaluation. Instead of evaluating the success of a therapy, the associations could give out a "quality stamp", a kind of seal of approval. Therapies must fufill certain quality criteria to obtain the "quality stamp". My suggestions would be, for example: The therapy is fully documented. The patients are informed about the latest understanding of PDS. The patients are told that a cure as such is unlikely but a significant improvement with hard work is possible. The therapy has a maintenance phase of at least one year. The therapy or therapist must exist for at least one year. And so on.

So what is your opinion? I think such an approach is doable, even though much work and lobbying would need to be done...

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