Clinical Significance in Real World Settings

[Extract] A while ago, for those of you who read these pieces regularly, you might remember that I spent a bit of time talking about inferential statistics and the question of significance. One of the areas that I touched on, relatively briefly, was the concept of clinical significance. I've been thinking a bit more about this concept lately and thought it might be worthwhile spending more time talking about this.\ud\udThe idea of Clinical Significance came about because there was an increasing criticism of the types of research\udmethodologies applied to real world clinical interventions.\udUntil quite recently the assessment of the relevance of data\udin psychotherapy outcome studies has tended to rely on methodologies which have emphasised internal validity (e.g.\udRandomised Controlled Trials). This approach essentially\udestablishes efficacy — whether or not there is some 'active\udingredient' that may be causally related to change. But, there has been a growing recognition that the question that\udis of most relevance, particularly to clinicians, is one of\udeffectiveness. That is, whether the use of an intervention\udunder more realistic (i.e. 'less controlled') conditions leads to change in 'real' clients. There are a range of arguments against using naturalistic design methodologies from a science perspective, but many clinicians intuitively accept the argument that unless you are using real clients under real conditions it is very hard to argue that an intervention has been properly tested