Accepted Manuscript Title: Motivational interviewing in the medical care setting Author: Johannes C. van der Wouden Chris Rietmeijer PII: DOI: Reference:
S0738-3991(14)00150-5 http://dx.doi.org/doi:10.1016/j.pec.2014.04.012 PEC 4774
To appear in:
Patient Education and Counseling
Received date: Accepted date:
7-4-2014 16-4-2014
Please cite this article as: van der Wouden JC, Rietmeijer C, Motivational interviewing in the medical care setting, Patient Education and Counseling (2014), http://dx.doi.org/10.1016/j.pec.2014.04.012 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
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Ac ce p
Corresponding author at:
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Johannes C. van der Wouden Chris Rietmeijer Department of general practice and elderly care medicine EMGO+ Institute of Health and Care Research VU University Medical Center Amsterdam, The Netherlands
ip t
Motivational interviewing in the medical care setting
Department of general practice and elderly care medicine EMGO+ Institute of Health and Care Research VU University Medical Center Amsterdam, The Netherlands PO Box 7057 1007 MB Amsterdam, The Netherlands Phone: +3120 444 8167 Fax: +3120 444 8361 E-mail: [email protected]
1 Page 1 of 2
ip t
We welcome the systematic review by Lundahl and co-authors on motivational interviewing in the medical care setting.(1) To our knowledge this is the first systematic review on motivational interviewing that shows a positive effect in medical practice. Motivational interviewing is a patient-centered approach; many studies underscore the benefits but strong evidence of positive effects in real life medical settings is lacking thus far, as illustrated by several systematic (Cochrane) reviews. This lack of evidence is a relative obstacle for implementing this approach in practice. Hence our enthusiasm for the results of this review, and also our interest in how the review was performed. We would like to point at a few issues that warrant further clarification.
cr
The difference between the results (odds ratios, p-values) presented in Table 2 and the forest plot (figure 1) is in need of an explanation. What is exactly shown in table versus figure, and how did the authors obtain these data?
an
us
The funnel plot (figure 2) is reported to be symmetrical, hence showing no publication bias. However, what is shown are two types of dots, 51 white spots and 15 black spots. The black spots seem to be mirrored from outliers at the right side of the plot, similar to the ‘trim and fill’ technique as described by Duval and Tweedie (2). As the black diamond (probably including the imputed values) seems to be very close to the ‘no difference’ line or even crossing it, it would be informative to know the 95% confidence interval.
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Finally, it is somewhat misleading to interpret the odds ratio as a relative risk in this case, where the event rate in the control group is far from rare. As the authors report themselves, the odds ratio of 1.55 is based on the difference between 56% improvement in case of motivational interviewing and 44% improvement in the control condition. The chance of improving in case of motivational interviewing is thus 56/44 = 1.27 more likely than in the control group, and not ‘one and a half times’.
Ac ce p
References 1. Lundahl B, Moleni T, Burke BL, Butters R, Tollefson D, Butler C, Rollnick S. Motivational interviewing in medical care settings: a systematic review and metaanalysis of randomized controlled trials. Patient Educ Couns 2013;93:157-68. 2. Duval S, Tweedie R. Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 2000;56:455-63.
2 Page 2 of 2
S0738-3991(14)00150-5 http://dx.doi.org/doi:10.1016/j.pec.2014.04.012 PEC 4774
To appear in:
Patient Education and Counseling
Received date: Accepted date:
7-4-2014 16-4-2014
Please cite this article as: van der Wouden JC, Rietmeijer C, Motivational interviewing in the medical care setting, Patient Education and Counseling (2014), http://dx.doi.org/10.1016/j.pec.2014.04.012 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
cr
Ac ce p
Corresponding author at:
te
d
M
an
us
Johannes C. van der Wouden Chris Rietmeijer Department of general practice and elderly care medicine EMGO+ Institute of Health and Care Research VU University Medical Center Amsterdam, The Netherlands
ip t
Motivational interviewing in the medical care setting
Department of general practice and elderly care medicine EMGO+ Institute of Health and Care Research VU University Medical Center Amsterdam, The Netherlands PO Box 7057 1007 MB Amsterdam, The Netherlands Phone: +3120 444 8167 Fax: +3120 444 8361 E-mail: [email protected]
1 Page 1 of 2
ip t
We welcome the systematic review by Lundahl and co-authors on motivational interviewing in the medical care setting.(1) To our knowledge this is the first systematic review on motivational interviewing that shows a positive effect in medical practice. Motivational interviewing is a patient-centered approach; many studies underscore the benefits but strong evidence of positive effects in real life medical settings is lacking thus far, as illustrated by several systematic (Cochrane) reviews. This lack of evidence is a relative obstacle for implementing this approach in practice. Hence our enthusiasm for the results of this review, and also our interest in how the review was performed. We would like to point at a few issues that warrant further clarification.
cr
The difference between the results (odds ratios, p-values) presented in Table 2 and the forest plot (figure 1) is in need of an explanation. What is exactly shown in table versus figure, and how did the authors obtain these data?
an
us
The funnel plot (figure 2) is reported to be symmetrical, hence showing no publication bias. However, what is shown are two types of dots, 51 white spots and 15 black spots. The black spots seem to be mirrored from outliers at the right side of the plot, similar to the ‘trim and fill’ technique as described by Duval and Tweedie (2). As the black diamond (probably including the imputed values) seems to be very close to the ‘no difference’ line or even crossing it, it would be informative to know the 95% confidence interval.
te
d
M
Finally, it is somewhat misleading to interpret the odds ratio as a relative risk in this case, where the event rate in the control group is far from rare. As the authors report themselves, the odds ratio of 1.55 is based on the difference between 56% improvement in case of motivational interviewing and 44% improvement in the control condition. The chance of improving in case of motivational interviewing is thus 56/44 = 1.27 more likely than in the control group, and not ‘one and a half times’.
Ac ce p
References 1. Lundahl B, Moleni T, Burke BL, Butters R, Tollefson D, Butler C, Rollnick S. Motivational interviewing in medical care settings: a systematic review and metaanalysis of randomized controlled trials. Patient Educ Couns 2013;93:157-68. 2. Duval S, Tweedie R. Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 2000;56:455-63.
2 Page 2 of 2
