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This practical book is designed for applied researchers who want to use mixed models with their data. It discusses the basic principles of mixed model analysis, including two-level and three-level structures, and covers continuous outcome variables, dichotomous outcome variables, and categorical and survival outcome variables. Emphasizing interpretation of results, the book develops the most important applications of mixed models, such as the study of group differences, longitudinal data analysis, multivariate mixed model analysis, IPD meta-analysis, and mixed model predictions. All examples are analyzed with STATA, and an extensive overview and comparison of alternative software packages is provided. All datasets used in the book are available for download, so readers can re-analyze the examples to gain a strong understanding of the methods. Although most examples are taken from epidemiological and clinical studies, this book is also highly recommended for researchers working in other fields.
Cognitive behavioural therapy (CBT) is an evidence-based treatment for chronic fatigue syndrome (CFS). Stepped care for CFS, consisting of a minimal intervention followed by face-to-face CBT, was found efficacious when tested in a CFS specialist centre. Stepped care implemented in a community-based mental health centre (MHC) has not yet been evaluated.
(1) To test the effectiveness of stepped care for CFS implemented in a MHC at post-treatment and at long-term follow-up; and (2) compare post-treatment outcomes of implemented stepped care with treatment outcomes of a CFS specialist centre.
An uncontrolled study was used to test effectiveness of stepped care implemented in a MHC (n = 123). The outcomes of implemented care were compared with the outcomes of specialist care reported in previous studies (n = 583). Data on outcomes from implemented stepped care were gathered at post-treatment and at long-term follow-up. Mixed models were used as method of analysis.
Fatigue decreased and physical functioning increased significantly following implemented stepped care (both p < .001). The follow-up was completed by 94 patients (78%) within 1–6 years after treatment. Treatment effects were sustained to follow-up. Patients in the MHC showed less improvement directly following stepped care compared with patients in a CFS specialist centre (p < .01).
Implemented stepped care for CFS is effective with sustained treatment gains at long-term follow-up. There is room for improvement when compared with outcomes of a CFS specialist centre. Some suggestions are made on how to improve stepped care.