Assessing change and establishing empirical cutoffs : the Brief INSPIRE-O measure for personal recovery in mental health services

Abstract

INTRODUCTION: Personal recovery in mental health services, encouraged by the World Health Organization, has gained significance in research and clinical settings. However, measuring personal recovery remains challenging due to the lack of universally accepted instruments. This study assessed Brief INSPIRE-O's ability to map personal recovery by determining cut-off scores and its ability to detect change in the process of personal recovery. METHOD: Data was from the internet-based monitoring system (IMS) at the Mental Health Service, Capital Region of Denmark. Between 2018 and 2020, 8,192 patients with baseline data on Brief INSPIRE-O were included to assess its role in measuring personal recovery. Additionally, for analyses focusing on Brief-INSPIRE-O as a measure of change in personal recovery, we included 2,714 patients with pre- and post-treatment data. MATERIALS: Brief INSPIRE-O was examined along with well-being (WHO-5) and measures of symptom distress (SCL-10), and functioning (SDS-M). RESULTS: Scores on all measures improved from pre- to post-treatment, except for functional impairment (SDS-M). Convergent validity was established with symptom distress (SCL-10; r = -0.63) and functioning (SDS-M; r = -0.55). A 10-point change in WHO-5 corresponded to an 18.9-point increase in Brief INSPIRE-O. ROC analysis identified an empirical cutoff of 50 for personal recovery and 8 points for clinically relevant change. DISCUSSION: The Brief INSPIRE-O demonstrated strong validity and sensitivity to change, supporting its use as a reliable tool for assessing personal recovery and treatment quality in clinical practice. It can be considered a relevant brief patient reported outcome measure to be used in international standards of quality and outcome monitoring.