This analysis was repeated for fatigue (0123 scoring method) and physical functioning, as shown in Table 2. The results are consistent. Patients in receipt of PR fare significantly better than patients in receipt of SL at 20 weeks, but the difference is no longer significant at the 70-week outcome. In the main trial results [4], randomization to PR only had a significant effect on the Chalder fatigue scale at 20 weeks when the fatigue scale was scored in 0011. Readers should note that the analysis reported in this paper compares two therapies, delivered by different therapists, in contrast to the main trial results [4], which compared each therapy to GP treatment as usual. Therapist effects are not significant.
Simple one-way analysis of variance models provided estimates of the proportion of variance in outcomes which is associated with the therapist (intra-class correlations, see Table 3). For fatigue scored 0123 at 70 weeks, intraclass correlations were 0.10 and -0.10 for PR and SL, respectively. For physical functioning, there were intraclass correlations of 0.05 and -0.01 for PR and SL, respectively suggesting that differences between therapists accounted for little of the variance in outcomes.
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Table 3. Intraclass Correlation Coefficients (IICC between ratings of therapeutic alliance (across three therapists) in the pragmatic rehabilitation and supportive listening conditions, and change in fatigue and physical functioning at 20 and 70 weeks.
https://doi.org/10.1371/journal.pone.0144623.t003
2. Analysis of differences in the therapeutic alliance between therapists
Table 3 shows that there was a significant main effect of therapist and a significant interaction between therapist and therapy on the patient-rated CALPAS total score and on the CALPAS task element. The significant main effect is due to the lower level of the patient-rated early therapeutic alliance when SL was delivered by therapist 3 compared to when SL was delivered by therapist 1. The significant interaction is the difference in the level of the therapeutic alliance when therapist 3 delivered PR compared to when therapist 1 delivered SL. Interpreting main effects in the presence of a statistically significant interaction requires caution. Inspecting the table of means (Table 1) reveals that for therapist 3, higher CALPAS values were obtained when delivering PR than when delivering SL. This accounts for both the main effect and interaction effect observed on the CALPAS scores. The results for the ‘task agreement’ element of therapeutic alliance exactly echo the results for the full therapeutic alliance, and have the same interpretation.
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