March 27, 2012
Adaptive health interventions are an increasingly important tool in behavioral health. They use individual variables (e.g., severity of condition, patient preferences) to adapt an intervention; then they dynamically use individual outcomes (e.g., response, adherence to treatment) to readapt the intervention. Altering the intensity or type of treatment can be critical to patient success when an individual is not responding, and it can reduce cost and burden when intensive treatment is no longer necessary. Sequential, multiple assignment, randomized trials (SMARTs) provide the high-quality data needed to construct effective adaptive interventions. In a recent article in the Annual Review of Clinical Psychology, “A ‘SMART’ Design for Building Individual Treatment Sequences,” authors Huitan Lei, Susan Murphy, and their collaborators explain the application of SMART in constructing and revising adaptive interventions compared to alternative experimental designs.
David Oslin led the Extending Treatment Effectiveness of Naltrexone study, which used a SMART design to test adaptive interventions that use the drug Naltrexone to treat alcohol dependence. The authors performed an illustrative data analysis on this study to demonstrate the knowledge that can be gained from a SMART. In the article, the authors show how SMARTs can provide information about which treatments are most effective and about how to define success or failure for a patient at intermediate points during the intervention.
Lei, H., Nahum-Shani, I., Lynch, K., Oslin, D., & Muprhy, S. A. (2012). A "SMART" design for building individualized treatment sequences. Annual Review of Clinical Psychology, 8, 14.1 - 14.28. doi: 10.1146/annurev-clinpsy-032511-143152