Defining reliable change, treatment response and remission on the Florida Obsessive Compulsive Inventory

Response in the treatment of OCD has been defined by an international consensus as. ≥35% reduction on a clinician rated interview, the Yale-Brown Obsessive Scale (Y– BOCS). Remission is defined as a score of ≤12 on the Y-BOCS. However, clinicians do not routinely use an observer rated scale for measuring outcomes as this requires training as well as resources to administer it. The Florida Obsessive Compulsive Inventory (FOCI) is a 5 item self-report scale that can be used for measuring change during treatment. Scores from a clinical service were used to calculate the cut-off scores for response and remission compared to the Y-BOCS and evaluated using receiver operating curves (ROC) analysis. We found that a reduction of 25% on the FOCI best corresponded to a reduction on the Y-BOCS of 35%. A score ≤7 on the FOCI at post-treatment was the optimal cut-off in determining full or partial remission from OCD. A reliable improvement was found to be a score of 6. This may assist clinicians in treatment evaluation and enable comparisons with results from clinical trials, when the Y-BOCS is not available. In a separate out-patient sample we found that the FOCI was just as sensitive to change with the same effect size as the Obsessive-Compulsive Inventory (OCI) and Obsessive-Compulsive Inventory-Revised (OCI-R). The FOCI imposes significantly less burden on clients, being only 5 items, and should be adopted more widely as an outcome measure in OCD.