The meanings and measurement of clinical significance

The previous articles in this special section make the case for the importa nce of evaluating the clinical significance of therapeutic change, present key measures and innovative ways in which they are applied. and more genera lly provide important guidelines for evaluating therapeutic change. Fundame ntal issues raised by the concept of clinical significance and the methods discussed in the previous articles serve as the basis of the present commen ts. Salient among these issues are ambiguities regarding the meaning of cur rent measures of clinical significance, the importance of relating assessme nt of clinical significance to the goals of therapy, and evaluation of the construct(s) that clinical significance reflects. Research directions that are discussed include developing a typology of therapy goals, evaluating cu toff scores and thresholds for clinical significance, and attending to soci al as well as clinical impact of treatment.