However, just because the test shows that the effect of treatment is statistically significant, it does not mean that the outcome is clinically important For example, if a large sample size study has a small standard error, it is easier to find small and unimportant effects for treatment that is statistically significant 5. Therefore, when a clinical trial presents a statistically significant difference in its variables, one should also consider whether it is clinically important and large enough to merit a change in practice 16 - Thus, it was possible to answer the two questions in this study based on RCI analyzes and clinical significance 8.
In IG, only two of the 34 individuals did not have a reliable change regarding the knowledge variable, and for only four men, it was not possible to infer that the intervention presented clinical significance for the knowledge variable. In CG, an individual presented a reliable negative change and most of them did not present a reliable change. In the CG, no clinical significance was identified for the knowledge variable in any of the individuals, that is, the statistical significance indicated by the inferential tests did not represent a clinically relevant change in the knowledge variable in the CG.
Therefore, it is suggested that patients with poor knowledge regarding the necessary care at home after surgery are subject to a negative impact on their clinical evolution, since the education of the patient has a satisfactory relation with the reduction of the occurrence of complications, satisfaction improvement, and increased capacity for care and quality of life In the context of the patient with prostatectomy, adequate knowledge allows the patient to be able to perform surgical wound care and the handling of the late bladder catheter LBC at home, as well as to cope with physical side effects such as urinary incontinence and the erectile dysfunction, and the consequent psychological suffering that these effects bring to men and their caregivers The JT Method articulates the analysis of clinical significance more focused on external validity with verification of the reliability of the changes obtained more related to internal validity 4 , In this study, it was very important to use it as a complement to the analysis of statistical significance.
From its application, it was possible to reaffirm the importance of the teaching program and its clinical significance in improving the knowledge of the 34 men who participated in the intervention, as well as the non-clinical representativeness of this variable among the CG participants. In clinical trials, the internal validity is usually verified by inferential statistical techniques based on central mean, median and dispersion standard deviation, standard error measures of the group results.
These analyses evaluate the probability of occurrence of the pre and post-test differences if they are sufficiently robust to discard the hypothesis of representing mere oscillations attributable to an error of measure and to accept that there are changes, attributable to the intervention conditions.
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In these designs, the external validity, mainly in terms of generalization, depends on the sampling characteristics of the IG or CG how representative the sample is of the larger population. Therefore, such tests have little information about the clinical significance of these differences 5 , In the literature, some clinical research that used the JT Method for the treatment of the data in recent years were identified.
There is a study highlighted that compared the performance of the JT Method with three other alternative methods to determine which one best measured the changes in treatment ratings for substance use disorders Another study evaluated an intervention program for hypertensive patients, according to the variables knowledge, skills for self-care, therapeutic adherence, coping strategies and stress management 17 , and other researchers discussed possible statistical analyses based on the relationship between RCI and clinical significance in the context of intervention for the improvement of speech and language disorders 5.
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Finally, a study that verified the use of methods to quantify the clinical significance of the change during participation in an intervention program for alcohol and drug prevention was identified In education, the JT Method has also been applied. Researchers used it to assess the progress of medical undergraduates in learning best practices and identified the major errors made by students More specifically in special education, scholars evaluated RCI and clinical significance for the results of a group of mentally retarded adults who participated in a program to promote social and communicative skills Also in special education, the effects of a phonological remediation program with eight regular students diagnosed with Down Syndrome 23 were verified using the JT method.
Regarding the use of clinical significance in primary nursing studies, a review of the literature with the objective of analyzing the advances of the topic in the area 24 identified that in a sample of quantitative studies published in , only 33 In some of these 33 studies, the citation of the term clinical significance was performed without analysis basis and definition of evaluation strategy.
Therefore, it is expected that the JT Method will offer sufficient advantages for its use in clinical change assessment research, and that may eventually be used by other Brazilian researchers, who wish to have an objective and reliable form of evaluation of change, without disregarding the clinical relevance of the procedure. With the use of the JT method in the analysis of the data of the exemplified clinical study and from the results found, the educational intervention carried out through the combination of oral orientation, writing and telephone follow-up was clinically effective in the scope of improvement knowledge about home care.
It is considered that this study contributes to the nursing science by proving the clinical effectiveness of the proposed intervention. It is clear the relevance of the preparation of patients for hospital discharge, mainly based on the knowledge needs about post-surgical care involving the treatment of individuals with a pathology such as cancer. It is imperative that the nurse carry out the planning and implementation of educational strategies capable of strengthening the knowledge to generate clinical impact in the reestablishment of the patient. In the context of methodological advances, it is believed that this study also has a contribution to future clinical trials in nursing, from the presentation and application of the JT Method, still little known and disclosed in nursing.
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It can be argued that the main differential of the JT Method is the possibility of analyzing individual results. That is, comparing the results of each person before and after a given intervention, even when group parameters are used for the reliability question. Thus, it is expected that this work will contribute to disseminate the potential of this method and stimulate researchers and professionals for its use in clinical nursing research.
Rev Bras Enferm. J Wound Ostomy Continence Nurs. J Speech Lang Hear Res.
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Psicol Teor Pesqui. Assessing clinical significance of treatment outcomes using the DASS Psychol Assess. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol. Cancer treatment and survivorship statistics, CA Cancer J Clin.
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Copenhagen: Samfundslitteratur. Jury board at work - Evaluation of architecture and process. Strebel Eds. London: Routledge. Department of Organization. E-mail: phj. Profile Teaching Publications Research. Primary research areas.
Organization theory Organization of markets and competitions Project management Qualitative method. EcoGrid 2. Link to this homepage. Selected publications. Jacobsen, Joyce P. Matthew J. Rosenbloom, More information Research fields, statistics, top rankings, if available. This author has had 18 papers announced in NEP.
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