OBJECTIVE To provide a comprehensive assessment of the association between psychological treatment adherence/competence/integrity (ACI) and clinical outcomes. METHOD The review protocol was preregistered (CRD42020193889). Studies that assessed ACI-outcome relationships for adult psychotherapy were searched across three databases (Scopus, PsycINFO, MEDLINE). Random effects meta-analyses were conducted on adherence-outcome, competence-outcome, and integrity-outcome relationships. Separate analyses were performed for studies with hierarchical (i.e., patients nested within therapist) versus nonhierarchical study designs. Moderator analyses were performed according to predefined clinical and methodological features. GRADE assessments rated the quality of each meta-analytic comparison. RESULTS The review identified 62 studies suitable for inclusion (45 adherence-outcome, 39 competence-outcome, and seven integrity-outcome effect sizes; N = 8,210 across all analyses). No significant adherence-outcome association was found. A small significant positive association was found only in nonhierarchical studies between competence and outcome, r = 0.17, 95% CI [0.07-0.26], p < .001, ∼d = .34, GRADE = moderate. Small-to-moderate significant positive associations between integrity and outcome were found for both nonhierarchical, r = 0.15, 95% CI [0.06-0.23], p < .001, ∼d = .30, GRADE = high, and hierarchical study designs, r = 0.23, 95% CI [0.01, 0.43], p < .044, ∼d = .47, GRADE = low. Diagnosis, treatment modality and year of publication significantly moderated the strength of ACI-outcome correlations. CONCLUSIONS Competence and integrity are significantly associated with clinical outcome, with a magnitude comparable to wider common factors. Further research is required to study these process-outcome associations with greater precision in routine-care settings and to understand the role of moderating variables. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

中文翻译：

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治疗依从性-能力-完整性（ACI）与成人心理治疗结果之间的关联：系统评价和荟萃分析。

目的 对心理治疗依从性/能力/完整性 (ACI) 与临床结果之间的关联进行全面评估。方法 审查方案已预先注册（CRD42020193889）。在三个数据库（Scopus、PsycINFO、MEDLINE）中检索了评估成人心理治疗的 ACI-结果关系的研究。对依从性-结果、能力-结果和完整性-结果关系进行了随机效应荟萃分析。对分层研究（即患者嵌套在治疗师内）与非分层研究设计进行了单独分析。根据预定义的临床和方法学特征进行调节分析。GRADE 评估评估了每个荟萃分析比较的质量。结果 该评价确定了 62 项适合纳入的研究（45 项依从性结果、39 项能力结果和 7 项完整性结果效应量；所有分析的 N = 8,210）。没有发现显着的依从性-结果关联。仅在能力和结果之间的非等级研究中发现了一个小的显着正相关，r = 0.17, 95% CI [0.07-0.26], p < .001, ∼d = .34, GRADE = 中等。非分层研究设计的完整性和结果之间存在小到中度显着正相关，r = 0.15, 95% CI [0.06-0.23], p < .001, ~d = .30, GRADE = 高和分层研究设计, r = 0.23, 95% CI [0.01, 0.43], p < .044, ∼d = .47, GRADE = 低。诊断、治疗方式和发表年份显着降低了 ACI-结果相关性的强度。结论 能力和完整性与临床结果显着相关，其幅度与更广泛的共同因素相当。需要进一步研究以在常规护理环境中更精确地研究这些过程-结果关联，并了解调节变量的作用。（PsycInfo 数据库记录 (c) 2022 APA，保留所有权利）。