Predicting Individualized Effects of Internet-Based Treatment for Genito-Pelvic Pain/Penetration Disorder: Development and Internal Validation of a Multivariable Decision Tree Model

Genito-Pelvic Pain/Penetration-Disorder (GPPPD) is a common disorder but rarely treated in routine care. Previous research documents that GPPPD symptoms can be treated effectively using internet-based psychological interventions. However, non-response remains common for all state-of-the-art treatments and it is unclear which patient groups are expected to benefit most from an internet-based intervention. Multivariable prediction models are increasingly used to identify predictors of heterogeneous treatment effects, and to allocate treatments with the greatest expected benefits. In this study, we developed and internally validated a multivariable decision tree model that predicts effects of an internet-based treatment on a multidimensional composite score of GPPPD symptoms. Data of a randomized controlled trial comparing the internet-based intervention to a waitlist control group (N =200) was used to develop a decision tree model using model-based recursive partitioning. Model performance was assessed by examining the apparent and bootstrap bias-corrected performance. The final pruned decision tree consisted of one splitting variable, joint dyadic coping, based on which two response clusters emerged. No effect was found for patients with low dyadic coping ($n$=33; $d$=0.12; 95% CI: -0.57-0.80), while large effects ($d$=1.00; 95%CI: 0.68-1.32; $n$=167) are predicted for those with high dyadic coping at baseline. The bootstrap-bias-corrected performance of the model was $R^2$=27.74% (RMSE=13.22).