The impact of response-guided baseline phase extensions on treatment effect estimates

Abstract

BackgroundWhen developmental disabilities researchers use multiple-baseline designs they are encouraged to delay the start of an intervention until the baseline stabilizes or until preceding cases have responded to intervention. Using ongoing visual analyses to guide the timing of the start of the intervention can help to resolve potential ambiguities in the graphical display; however, these forms of response-guided experimentation have been criticized as a potential source of bias in treatment effect estimation and inference. Aims and methodsMonte Carlo simulations were used to examine the bias and precision of average treatment effect estimates obtained from multilevel models of four-case multiple-baseline studies with series lengths that varied from 19 to 49 observations per case. We varied the size of the average treatment effect, the factors used to guide intervention decisions (baseline stability, response to intervention, both, or neither), and whether the ongoing analysis was masked or not. ResultsNone of the methods of responding to the data led to appreciable bias in the treatment effect estimates. Furthermore, as timing-of-intervention decisions became responsive to more factors, baselines became longer and treatment effect estimates became more precise. ConclusionsAlthough the study was conducted under limited conditions, the response-guided practices did not lead to substantial bias. By extending baseline phases they reduced estimation error and thus improved the treatment effect estimates obtained from multilevel models.