Baseline Single-case Experimental Design Research Articles

STANDARD AND BIOPSYCHOSOCIAL OSTEOPATHIC MANAGEMENT FOR PATIENTS WITH NON-SPECIFIC LOW BACK PAIN (THE OSCAR STUDY): A SINGLE-CASE EXPERIMENTAL DESIGN

Purpose and BackgroundGuidelines recommend biopsychosocial care for chronic, complex musculoskeletal conditions, including non-specific low back pain. The aims were: 1/ to assess how patients with low back pain respond to osteopathic treatment, both before and after an osteopath has completed a Biopsychosocial Pain Management (BPM) course; and 2/ to assess if it is feasible and acceptable for osteopath participants to receive weekly SCED data and use it to guide patient management.Methods and ResultsA multiple baseline single case experimental design trial (clinicaltrials.gov, on 18/10/2021, ID number NCT05120921) with 11 UK osteopaths was conducted. Patients were randomised to early, middle or late treatment start dates. Statistical analysis assessed the change between baseline, intervention and follow-up periods. Primary outcomes were the Numeric Pain Rating (NPR) and Patient Specific Function Scales (PSFS), measured during the baseline, the 6-week intervention, and during a 12-week follow-up period.At baseline, the osteopaths reported stronger biopsychosocial attitudes to pain, compared to biomedical beliefs (PABS: 34 behavioural scale; 29 biomedical scale). Overall, patient participants showed daily increases in symptoms during the pre-treatment phase (+0.24/day, p<0.001), and daily decreases during treatment (−2.94 over the treatment phase, p<0.001), which continued post-treatment (−3.36 over 12 weeks, p=0.04). Similar improvements were observed for function.ConclusionOsteopathic care was shown to help patients with persistent low back pain. Patient recruitment was challenging because of the randomisation. With further development, the method shows feasibility as a means of enhancing research activity among practising clinicians.Previous presentations or publications of the workThe protocol was published (https://doi.org/10.1016/j.ijosm.2023.100660) and presented at SBPR in 2022. The results were presented to an osteopathic conference in October 2023.Ethics approval was received from the University College of Osteopathy Research Ethics Committee.Conflicts of interestsJerry Draper-Rodi receives fees from the sales of the e-learning course on the biopsychosocial management on the UCO CPD platform.Sources of fundingThe research was funded by the Osteopathic Foundation.

Effect of digital game intervention on cognitive functions in older adults: a multiple baseline single case experimental design study

BackgroundResidents in nursing homes are prone to cognitive decline affecting memory, visuospatial cognition, and executive functions. Cognitive decline can lead to dementia, necessitating prioritized intervention.MethodsThe current study aimed to investigate whether an intervention using a digital game was effective for preserving and improving the cognitive function of residents in nursing homes. An intervention study was conducted using a single-case AB design with multiple baselines. The participants in the study were five older adults aged 65 and over who do not play digital games regularly. The study ran for 15 weeks, including a baseline (phase A) and an intervention phase (phase B). Phase A had five baselines (5 to 9 weeks) with random participant assignment. In phase B, participants engaged in a digital game (Space Invaders) individually. Cognitive function was assessed as the outcome, measured using the Brain Assessment (performed on a tablet through the Internet) at 16 measurement points. Four of five participants (two female and two male) were included in the analysis, using visual inspection and Bayesian statistics with multi-level modeling.ResultsVisual inspection of the graphs revealed cognitive function score improvements after the intervention for most layers in terms of memory of numbers, memory of words, mental rotation test (visuospatial ability), and total scores in the Brain Assessment. These effects were also significant in the analysis by multi-level modeling.ConclusionsThe results suggest that the use of digital games may be effective for preserving and improving cognitive function among residents of nursing home.Trial registrationThis study was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000048677; public title: Effect of a Digital Game Intervention for Cognitive Functions in Older People; registration date: August 30, 2022).

OSCAR (Osteopathic Single CAse Research) – Assessing the effect of standard and biopsychosocial osteopathic management for patients with non-specific low back pain: Protocol for a Single Case Experimental Design (SCED)

BackgroundOsteopathy has been shown to be effective in the management of chronic low back pain (LBP). Guidelines recommend biopsychosocial care for chronic, complex musculoskeletal conditions, including non-specific LBP. ObjectivesThis study has four aims: 1/to assess how patients with LBP improve after osteopathic treatment, both before and after an osteopath has completed a Biopsychosocial Pain Management course; 2/to assess if it is feasible and acceptable for osteopaths to receive weekly SCED data and use it to guide patient management; 3/to assess if it is acceptable for patients to submit daily data and discuss weekly summary with their osteopaths; and 4/to test feasibility for researchers in collecting, managing and storing large quantities of individual patient data. MethodsA multiple baseline single case experimental design trial with up to 10 UK osteopaths with more than 15 years in practice and 60 patients will assess how change occurs as a result of osteopathic treatment for patients with non-specific LBP of more than 12 weeks’ duration. Statistical analysis will assess the degree and rate of change between baseline, intervention and follow-up periods, and whether differences in effect are observed after the osteopaths have completed the biopsychosocial patient management training course. Primary outcomes will be the Numeric Pain Rating and Patient Specific Function Scales, measured daily at baseline and for 6 weeks during the intervention stage, and weekly or fortnightly during a 12-week follow-up period. EthicsThis research was approved by the University College of Osteopathy Research Ethics Committee.

The Effects of a Virtual Reality-Based Training Program for Adolescents With Disruptive Behavior Problems on Cognitive Distortions and Treatment Motivation: Protocol for a Multiple Baseline Single-Case Experimental Design.

BackgroundSerious disruptive behavior among adolescents is a prevalent and often persistent problem. This highlights the importance of adequate and effective treatment to help adolescents with disruptive behavior problems react less hostile and aggressive. In order to create a treatment environment in which behavioral change can be enhanced, treatment motivation plays an essential role. Regarding treatment itself, a focus on challenging self-serving cognitive distortions in order to achieve behavioral change is important. Street Temptations (ST) is a new training program that was developed to address both treatment motivation and cognitive distortions in adolescents with disruptive behavior problems. One of the innovative aspects of ST is the use of virtual reality (VR) techniques to provide adolescents during treatment with visually presented daily social scenarios to activate emotional engagement and dysfunctional cognitions. By using the VR scenarios as an integral starting point of ST’s sessions and transferring the power of the VR experience into playful and dynamic exercises to practice social perspective–taking, adolescents are encouraged to reflect on both their own behavior and that of others. This focus on reflection is grounded in ST’s main treatment mechanism to influence treatment motivation and cognitive distortions, namely, mentalizing (ie, reflective functioning).ObjectiveThe aim of this study is to describe the research protocol to evaluate the effects of ST on treatment motivation and cognitive distortions. We take a closer look at the use of ST and the methodology used, namely, the repeated single-case experimental design (SCED).MethodsThe effects of ST are studied through a multiple baseline SCED, using both quantitative and qualitative data. In total, 18 adolescents from secure residential youth care facilities and secondary special education schools are randomly assigned to 1 of the 3 different baseline conditions. Throughout the baseline phase (1, 2, or 3 weeks), intervention phase (4 weeks), and follow-up phase (1, 2, or 3 weeks), daily measurements on treatment motivation and cognitive distortions are conducted. Secondary study parameters are assessed before baseline, after intervention, and after follow-up. Qualitative data are collected after intervention, as well as at 3 months and 6 months after the intervention.ResultsData collection for this study started in November 2021 and is planned to be completed by August 2023. The results will be published in peer-reviewed journals and presented at national and international conferences.ConclusionsST aims to improve the disruptive behavior problems of adolescents. This study will be the first to gain insights into the effectiveness of ST. The strengths of this study include its thorough and individually focused design (SCED), the focus on a residential as well as a secondary special education setting, and the ecological validity. The implications for practice are discussed.Trial RegistrationCentral Committee on Research Involving Human Subjects NL75545.029.20. Netherlands Trial Register NL9639; https://www.trialregister.nl/trial/9639International Registered Report Identifier (IRRID)PRR1-10.2196/33555

Vocabulary Acquisition and Usage for Late Talkers Treatment: Effect on Expressive Vocabulary and Phonology.

Purpose This study examined the effect of Vocabulary Acquisition and Usage for Late Talkers (VAULT) treatment on toddlers' expressive vocabulary and phonology. Parent acceptability of VAULT treatment was also considered. Method We used a nonconcurrent multiple baseline single case experimental design with three late talking toddlers aged 21-25 months. The treatment was delivered twice weekly in 30-min sessions for 8 weeks by a rotating team of four speech-language pathologists. Toddlers heard three of their 10 strategically selected target words a minimum of 64 times in play activities each session. Expressive vocabulary and phonology was assessed pre-post, with parent interviews conducted posttreatment. Results All toddlers increased production of target words and expressive vocabulary. Ambient expressive vocabulary size increased by an average of 16 words per week (range of 73-169 words learned over the treatment period). On a 20-item, single-word speech assessment, the toddlers' phonetic inventories increased on average from three to seven consonants, and five to eight vowels. Two toddlers used protowords pretreatment, which were replaced by recognizable attempts at words posttreatment. Parents reported the treatment was acceptable for the child and their family with future consideration of parent-based delivery of the treatment in the home. Conclusions The results of this treatment provide further evidence of a model of intervention informed by the principles of implicit learning, and the interconnectedness of phonological and lexical learning. Investigation is required to establish the efficacy and feasibility of VAULT in clinical contexts. Supplemental Material https://doi.org/10.23641/asha.14714733.

Detecting behavioural change in conversation: procedures and preliminary data

ABSTRACT Background Improvement in daily life activities such as conversation has been prioritized by people with aphasia, which has led to an increased interest in developing and evaluating therapies that target conversation abilities. However, many questions remain about reliable and valid procedures for examining outcomes related to conversation. In this paper, we detail a procedure for quantifying conversational behaviours to improve the protocol described in previous interaction-focused studies and report preliminary data on the effects of a conversation-based intervention using the refined protocol. Methods & Procedures To address the first aim, the authors reviewed procedures developed for previous interaction-focused interventions and included additional practices in the procedure to increase experimental control, ensure similarity across samples, and capture reliability data. To address the second aim, a multiple baseline single case experimental design was employed to examine potential treatment effects associated with a conversation-based intervention across two participants with aphasia. Outcomes & Results Krippendorff’s alpha statistics revealed inter-rater reliability scores ranging from 0.81 to 0.98 for identifying conversation-based outcomes. Visual inspection and statistical analysis of intervention data revealed improvement in frequency of conversation strategy usage over baseline levels and medium to large treatment effects for two of the three strategies targeted in both participants. Conclusions Results of this study, coupled with findings from previous studies of conversation intervention, add to the growing body of literature which highlights the possible efficacy of interaction-focused intervention and the therapeutic value of natural contexts such as conversation. Developing effective, conversation-based therapies will help to bring treatment practices into closer alignment with client values which tend to emphasize conversational abilities as therapeutic targets.

Rhythmic Auditory Stimulation In Gait Rehabilitation For Children And Youth Following Acquired Brain Injury

Background/Aims Relearning to walk is an important goal for many children and young people after acquired brain injury. Rhythmic auditory stimulation uses rhythm to support gait retraining. Its efficacy has been shown for adults with acquired brain injury and children and young people with cerebral palsy. No studies exist for children and young people with acquired brain injury. The aim of this pilot study was to investigate whether the addition of rhythmic auditory stimulation to standard physiotherapy improves children and young people's gait speed and quality after severe acquired brain injury. Methods Four children and young people (aged 10–13 years) with severe acquired brain injury accessing residential rehabilitation were recruited to a multiple baseline single case experimental design study, AB design. During baseline (A) phase children and young people accessed standard rehabilitation (10 physiotherapy sessions per week). In the intervention (B) phase, 2 out of the 10 standard physiotherapy sessions were replaced with rhythmic auditory stimulation. Length of baseline was randomised and intervention phases were 4 weeks. The 10 m walk test and Edinburgh Visual Gait Scale were completed pre and post sessions biweekly. Data analysis including visual analysis of level, slope and trend of the data will be presented with the results of a test of statistical significance. Results Data collection will finish in December 2018. Early results indicate that the quality of walking improved more during the intervention phase than the baseline phase for at least one of the participants, and rhythmic auditory stimulation was equal to normal physiotherapy in the other participants. Statistical testing is required. Conclusions Early results indicate that rhythmic auditory stimulation is at least as effective as normal physio in improving the walking quality of children and young people with acquired brain injury, but this needs to be confirmed. Recommendations for clinical practice and future studies can be made based on the findings and experience of this study.

Added-value of Early Post-stroke Spasticity Reduction during Arm-hand Rehabilitation in Improving Functional Arm-hand Skill Performance: A Multiple Baseline Single Case Experimental Design Study

Added-value of Early Post-stroke Spasticity Reduction during Arm-hand Rehabilitation in Improving Functional Arm-hand Skill Performance: A Multiple Baseline Single Case Experimental Design Study

Combining implicit and explicit intervention approaches to target grammar in young children with Developmental Language Disorder

Children with Developmental Language Disorder are likely to experience difficulties with morphosyntax, especially regular past tense marking. Few studies have evaluated the effectiveness of intervention to improve morphosyntax in young school-aged children with DLD. This study investigated the efficacy of combined explicit and implicit intervention techniques delivered by a speech pathologist to improve receptive and expressive grammar, including the use of past tense morphosyntax, using a multiple baseline single case experimental design. Participants were aged six to seven years and received two 1:1 45 minute sessions per week for five weeks (total 7.5 hours) using Shape Coding intervention techniques combined with implicit approaches. Two of the three participants made statistically significant gains on standardized tests of general receptive and expressive grammar. Two of the three children made statistically significant improvement on measures of expressive morphosyntax, with one participant continuing to improve five weeks post treatment. Findings suggest that this approach was efficacious. These findings warrant further investigation using larger group comparison research studies.

Effectiveness of cognitive orientation to (daily) occupational performance (CO-OP) on children with cerebral palsy: A mixed design

BackgroundCerebral palsy (CP) is the most common cause of physical disabilities during childhood. Therapeutic interventions mainly focus on impairment reduction to address motor-based difficulties. In contrast, Cognitive Orientation to daily Occupational Performance (CO-OP) is a cognitive approach, providing intervention at the level of activity and participation. AimsThis study aims to determine whether the CO-OP approach improves motor skills and achievement in motor-based occupational performance goals in children with CP. Methods and proceduresIn this mixed design research (i.e., a multiple baseline single case experimental design and a one-group pretest-posttest design), five children with CP participated in 12 CO-OP intervention sessions. Repeated measures of motor skills for the multiple baseline single case experimental design were taken using the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP); pre- and post-measures of parent/child perception of performance and satisfaction were identified using the Canadian Occupational Performance Measure (COPM); level of achievement was identified using Goal Attainment Scaling (GAS). Outcomes and resultsAccording to the BOTMP results, all children were able to engage in the CO-OP intervention to improve motor performance. Significant differences after treatment were found in both performance and performance satisfaction ratings using the COPM as rated by parents and children. The GAS results showed progress in achievement levels for all children; all goals were achieved or exceeded. Conclusions and implicationsCO-OP intervention can be helpful in improving motor skills and achieving self-identified, motor-based goals in children with CP.

Visual Attention and Key Word Sign in Children with Autism Spectrum Disorder

The aim of this study was to examine the relationship between children’s visual attention to, and acquisition of, Key Word Sign (KWS). Our hypothesis was that children’s visual attention to the clinician’s modelling would be associated with their acquisition and production of KWS. A multiple baseline single case experimental design with additional exploratory analyses was used to examine the effect of visual attention on sign acquisition among three preschool children with ASD. This paper extends from the previous intervention study (see Tan et al. 2014) by examining visual attention as a potential factor underpinning individual differences in sign acquisition documented in the initial study. All three children visually attended to the clinician’s modelling of KWS, and acquired signs to varying degrees following the introduction of KWS intervention. A weak, non-significant correlation was found between the children’s amount of visual attention and their production of signs. The results provide preliminary evidence for a lack of association between children’s amount of ‘looking’ and ‘doing’ during KWS intervention. Replication and examination of other factors impacting on KWS intervention outcomes is required.

Instructional control of the components of alcoholic drinking behavior

The purpose of the present study was to evaluate (1) the influence of instructions on modifying the components of the drinking behavior of alcoholics in the direction of controlled social drinking and (2) the interrelationships among these components. Three inpatient chronic alcoholic males were permitted to drink alcoholic beverages on a daily basis. All drinking sessions were videotaped and occurred within a simulated living room setting. Within a multiple baseline single case experimental design, subjects were sequentially instructed to decrease sip amount, increase intersip interval, and decrease potency (% of alcohol to mix) of their drinks. Instructional control was demonstrated for each component with all subjects. With two subjects, a negative reactivity among components was observed so that positive changes (i.e., toward a controlled drinking pattern) in one component resulted in negative changes (i.e., toward a more “alcoholic” drinking pattern) in other components. For example, as sip amount decreased, intersip interval also decreased so that subjects were drinking more rapidly.