Multiple Single-case Experimental Design Research Articles

Individual Patterns and Temporal Trajectories of Changes in Fear and Pain during Exposure In Vivo: A Multiple Single-Case Experimental Design in Patients with Chronic Pain.

Exposure in vivo (EXP) is an effective treatment to reduce pain-related fear and disability in chronic pain populations. Yet, it remains unclear how reductions in fear and pain relate to each other. This single-case experimental design study attempted to identify patterns in the individual responses to EXP and to unravel temporal trajectories of fear and pain. Daily diaries were completed before, during and after EXP. Multilevel modelling analyses were performed to evaluate the overall effect. Temporal effects were scrutinized by individual regression analyses and determination of the time to reach a minimal clinically important difference. Furthermore, individual graphs were visually inspected for potential patterns. Twenty patients with chronic low back pain and complex regional pain syndrome type I were included. On a group level, both fear and pain were reduced following EXP. Individually, fear was significantly reduced in 65% of the patients, while pain in only 20%. A decrease in fear was seen mostly in the first weeks, while pain levels reduced later or remained unchanged. Daily measurements provided rich data on temporal trajectories of reductions in fear and pain. Overall, reductions in fear preceded pain relief and seemed to be essential to achieve pain reductions.

Illness perceptions; exploring mediators and/or moderators in disabling persistent low back pain. Multiple baseline single-case experimental design

IntroductionIllness Perceptions (IPs) may play a role in the management of persistent low back pain. The mediation and/or moderation effect of IPs on primary outcomes in physiotherapy treatment is unknown.MethodsA multiple single-case experimental design, using a matched care physiotherapy intervention, with three phases (phases A-B-A’) was used including a 3 month follow up (phase A’). Primary outcomes: pain intensity, physical functioning and pain interference in daily life. Analyzes: linear mixed models, adjusted for fear of movement, catastrophizing, avoidance, sombreness and sleep.ResultsNine patients were included by six different primary care physiotherapists. Repeated measures on 196 data points showed that IPs Consequences, Personal control, Identity, Concern and Emotional response had a mediation effect on all three primary outcomes. The IP Personal control acted as a moderator for all primary outcomes, with clinically relevant improvements at 3 month follow up.ConclusionOur study might indicate that some IPs have a mediating or a moderating effect on the outcome of a matched care physiotherapy treatment. Assessing Personal control at baseline, as a relevant moderator for the outcome prognosis of successful physiotherapy management of persistent low back pain, should be further eplored.

Effects of a dynamic hand orthosis for functional use of the impaired upper limb in sub-acute stroke patients: A multiple single case experimental design study

OBJECTIVE: To investigate the usability and the effects of a dynamic spring-loaded orthosis, adjunct to therapy-as-usual (TAU), on functional use of the impaired hand in moderately/severely impaired sub-acute stroke patients. DESIGN: Single case experiment (A-B-A’-design). SUBJECTS: Eight sub-acute stroke patients. METHODS: The orthosis was used for six weeks, five days/week, 45’/day, and adjunct to TAU. Outcome measures: Action Research Arm Test (ARAT), ABILHAND, Intrinsic Motivation Inventory (IMI). RESULTS: At group level, patients improved on ARAT (p = 0.001) and ABILHAND (p = 0.005). After detrending for baseline trends (caused by e.g. spontaneous recovery and/or TAU), such improvement was only found for ARAT (p = 0.009). At individual level, three patients whose baseline ARAT changed little (0–3 points), had improved at follow-up, and four remained constant regarding detrended ARAT results. In four patients mean detrended ABILHAND results were higher during follow-up relative to baseline (p 0.036). Average IMI sub-scores were between 5.4 and 6.6 (of 7), except for ‘pressure/tension’ (2.1). CONCLUSION: Patients, who, in the early sub-acute phase after stroke, display only little/modest improvement on their capacity to perform activities or their perceived level of daily performance, seem to benefit most from training with a dynamic arm orthosis. Patients perceived a high intrinsic motivation and sense of self-regulation.

A Multiple Single Case Experimental Design Investigating the Maitland Concept Approach to Treatment of Patients with Probable Cervicogenic Headache

Some physiotherapists specialising in cardiopulmonary care have been identified as ‘experts’ within their field. However, the concept of ‘expertise’ has not been clearly defined in cardiopulmonary care. Consequently, there is little evidence t o inform appropriate undergraduate and postgraduate educational opportunities for facilitation of ‘expertise’. Also, studies into physiotherapy efficacy have failed to take account of possible notions of expertise in cardiopulmonary care. This study aims to help in attempts to define ‘expertise’ in cardiopulmonary care by eliciting clinicians’ perceptions of elements which may characterise expert behaviour using the Delphi technique (Walker and Selfe, 1996). Opinion was sought from an expert panel comprising three groups of physiotherapists: 18 ‘national experts’, 230 senior Is, and 99 senior 11s. Each was sent a selfadministered questionnaire requesting 10-20 adjectives which characterised expert behaviour in physiotherapists specialising in cardiopulmonary care. Round 1 returned 155 forms (15 from national experts, 108 from Senior Is, and 32 from Senior 11s). Content analysis produced a list of categories (31 from experts and senior 11s and 36 from senior Is). Twenty-seven categories were common to all three groups. The round 2 questionnaire was distributed to respondents for ranking in order of preference. Subjects selected and rank ordered 20 categories from those supplied. Round 2 returned 122 forms (12 from national experts, 83 from senior Is (2 spoilt), and 27 from senior 11s (1 spoilt).