Single-Subject Research Flashcards
Understanding _____ designs, analyses, and applications improves your ability to evaluate the evidence-based literature and eventually to answer your clinical questions.
single-case experimental
Rigorous research with single participants can be applied to your patients, sometimes more ___ than the results of group RCTs.
directly
In a typical single subject design (SSD), one participant is ____.
followed intensely
SD typically creates ___ data, but on only one participant.
abundant
_____ are repeatedly measured during a baseline period, before intervention begins.
This may occur over successive days or weeks.
Variables of interest
The intervention period begins after ____ and then data are collected periodically on the single subject during the intervention.
baseline
Then a period after _____ during which the participant is measured, but no treatment is given.
intervention
The ____ in the variables during the treatment period is then compared to the variables during baseline and post-treatment periods.
change
T or F
In contrast to an SSD, case studies are typically written prospectively and detail the characteristics of one case and the course of intervention for that case.
F (retrospectively)
T or F
A case study is a controlled single-case experimental design.
F (NOT)
T or F
A case study is not a two systematically reported single-patient example that does not include a controlled manipulation of intervention.
T
A case study does not include other experimental controls that are implemented in an ____.
Single-Subject Design (SSD)
Case studies may be helpful to our ____ but they lack systematic control, implementation, and evaluation of treatment.
clinical decisions
_____ for SSDs is different from notation for other intervention designs.
Research notation
___ refers to the phase of observation with measurement.
“A”
T or F
“A” designates baseline or treatment withdrawal phases.
T
“B”
Phase for intervention
This stands for the phase of comparison interventions.
“C, D, etc.”
T or F
Randomized Control Trials can be implemented using SSDs.
T
For an RCT with single subjects, __ is randomly assigned to treatment condition A and the next subject is assigned to an alternative (comparison) treatment B.
1 subject
_____ is standardized across subjects, just as in a group design.
Treatment protocol
This is the benefit of using RCT with single-subject design.
Multiple measures are obtained on each subject
RCT with single-subject design has repeated measures that document the natural fluctuations of the outcome of interest during phases of ____ and give insight into the trend and variability of responses to treatment.
no treatment
T or F
A crossover design can also be used with a group of single subject studies.
T
T or F
In RCT with single-subject design, a subject is randomly assigned to treatment A. The outcome is measured and this is followed by the same subject receiving treatment B with measurements taken after the second treatment.
with crossover design
Part A or appraising SSR designs
Determining the applicability of SSR
This is the first question to consider in determining the applicability of SSR.
Is the study’s purpose relevant to my clinical question?
Question 2:
Is the ___ sufficiently similar to my patient to justify the expectation that my patient would respond similarly to the population?
study subject
Question 3:
Are the inclusion and exclusion criteria clearly ____ and would my patient qualify for the study?
defined
The disadvantage of group design is the ____ introduced with a large sample. This will reduce the likelihood of finding a significant difference between the effects of different interventions when they actually exist.
inter-subject variability
In SSD, the subject acts as his own control, and the participant’s baseline and intervention periods are compared to detect possible ______.
treatment effects
Another challenge of RCT designs is the application of _____ from a group to a single patient.
study findings
T or F
The trade-off between SSDs and group designs is that the treatment responses of a single participant are as powerful as the treatment responses from a group of participants.
F (NOT as powerful)
Part B of appraising SSR designs.
Determining the Quality of SSR (Measurement)
Question 4:
Are the outcome measures relevant to the _____ and are they conducted in a clinically realistic manner?
clinical question
In SSR, measures are taken repeatedly on a single participant over the course of _____ before intervention is initiated.
several days or even weeks
With group designs, participants’ measurements are typically taken ______ at baseline.
only once
The _____ is a single measurement of many subjects versus multiple measures of a single person.
trade-off
An important consideration for SSR is the possible impact of multiple measures on the _____.
outcome of interest
Based on question 5, who should be blinded or masked in the study design?
Evaluators
T or F
Therapists must be reliable in their measurements, and the treating therapist should measure the subject during the study.
F (NOT measure)
This blinding is often challenging in an SSD, but it is critical to the rigor of the study.
“treating therapist should not measure the subject”
What is Question 6?
Is the intervention clinically realistic?
T or F
Question 7 aims to answer if the outcome measures are relevant to the clinical
question and if they are conducted in a clinically realistic manner.
T
T or F
In SSD, the intervention is specific to the participant.
T
____ designs are more costly and typically take longer to complete, but they do address the issue that no one treatment fits all.
Group
What is Question 8?
Aside from the planned intervention, could other events have contributed to my patient’s outcome?
SSDs should be rigorously _____.
controlled
SSDs should include monitoring the patient for all possible ___ to
outcomes during the study period.
contributions
What is Question 9?
Were both visual and statistical analyses applied to the data?
Published reports of SSR typically include the ____ to describe the study, and the data are reported according to the phases.
research notation
Both visual inspection and statistical analysis are essential in the analysis of
the data from single-subject studies. Therefore, the analysis of the results of a single-subject study should include _____.
graphs and statistics
“Best fit” line through the data beginning in the first phase and extending through each phase in the study.
Celebration line
The celebration line technique assumes that?
This technique assumes that the data can be fit with a linear function.
Assist in describing increasing and decreasing trends in the data.
Celebration line
Slopes for _____ in the study and the slope from the beginning of the study to the end visually capture the nature of change in the outcomes.
all phases
What is Question 10?
Were data trends in the baseline removed from the
intervention data?
Explain detrending data.
Repeated measures provide a description of the natural variation of the variables of interest during the baseline phase, before treatment initiation. Because this natural trend would be expected throughout the study, it must then be removed from the subsequent treatment phase.
The trend(s) that remains is then considered the result of the treatment with the natural fluctuation removed.
There are a variety of methods to “detrend” the data but the important point in the appraisal of SSD is that this issue has been addressed in the ____ of the study.
analysis of the results
The problem for statistical analysis is that repeated measures on the same person create dependency in the data, termed _____.
serial dependency
T or F
Repeated measurement of an individual has potential drawbacks. Performance may improve or be degraded through the repetition of measurement.
T
Data points from the same person are positively correlated.
Autocorrelation
A statistic used in combination with celebration line.
Two-Standard Deviation Band
In using the Two-Standard Deviation Band, data must be normally distributed and not have a significant _____.
autocorrelation
coefficient
T or F
By convention, if two data points are above or below the 2SD bands in the treatment phase, the change is considered ___.
statistically significant
What is Question 11?
Were outcome measures clinically important and meaningful to my patient?
The relevance of the outcomes of SSR is based on what constitutes a successful may be statistically significant, but that significant difference may not be _____.
clinically relevant
SSR could provide a ___ for your clinical practice.
framework
Successful implementation of SSR requires the same rigor as implementation of an _____, but it is a convenient and effective design to measure the effects of your treatment with your specific patient.
RCT design
Summarize SSR
- SSR is an alternative to group design research that can contribute to your clinical decisions.
- Appraising the applicability and validity of SSR follows the same guidelines as the appraisal process for group designs, with the specific questions modified to fit the reduced number of participants, design alternatives, and statistics for analysis of SSR.
- Although SSR requires additional clinic time, it can be conducted in most clinical settings.
