Case reports and single subject research designs

Question 1

Case reports: uses and advantages

Answer 1

-Provides a realistic view of practice:
No controls
Includes the context and the whole person
Shares clinical experiences

-Allows a thorough analysis of a single clinical situation:
Stimulates more questions/hypotheses
Builds theory

• Replication of interventions
• Bridges clinical and research fields

Question 2

Case reports: methodology

Answer 2

-Case reports are descriptions of practice:
Best practice and decision making process
Unusual patients/unusual responses
Teaching benefits

• Should contain all the elements of patient/client management
• DESCRIPTIVE

Question 3

Case reports: methodology- what is included?

Answer 3

• Introduction: Literature review
• Full patient history
• Pre and post measurements
• Intervention (should be described so it can be repeated)
• Outcome (results)
• Discussion

Question 4

Enhancing case report credibility

Answer 4

-Theoretical Validity:
Legitimacy of the constructs that support your intervention
Supported by theories in physical therapy: Stages of inflammation; Models of Disablement; Motor control theories; Physical Stress Theory

• Use outcome measures with known reliability and validity
• Systematic collection of data
• State clinical hypotheses, predictions
• Provide clinical reasoning
• Propose alternate explanations

Question 5

Single subject research designs: rationale

Answer 5

-Allows for meaningful research within the clinical environment:
Lack of access to large groups of subjects
Control groups not available

• Clinicians may draw conclusions about the effects of treatment based on the responses of a single patient under controlled conditions
• EMPERIMENTAL

Question 6

Single subject research design: what is examined?

Answer 6

Treatment vs. no treatment
New treatment vs. “standard” treatment
Comparison of two “new” treatments

• Sensitive to meaningful clinical changes
• May link impairments to functional limitations and disabilities
• Cannot infer to populations

Question 7

Single subject research design: target behavior (outcome) must be

Answer 7

• Observable/measurable
• Reliable between/within observers
• Valid indicator of treatment effectiveness
• Sensitive to intervention (changes)
• Stable at baseline

Question 8

Single subject research design: types of target designs or outcomes

Answer 8

• Continuous (numeric) scale measures
• Dichotomous measures
• Selected behavior(s): Frequency per session, Rate (# of occurrences/unit time), Duration, Magnitude

Question 9

Single subject research design: measurement issues

Answer 9

• Repeated measures taken over time
• Stability: consistency of response (Instability decreases reliability)
• Trend: patterns of change (up or down) over time

Question 10

Single subject research design: Phases of study

Answer 10

-Baseline: Must establish…stability and trend (slope)

-Intervention:
Stability and trend are also important
Must “control” for extraneous influences

Question 11

Design variations: A-B

Answer 11

baseline - treatment (phases)

Question 12

Design variations: A-B-A

Answer 12

baseline - treatment - post-treatment (baseline) (phases)

Question 13

Design variations: A-B-A-B

Answer 13

Baseline - treatment - baseline - treatment (phases)

Question 14

Design variations: A-B-C-B

Answer 14

Baseline - treatment - altered treatment - original treatment (phases)

Question 15

Single subject research designs: data anlysis

Answer 15

want to look at stability and slope

Question 16

Cleration line

Answer 16

estimates slope; basically taking the average of all the points and then drawing a line that goes through the midline of the points. It continues across the graph so that you can compare the average to the intervention phase