Single subject research designs for disability research

An Analysis of Teaching Menstrual Care Skills Using Single-Subject Methodology: A Systematic Literature Review

PURPOSE

There is a paucity in research supporting procedures to teach skills needed during an individual's menstrual cycle. The purpose of this study was two-fold. First, a literature review was conducted to find publications on the topic of menstrual care. Second, the studies found were evaluated against What Works Clearinghouse™ (WWC) standards and analyzed to determine the presence of clinical components relevant to teaching these skills.

METHODS

A literature review was conducted according to PRISMA guidelines. The review identified publications that taught menstrual care skills to individuals diagnosed with autism spectrum disorder (ASD) or other disabilities. The review focused specifically on studies that employed single-subject research methodology. Studies found were analyzed against the WWC's criteria to assess the rigor of each studies' methodology. Finally, studies were categorized across indicators that are clinically relevant to teaching menstrual care skills.

RESULTS

The results highlighted a lack of empirical support for teaching menstrual care skills. 7 single-subject design studies were identified in the previous 40 years of research. One study met all criteria required to receive the WWC's highest rating.

CONCLUSION

The complexity and private nature of menstrual care skills can make intervention development daunting. This paper was intended to provide menstrual care researchers with guidance in implementing high-quality studies. Additionally, scientist-practitioners can find guidance regarding important considerations to support programming that is both effective and respectful.

Effects of enriched task-specific training on sit-to-stand tasks in individuals with chronic stroke

BACKGROUND

Approximately 80% of stroke survivors experience motor impairment of the contralateral limb that severely affects their activities of daily living (ADL).

OBJECTIVE

To evaluate whether an enriched task-specific training (ETT) program affected the performance and kinetics of sit-to-stand (STS) tasks.

METHODS

The study was part of an exploratory study with a within-subject, repeated-measure-design, with assessments before and after a three-week-long baseline period, and six months after the intervention. Forty-one participants underwent assessments of strength and endurance measured by the 30-second-chair-stand test (30sCST). The STS-kinetics, including the vertical ground reaction force (GRF) during STS, were analysed in an in-depth-subgroup of three participants, using a single-subject-experimental-design (SSED). For kinetic data, statistical significance was determined with the two-standard deviation band method (TSDB).

RESULTS

After the baseline period, a small increase was seen in the 30sCST (from 5.6±4.5 to 6.1±4.9, p = 0.042). A noticeable significant change in the 30sCST was shown after the intervention (from 6.1±4.9 to 8.2±5.4, p < 0.001), maintained at six months. The in-depth kinetic analyses showed that one of three subjects had a significant increase in loading of the affected limb post-intervention.

CONCLUSION

ETT can produce long-term gains in STS performance. Weight-bearing strategies could be one of several factors that contribute to improvements in STS performance in the chronic phase after stroke.

The Impact of Two Telerehabilitation Supervision Schedules on Physical Activity, Mobility, and Balance Among People with Moderate to Severe Traumatic Brain Injury: A Mixed-Method Single-Subject Design

Background

Many individuals who experience a moderate or severe traumatic brain injury (TBI) have long-term deficits in physical activity, balance, and mobility requiring specialized care. New delivery models are being investigated for interventions to address challenges caused by living in remote communities, difficulties with transportation, and/or physical distancing requirements. Determining the effectiveness of telerehabilitation is critical given the current movement toward remote health care delivery.

Objective

We investigated the effectiveness of two teletherapy supervision schedules used to deliver a home-based, intensive exercise programme on 1) physical activity, mobility, balance, participation, and 2) concerns with falling, and satisfaction with life.

Methods

A mixed methods approach with alternating single subject design (SSD) and interviews was used. Five individuals who experienced a moderate or severe TBI completed two intensive home-based telerehabilitation programmes. Programmes differed only by supervision schedule - daily or weekly. Impacts on objective and patient-reported outcomes were measured.

Results

Four individuals demonstrated clinically significant improvements in physical activity level, balance, and mobility. One individual experienced less concerns with falling after both schedules, while two other individuals showed a trend in that direction after the weekly remote supervision. Important functional gains (i.e., improved balance and decreased fatigue) were also perceived and reported by family partners regardless of supervision schedule.

Conclusion

Although the study has limitations, the findings indicate that exercise programmes delivered via telerehabilitation can improve balance and mobility as well as positively affect concerns with falling and physical activity levels for this population. No clear differences were seen between the two telerehabilitation supervision schedules.

Single-Case Experimental Design in Rehabilitation: Basic Concepts, Advantages, and Challenges

ABSTRACT

Single-case experimental design is a family of experimental methods that can be used to examine the efficacy of interventions by testing a small number of patients or cases. This article provides an overview of single-case experimental design research for use in rehabilitation as another option along with traditional group-based research when studying rare cases and rehabilitation interventions of unknown efficacy. Basic concepts related to single-case experimental design and the characteristics of common subtypes ( N-of-1 randomized controlled trial, withdrawal design, multiple-baseline design, multiple-treatment design, changing criterion/intensity design, and alternating treatment design) are introduced. The advantages and disadvantages of each subtype are discussed along with challenges in data analysis and interpretation. Criteria and caveats for interpreting single-case experimental design results and their use in evidence-based practice decisions are discussed. Recommendations are provided for appraising single-case experimental design articles as well as using single-case experimental design principles to improve real-world clinical evaluation.

Evaluating Note Frequency and Velocity During Improvised Active Music Therapy in Clients With Parkinson's Disease

The purpose of this article was to report on the findings of the note frequency and velocity measures during Improvised Active Music Therapy (IAMT) sessions with individuals with Parkinson's disease (PD). In this single-subject multiple baseline design across subjects, the article reports the note frequency (note count) and velocity of movement (mean note velocity) played by three right-handed participants while playing uninterrupted improvised music on a simplified electronic drum-set. During baseline, the music therapist played rhythmic accompaniment on guitar using a low-moderate density of syncopation. During treatment, the Music Therapist introduced rhythms with a moderate-high density of syncopation. The music content of the sessions was transformed into digital music using a musical instrument digital interface. Results of this study indicated that all participants exhibited an increase in note count during baseline until reaching a plateau at treatment condition and were found to be significantly positively correlated with the Music Therapist's note count. All participants played more notes with upper extremity (UE) across conditions than with lower extremity. All participants also scored similar total mean velocity across conditions. Two participants demonstrated higher mean note velocity with UE than right foot, whereas the other participant did not demonstrate this difference. Two participants also exhibited greater mean note velocity variability with left foot within and across conditions. More research is required to identify commonalities in note count and mean note velocity measures in individuals with PD during IAMT sessions.

Evaluating a brief intervention for mealtime difficulty on older adults with dementia

AIMS AND OBJECTIVE

To test a spaced retrieval intervention using spaced retrieval to alleviate mealtime difficulties in older people with dementia.

DESIGN

A single-case study design.

SETTING

Nursing Homes in North Central England, United Kingdom.

PARTICIPANTS

Older people with Alzheimer's disease.

METHODS

A single-case study using an ABA design was used. Data were collected using the Edinburgh Feeding Evaluation in Dementia scale, Mini Nutritional Assessment, and Body Mass Index before intervention, postintervention and following 3 months of postintervention. Realist evaluation was used to identify for which participants the intervention was effective, and an economic evaluation was also carried out.

FINDING

Of 15 participants who entered the study, eight completed all phases of the study. A mean 104.4 h were needed to deliver the intervention. The number of sessions required ranged from 90-222. The length of time each participant retained information (for all sessions) ranged from 13-28 min. Participants had most difficulty with: "putting food into mouth and chewing it"; "realizing it was mealtime"; and "eating a whole meal continuously." A reduction in the difficulty with mealtimes occurred between phase A1-A2 for most participants. Six participants maintained this in phase A3. Similar patterns were evident for nutritional scores. For most participants, the effect size of the intervention was moderate or large.

CONCLUSIONS

Spaced retrieval is useful in reducing mealtime difficulties in older participants with dementia. While the results of this study are promising, further large and multicentre trials are needed to explore the effectiveness of the intervention in diverse populations.

ICT-Based Individualized Training of Institutionalized Individuals With Dementia. Evaluation of Usability and Trends Toward the Effectiveness of the InCoPE-App

Physical activity interventions can alleviate the course of disease for individuals with dementia (IWD) who have been extraordinarily affected by the COVID-19 pandemic. Information and Communication Technology (ICT) provides new opportunities not only to mitigate negative effects of the pandemic but also to sustainably improve everyday life of IWD in nursing homes. The aim of the present study was to evaluate the ICT-based InCoPE-App, which was used to assess physical and cognitive performance and deliver individualized exercise for IWD, with regard to 1) user experience of nursing assistants, and 2) trends toward the effectiveness of the intervention on physical and cognitive performance of IWD. An 18-week individualized multidomain intervention (2 × 60 min/session) was delivered to an intervention group (IG; n = 10, mean age 88.4 ± 5.6, 70% female) by nursing assistants (n = 10, mean age 56.1 ± 10.4, 90% female) using the InCoPE-App. A control group (CG; n = 3, mean age 87.3 ± 3.5, 100% female) received conventional treatment. User experience was assessed among nursing assistants by different questionnaires, i.e., PSSUQ and ISONORM 9241/110-S for usability, and AttrakDiff2 for pragmatic (PQ), hedonic quality-identity and stimulation (HQI and HQS), and attractiveness (ATT). Trends toward the effectiveness of the intervention were assessed using MMSE (global cognitive function), FICSIT-4 (balance), 6MWT and TUG (mobility), and m30CST (function of lower limbs). Usability of the InCoPE-App was rated as high by nursing assistants (mean ± SD; overall PSSUQ 2.11 ± 0.75; overall ISONORM 9241/110-S 1.90 ± 0.88; ATT 1.86 ± 1.01; PQ 1.79 ± 1.03; HQI 1.8 ± 0.79; and HQS 1.37 ± 0.69). Dropout was high in the total sample (36.7%). Trends toward the effectiveness were observed within IG in nine IWD who showed positive or neutral trends in at least two physical performance outcomes. Seven participants had positive or neutral trends in the FICSIT-4, seven participants in m30CST, and four and seven participants in 6MWT and TUG, respectively. In conclusion, the InCoPE-App has good nursing assistant-rated usability, whereas training effects and intervention adherence were rather low most likely due to COVID-19 restrictions. Single-subject research revealed more positive than negative trends in IG of IWD. Further research is needed to evaluate feasibility, suitability, and effectiveness of the InCoPE-App.

Study protocol for a mixed-design evaluation of self-assured parents – A parenting support program for immigrant parents living in deprived areas in Sweden with teenage children

Background

Immigrant parents of adolescents experience challenges in their role as parents in the new country and express a need for parental support. Still, they are underrepresented in existing parenting programs and when they do attend, their parenting practices improve less than what they do among native parents. Self-assured parents (SAP; Swe. Trygga Föräldrar) targets immigrant parents living in deprived areas in Sweden who worry about their adolescents' adjustment. This study's purposes are to examine if SAP is a feasible intervention in Swedish municipalities and if SAP is effective in reaching its aims, namely to promote parental self-efficacy and parent-adolescent communication and to reduce parents' worries in the target group.

Methods

SAP will be evaluated when implemented by social workers in three Swedish municipalities using a culturally-informed mixed design procedure. Parents will be recruited to the program by local social workers. Groups leaders will be interviewed, observed, and they will fill out self-reports to measure implementation quality, including fidelity and acceptability. A group of parents will be interviewed to better understand their perceived challenges and needs in their parenting in Sweden and their experience of participating in SAP. An interrupted time series design with three measurements before, two measurements during, and two measurements after the intervention has ended will be employed using self-reports of parental self-efficacy, parent-child communication, and parents' worries. Informed consent will be collected from all study participants.

Discussion

Immigrant parents living in deprived areas is an understudied and marginalized population. There is a lack of culturally-informed, evidence-based parenting programs aimed at this group in Sweden. The need for specifically developed programs for immigrant parents living in deprived areas with teenage children, has been voiced by both immigrant parents themselves and the Swedish government. Thus, this study will contribute not only to the scientific literature, but also to social service practice and potentially policy making.

Improvised active music therapy for clients with Parkinson’s disease: A feasibility study

The purpose of this study was to test the feasibility of delivering Improvised Active Music Therapy sessions in measuring the impact of acquisition of rhythmic complexity levels on gait performance in individuals with Parkinson’s disease. In this single subject multiple baseline design, the study measured the ability of three right-handed participants with Parkinson’s disease to acquire greater density of syncopation, as a measure of rhythmic complexity levels, while playing uninterrupted improvised music on a simplified electronic drum-set. The music content of the sessions was transformed into digital music data in real-time using Musical Instrument Digital Interface. The Musical Instrument Digital Interface data were analyzed to determine the participants’ and the Music Therapist’s density of syncopation (on acoustic guitar) during baseline and treatment conditions. Results from visual analyses and Pearson’s correlations on the outcomes indicated conflicting and inconclusive outcomes about whether higher acquisition of rhythmic complexity levels improves gait performance in individuals with Parkinson’s disease. Despite this, evidence was found to support the overall value of Improvised Active Music Therapy sessions on gait performance. The study design, the intervention, and outcome measures were found to be feasible and could be scaled-up into a larger trial.

Contribution of Solid Food to Achieve Individual Nutritional Requirement during a Continuous 438 km Mountain Ultramarathon in Female Athlete

Background: Races and competitions over 100 miles have recently increased. Limited information exists about the effect of multiday continuous endurance exercise on blood glucose control and appropriate intake of food and drink in a female athlete. The present study aimed to examine the variation of blood glucose control and its relationship with nutritional intake and running performance in a professional female athlete during a 155.7 h ultramarathon race with little sleep. Methods: We divided the mountain course of 438 km into 33 segments by timing gates and continuously monitored the participant’s glucose profile throughout the ultramarathon. The running speed in each segment was standardized to the scheduled required time-based on three trial runs. Concurrently, the accompanying runners recorded the participant’s food and drink intake. Nutrient, energy, and water intake were then calculated. Results: Throughout the ultramarathon of 155.7 h, including 16.0 h of rest and sleep, diurnal variation had almost disappeared with the overall increase in blood glucose levels (25–30 mg/dL) compared with that during resting (p < 0.0001). Plasma total protein and triglyceride levels were decreased after the ultramarathon. The intake of protein and fat directly or indirectly contributed to maintaining blood glucose levels and running speed as substrates for gluconeogenesis or as alternative sources of energy when the carbohydrate intake was at a lower recommended limit. The higher amounts of nutrient intakes from solid foods correlated with a higher running pace compared with those from liquids and gels to supply carbohydrates, protein, and fat. Conclusion: Carbohydrate, protein, and fat intake from solid foods contributed to maintaining a fast pace with a steady, mild rise in blood glucose levels compared with liquids and gels when female runner completed a multiday continuous ultramarathon with little sleep.

Patients' experiences and effects of non-pharmacological treatment for myalgic encephalomyelitis/chronic fatigue syndrome - a scoping mixed methods review

PURPOSE

The EU COST Action 15111 collaboration on myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) aims to assess current research and identify knowledge gaps in Europe. Presently, our purpose is to map the effects of non-pharmacological therapies (NPTs) for ME/CFS, and what patients find important in the treatment process.

METHODS

A scoping mixed methods literature review of European studies identified 16 papers fulfiling our inclusion criteria. The quantitative and qualitative studies were synthesized separately in tables. Additionally, extracts from the qualitative studies were subjected to translational analysis.

RESULTS

Effect studies addressed cognitive behavioural therapy (CBT, n = 4), multimodal rehabilitation (n = 2) and activity-pacing (n = 2). CBT reduced fatigue scores more than usual care or waiting list controls. The effects of rehabilitation and activity-pacing were inconsistent. The contents, assessment methods and effects of rehabilitation and activity pacing studies varied. For patients, health professionals' recognition of ME/CFS and support were crucial, but they expressed ambiguous experiences of what the NPTs entail.

CONCLUSIONS

Methodological differences make comparisons across NPTs impossible, and from a patient perspective the relevance of the specific contents of NPTs are unclear. Future well-designed studies should focus on developing NPTs tailored to patients' concerns and evaluation tools reflecting what is essential for patients.

Commercial head-mounted display virtual reality for upper extremity rehabilitation in chronic stroke: a single-case design study

Background

Rehabilitation is crucial for maximizing recovery after stroke. Rehabilitation activities that are fun and rewarding by themselves can be more effective than those who are not. Gamification with virtual reality (VR) exploits this principle. This single-case design study probes the potential for using commercial off-the-shelf, room-scale head-mounted virtual reality for upper extremity rehabilitation in individuals with chronic stroke, the insights of which can inform further research.

Methods

A heterogeneous volunteer sample of seven participants living with stroke were recruited through advertisement. A single-case design was employed with a 5-week baseline (A), followed by a 10-week intervention (B) and a 6-month follow-up. Upper extremity motor function was assessed with validated kinematic analysis of drinking task. Activity capacity was assessed with Action Research Arm Test, Box and Block Test and ABILHAND questionnaire. Assessments were done weekly and at follow-up. Playing games on a VR-system with head-mounted display (HTC Vive) was used as rehabilitation intervention. Approximately 300 games were screened and 6 tested. Visual analysis and Tau-U statistics were used to interpret the results.

Results

Visual analysis of trend, level shift and overlap as well as Tau-U statistics indicated improvement of Action Research Arm Test in six participants. Four of these had at least a moderate Tau-U score (0.50–0.92), in at least half of the assessed outcomes. These four participants trained a total of 361 to 935 min. Two out of four participants who were able to perform the drinking task, had the highest training dose (> 900 min) and showed also improvements in kinematics. The predominant game played was Beat Saber. No serious adverse effects related to the study were observed, one participant interrupted the intervention phase due to a fall at home.

Conclusions

This first study of combining commercial games, a commercial head-mounted VR, and commercial haptic hand controls, showed promising results for upper extremity rehabilitation in individuals with chronic stroke. By being affordable yet having high production values, as well as being an easily accessible off-the-shelf product, this variant of VR technology might facilitate widespread adaption. Insights garnered in this study can facilitate the execution of future studies.

Trial registration The study was registered at researchweb.org (project number 262331, registered 2019-01-30, https://www.researchweb.org/is/vgr/project/262331) prior to participant enrolment.

Single-Subject Research in Psychiatry: Facts and Fictions

Scientific evidence in the field of psychiatry is mainly derived from group-based ("nomothetic") studies that yield group-aggregated results, while often the need is to answer questions that apply to individuals. Particularly in the presence of great inter-individual differences and temporal complexities, information at the individual-person level may be valuable for personalized treatment decisions, individual predictions and diagnostics. The single-subject study design can be used to make inferences about individual persons. Yet, the single-subject study is not often used in the field of psychiatry. We believe that this is because of a lack of awareness of its value rather than a lack of usefulness or feasibility. In the present paper, we aimed to resolve some common misconceptions and beliefs about single-subject studies by discussing some commonly heard "facts and fictions." We also discuss some situations in which the single-subject study is more or less appropriate, and the potential of combining single-subject and group-based study designs into one study. While not intending to plea for single-subject studies at the expense of group-based studies, we hope to increase awareness of the value of single-subject research by informing the reader about several aspects of this design, resolving misunderstanding, and providing references for further reading.

Deep Neural Network for Visual Stimulus-Based Reaction Time Estimation Using the Periodogram of Single-Trial EEG

Multiplexed deep neural networks (DNN) have engendered high-performance predictive models gaining popularity for decoding brain waves, extensively collected in the form of electroencephalogram (EEG) signals. In this paper, to the best of our knowledge, we introduce a first-ever DNN-based generalized approach to estimate reaction time (RT) using the periodogram representation of single-trial EEG in a visual stimulus-response experiment with 48 participants. We have designed a Fully Connected Neural Network (FCNN) and a Convolutional Neural Network (CNN) to predict and classify RTs for each trial. Though deep neural networks are widely known for classification applications, cascading FCNN/CNN with the Random Forest model, we designed a robust regression-based estimator to predict RT. With the FCNN model, the accuracies obtained for binary and 3-class classification were 93% and 76%, respectively, which further improved with the use of CNN (94% and 78%, respectively). The regression-based approach predicted RTs with correlation coefficients (CC) of 0.78 and 0.80 for FCNN and CNN, respectively. Investigating further, we found that the left central as well as parietal and occipital lobes were crucial for predicting RT, with significant activities in the theta and alpha frequency bands.

Nordic walking for people with relapsing-remittent multiple sclerosis: A case series study

BACKGROUND

Patients with multiple sclerosis (MS) show fatigue, impaired gait and decreased functional mobility, which lead to a low quality of life (QoL). Low-cost and easy to perform exercise modalities having a positive impact on the aforementioned symptoms are needed. The performance of Nordic Walking (NW) could be a useful rehabilitation strategy but, to our knowledge, no study has been published in this regard as yet. This case series study aims at providing information regarding the usefulness and impact of a three-month NW program on self-perceived fatigue, functional mobility, physical fitness and QoL on a group of people with mild relapsing-remitting MS.

METHODS

A case series study with multiple assessments was performed. Three data collection points at 1-week intervals for three weeks were done at baseline. The intervention consisted of a 12-weeks NW program with a total of four measurement occasions, one every three weeks. The Fatigue Severity Scale (FSS), the Timed up and Go test (TUG), the 6-Minute Walk test (6MWT) and the Multiple Sclerosis Impact Scale (MSIS-29), were used to assess the outcomes of the program on the participants' self-perceived fatigue, functional mobility, physical fitness and QoL, respectively.

RESULTS

Of the 14 participants who volunteered for the study, five completed at least 80% of the planned sessions and were included in the final analysis. The intervention did not have a clinical significant impact on the participants' fatigue while its impact on their QoL showed mixed results. Positive trends were found for all the participants in their functional mobility and physical fitness. Regarding functional mobility, clinically important changes were observed in three participants. None of the observed changes in physical fitness achieved clinical significance.

CONCLUSION

A 12-week Nordic walking program did not appear to be particularly feasible and had little impact on the functional levels on a group of people with mild relapsing-remitting MS. Given that beneficial effects were seen in some participants, and taken into account the low adherence rate observed, future studies should explore the feasibility of NW programs performed under different environmental conditions (i.e. outdoors) and including motivational strategies aimed at increasing participation.

Incorporating Conversational Strategies in a Social Robot to Interact with People with Dementia

BACKGROUND

Socially assistive robots (SARs) have the potential to assist nonpharmacological interventions based on verbal communication to support the care of persons with dementia (PwDs). However, establishing verbal communication with a PwD is challenging. Thus, several authors have proposed strategies to converse with PwDs. While these strategies have proved effective at enhancing communication between PwDs and their caregivers, they have not been used or tested in the domain of human-robot interaction.

OBJECTIVES

This study aimed to assess the effectiveness of incorporating conversational strategies proposed in the literature for caregivers, during PwD-robot interactions.

METHODS

We conducted a total of 23 group sessions based on music and conversation therapy, where a SAR interacted with 12 PwDs (mean = 80.25 years) diagnosed with mild to moderate-stage dementia. Using a single subject research approach, we designed an AB study to assess the effectiveness of the conversational strategies in the PwD-robot interaction. Our analysis focuses on the direct communication between the PwDs and the robot, and the perceived enjoyment of PwDs.

RESULTS

The number of utterances made from a PwD to the robot increased significantly when the conversational strategies were included in the robot. In addition, PwDs engaged in more sustained conversations. Additionally, PwDs enjoyed conversing with the robot Eva, as much as listening to music. These results indicate that the use of these conversational strategies is -effective at increasing the interaction between PwD and a SAR.

CONCLUSIONS

PwDs who participated in the study engaged and enjoyed the interaction with the SAR. The results provide evidence of the importance of incorporating appropriate conversational strategies in SARs that support interventions for the care and social stimulation of PwDs.

Remotely Supervised Home-Based Intensive Exercise Intervention to Improve Balance, Functional Mobility, and Physical Activity in Survivors of Moderate or Severe Traumatic Brain Injury: Protocol for a Mixed Methods Study

Background

Traumatic brain injury (TBI) may impact an individual physically, cognitively, socially, and emotionally. Poor balance, reduced mobility, and low daily physical activity often will require ongoing physical rehabilitation intervention. However, face-to-face specialized physiotherapy is not always accessible for individuals living in rural settings.

Objective

We will answer four questions: (1) What is the feasibility of a remotely supervised, home-based, intensive exercise intervention with survivors of moderate and severe TBI? (2) Does the frequency of remote supervision have an impact on the feasibility of completing a home-based intensive exercise program? (3) Does the frequency of remote supervision impact balance, functional mobility, and physical activity? (4) What is the lived experience of remote supervision for both survivors and caregivers?

Methods

Four participants will complete two intensive, 4-week (five days per week) home-based exercise interventions remotely supervised via synchronous videoconference. Each exercise intervention will have a goal of 160 to 300 repetitions or 60 minutes of tailored exercises to promote neuroplasticity and be defined as an intensive home-based exercise intervention. An alternating single-subject design will allow for the comparison between two frequencies of remote supervision, once weekly and five times weekly. Daily repeated outcome measures, pre- and postintervention outcome measures, and 1-month follow-up outcome measures will be collected to explore the effect on feasibility and physical variables. Daily outcome measures include step count and Five Times Sit-to-Stand test. Pre-post measures include assessment of quiet stance and the Community Balance and Mobility Scale. A semistructured interview will be completed at the end of each intervention segment to document the lived experience of both survivors and their study partners. Finally, five questionnaires will be used to understand the overall experience: the Mayo-Portland Adaptability Inventory-4 Participation Index, Satisfaction With Life Scale, Fall Efficacy Scale-International, Interpersonal Behavior Questionnaire, and System Usability Scale. Data will be analyzed following traditional single-subject methods of analysis.

Results

Ethics approval was received from both the Bruyère Research Institute and University of Ottawa review boards in March 2019. Recruitment is underway.

Conclusions

The proposed intervention is complex in nature due to the involvement of multiple technology sources and the inclusion of a complex dyad (survivors and caregivers) in a community setting. This type of research is timely given that alternative methods of physical intervention delivery are needed to facilitate gains in balance, mobility, physical activity among TBI survivors with limited access to clinical care, and the quality of the patients’ experience.

International Registered Report Identifier (IRRID)

PRR1-10.2196/14867

Effect of Impairment-Oriented and Function-Oriented Exercises on Mouth Function in Subjects with Systemic Sclerosis

PURPOSE

The aim of this study was to develop an exercise protocol to improve maximal mouth opening (MMO), tongue protrusion (Tprot), tongue strength (Tstren), and lip strength (Lstren), and to assess its effects on subjects with scleroderma.

METHODS

We performed four replicated single-system studies in a consecutive sample of subjects with scleroderma. An instrumented assessment measured MMO, Tprot, Tstren, and Lstren. Each day, subjects were assessed and performed orofacial exercises conducted by speech therapists. Treatments were first aimed at improving mouth physical characteristics by impairment-oriented exercises and then to improve skills with function-oriented exercises.

RESULTS

The mean phase differences between assessment and treatment phases across subjects were from 0.88 to 9.56 mm in MMO, from 2.03 to 12.3 mm in Tprot, from -0.12 to 5.35 N in Tstren, and from -0.84 to 5.19 N in Lstren. After treatment, 3 subjects crossed the 5th percentile discriminating normal from abnormal performances for both Tstren and Tprot, while this occurred in 2 subjects for MMO and Lstren.

CONCLUSIONS

The results of this study suggest that rehabilitation appears to be useful in reducing tongue and lip impairments and in improving oral functions in subjects with scleroderma.

A single-subject study of robotic upper limb training in the subacute phase for four persons with cervical spinal cord injury

Study design

Single-subject design, standard training ("B") compared with Robotic training ("C").

Objectives

To explore the impact of robotic training on upper limb function, activities of daily living (ADL) and training experience in subacute tetraplegic inpatients.

Setting

Inpatient subacute Norwegian spinal cord injury (SCI) unit.

Methods

Four participants (C4-7, AIS A-C) completed 11 sessions of robotic training using a passive robotic exoskeleton (Armeo Spring®). Descriptive statistics and visual analyses were used for comparing standard occupational therapy and robotic training. Outcome measures included the Spinal Cord Independence Measure (SCIM-III), the Graded Redefined Assessment of Strength Sensibility and Prehension (GRASSP), and a questionnaire.

Results

All of the participants exhibited an increase in assessments of upper limb function (GRASSP-total) right side (0.4%-61.2%), and all except for one participant (-8%) showed an increase on their left side (20.9%-106.2%). Three out of four participants had improvements in ADL function SCIM-III (ranging from 5.6% to 46.7%). Results demonstrated improvements during the robotic intervention period in five out of 28 measurements. The participants enjoyed the exercise, and found it motivating and relevant to their injury (median ranged from 3.5 to 6.5 on a 0-7 scale).

Conclusions

Three out of four participants improved upper limb function and ADL independence, but the study could not confirm that improvements were due to the robotic intervention. The participants enjoyed the robotic training and found it relevant to their injury.

Palin Parent-Child Interaction Therapy: The Bigger Picture

PURPOSE

Palin Parent-Child Interaction therapy (Kelman & Nicholas, 2008) is an evidence-based intervention for young children who stutter. The evidence consists of multiple single-subject replicated studies, and this demonstrates that the intervention is effective. The aim of this study was to enhance the evidence base by exploring the effectiveness of the therapy with a large cohort of children who stutter.

METHOD

Children and parents completed a range of assessments at 4 time points: start of therapy and then 3, 6, and 12 months later. The following variables were included: stuttering frequency, child's communication attitude, parents' perception of the impact of the stuttering on the child, the severity of stuttering and its impact on the parents, and their knowledge of stuttering and confidence in managing it. Hierarchical multiple regression analyses were conducted to explore whether the variables are predictive for the outcome "parent knowledge and confidence." In addition, we sought a preliminary view of factors associated with outcome level by separating children into 2 groups according to response to treatment (more successful and less successful).

RESULTS

The results demonstrated a significant improvement in all variables, and this improvement was maintained for 1 year posttreatment. Measures collected 3 months after the start of therapy showed significant improvement in child attitude to communication, parents' knowledge and confidence in how to manage stuttering, and mothers' ratings of stuttering severity and impact the child's stuttering has on the mothers. By 6 months after therapy onset, there was a significant reduction in stuttering frequency and fathers' perception of severity and their worry about it. Furthermore, these improvements were maintained 1 year posttherapy. Several variables predicted parents' knowledge and confidence 6 months after the start of therapy. Finally, those who made greater improvements had mothers who were more negative in their ratings of severity and worry, and had less knowledge and confidence at the start of therapy. There were no differences between the groups on a range of other variables.

CONCLUSIONS

The results demonstrate that, over a year, children who attend a course of Palin Parent-Child Interaction show reduced stuttering frequency and a more positive attitude to speech. In addition, parents observe these improvements in the child, feel more confident in managing the stuttering, and are less worried about it. The different times at which specific variables significantly improved provides insight to a process of change over time. Results suggest that parents' ability to notice positive change in fluency and the impact that these observations have on both the child and the family are linked to their confidence in how to support the child. The preliminary findings with regard to response to treatment suggest that children can benefit from this program even with factors that might be predicted to reduce therapy success.

Effects of virtual reality exercise for Korean adults with schizophrenia in a closed ward

The purpose of this study was to examine the effects of virtual reality exercise (VRE) using Nintendo Wii-Fit on physical fitness of Korean adults with schizophrenia living in a mental health facility located in South Korea. Two male participants diagnosed with schizophrenia, ages 53 and 61, were recruited and selected for inclusion in this study. The intervention using the Nintendo Wii-Fit consisted of 35-min sessions, 3 times per week for 8 weeks and was facilitated by the primary researcher and two graduate students. The senior fitness test and 10-m walking test were used to measure the physical functioning, specifically, physical fitness and mobility, of the participants. The study was divided into three phases using an A-B-A single-subject design and involved multiple repeated measures of functional physical fitness. Both participants were evaluated each week for the duration of 18 weeks. Both participants exhibited measureable improvement in some of the physical fitness measures, but not in the mobility. These results thus provide preliminary evidence to support the use of VRE to improve physical function for Korean adults with schizophrenia as an alternative exercise regimen to the conventional exercise.

Mirror Therapy and Task-Oriented Training for People With a Paretic Upper Extremity

OBJECTIVE

This study investigates the effect of mirror therapy and task-oriented training on the paretic upper extremity function and occupational performance of people with stroke.

METHOD

This study used a repeated-measures, case-series design in which 4 participants completed a 4-wk intervention consisting of mirror therapy and task-specific training. The intervention was conducted 2×/wk in the clinic and 4×/wk at home.

RESULTS

All participants displayed clinically meaningful improvements in self-identified goals at the end of the intervention and at follow-up. Three participants showed clinically meaningful changes in motor function. Although only 1 participant improved in his reported amount of use, all participants showed clinically meaningful improvements in perceived movement quality at varying points of assessment.

CONCLUSION

Mirror therapy, when used as priming for task-oriented training, can produce clinical improvements in upper extremity function and occupational performance in people with hemiparesis.

The McMaster Toronto Arthritis patient preference questionnaire (MACTAR): a methodological study of reliability and minimal detectable change after a 6 week-period of acupuncture treatment in patients with rheumatoid arthritis

Objectives

The McMaster Toronto Arthritis patient preference questionnaire (MACTAR) is a semi-structured interview consisting of a baseline and a follow-up interview. The MACTAR baseline is reliable and valid, however the reliability of the MACTAR follow-up is scarcely described. The aim of this study was to describe aspects of reliability and ability to detect changes of the Swedish MACTAR follow-up following acupuncture treatment in individuals with rheumatoid arthritis.

Results

The study was of Single Subject Experimental Design, with a 2-week non-interventional A-phase and a 6-week intervention B-phase. Eight individuals with RA, age 30–68 years, were included. MACTAR baseline was performed once followed by five assessments with MACTAR follow-up during the A-phase and another ten assessments during the B-phase. Reliability statistics were calculated for measurements 1–3 during the A-phase and the ability to detect effects of acupuncture treatment was tested by celeration lines in the B-phase. The MACTAR follow-up was highly reliable (ICC = 0.7–0.9, SEM = 2.3–4.3, and SDD = 6.2–11.7). Visual and statistical analyses indicated that the MACTAR follow-up could detect effects on individual- and group levels after acupuncture treatment, indicating that the MACTAR follow-up seems to be reliable and is able to detect effects of acupuncture treatment in RA.

Electronic supplementary material

The online version of this article (10.1186/s13104-017-2991-0) contains supplementary material, which is available to authorized users.

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

BACKGROUND

Cerebral 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.

AIMS

This 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 PROCEDURES

In 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 RESULTS

According 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 IMPLICATIONS

CO-OP intervention can be helpful in improving motor skills and achieving self-identified, motor-based goals in children with CP.

Effect of functional electrical stimulation on the proprioception, motor function of the paretic upper limb, and patient quality of life: A case report

Functional electrical stimulation (FES) has shown to improve motor function of the affected side in stroke patients; however, the effects of FES on proprioception, the functional recovery of the paretic upper limb, and the patient quality of life (QoL) are not clear. The aim of the current case report was to determine whether FES can improve joint position sense and the scores on measurements of upper limb function and a QoL survey. The participant was assessed before and after 10 consecutive intervention sessions; in addition, the patient performed the training tasks in the workstation assisted by the FES device. Improvements in angles and time only in the affected wrist and enhancement in the Action Research Arm Test scores for both upper limbs were found after FES intervention. In addition, the patient's health-related QoL measurements improved. FES could ameliorate the proprioceptive deficit and the activity limitations of a stroke survivor.

OXFORD LEVEL OF EVIDENCE

3b; individual case control study.

Single-subject research designs in pediatric rehabilitation: a valuable step towards knowledge translation

Knowledge translation may be particularly challenging in pediatric rehabilitation, where study findings are often ambiguous owing to low statistical power or inconsistent responses to intervention. Disconnection between research protocols and clinical practicality, as well as variability of responsiveness in heterogeneous pediatric populations, may further impede integration of research findings into everyday practice. Use of single-subject research designs (SSRDs) may bridge the gap between research and practice, with robust design options that better identify and preserve patterns of responsiveness to specific interventions and offer protocols that are more readily implemented in practice settings than can be done in traditional randomized controlled trials. This review defines SSRD, provides examples of research questions that can be answered using SSRD, details the experimental designs that can be used and the level of evidence of each design, and describes statistical analysis approaches and clinical application. This analysis will aid researchers, reviewers, clinicians, and others in better understanding SSRD methodology and its application in everyday practice.

Using Xbox kinect motion capture technology to improve clinical rehabilitation outcomes for balance and cardiovascular health in an individual with chronic TBI

BACKGROUND

Motion capture virtual reality-based rehabilitation has become more common. However, therapists face challenges to the implementation of virtual reality (VR) in clinical settings. Use of motion capture technology such as the Xbox Kinect may provide a useful rehabilitation tool for the treatment of postural instability and cardiovascular deconditioning in individuals with chronic severe traumatic brain injury (TBI). The primary purpose of this study was to evaluate the effects of a Kinect-based VR intervention using commercially available motion capture games on balance outcomes for an individual with chronic TBI. The secondary purpose was to assess the feasibility of this intervention for eliciting cardiovascular adaptations.

METHODS

A single system experimental design (n = 1) was utilized, which included baseline, intervention, and retention phases. Repeated measures were used to evaluate the effects of an 8-week supervised exercise intervention using two Xbox One Kinect games. Balance was characterized using the dynamic gait index (DGI), functional reach test (FRT), and Limits of Stability (LOS) test on the NeuroCom Balance Master. The LOS assesses end-point excursion (EPE), maximal excursion (MXE), and directional control (DCL) during weight-shifting tasks. Cardiovascular and activity measures were characterized by heart rate at the end of exercise (HRe), total gameplay time (TAT), and time spent in a therapeutic heart rate (TTR) during the Kinect intervention. Chi-square and ANOVA testing were used to analyze the data.

RESULTS

Dynamic balance, characterized by the DGI, increased during the intervention phase χ2 (1, N = 12) = 12, p = .001. Static balance, characterized by the FRT showed no significant changes. The EPE increased during the intervention phase in the backward direction χ2 (1, N = 12) = 5.6, p = .02, and notable improvements of DCL were demonstrated in all directions. HRe (F (2,174) = 29.65, p = < .001) and time in a TTR (F (2, 12) = 4.19, p = .04) decreased over the course of the intervention phase.

CONCLUSIONS

Use of a supervised Kinect-based program that incorporated commercial games improved dynamic balance for an individual post severe TBI. Additionally, moderate cardiovascular activity was achieved through motion capture gaming. Further studies appear warranted to determine the potential therapeutic utility of commercial VR games in this patient population.

TRIAL REGISTRATION

Clinicaltrial.gov ID - NCT02889289.

Effectiveness of a multidisciplinary rehabilitation program for persons with acquired brain injury and executive dysfunction

PURPOSE

The purpose of this study is to explore the effects of a multidisciplinary acquired brain injury rehabilitation out-patient program (5 d/week for 7 weeks) on improvements to participants' activity and participation outcomes related to meal preparation and to determine whether gains are maintained at 3 and 6 months post program.

METHODS

A single case experimental design with repeated measures pre- and post-intervention with 7 adult participants with ABI and executive dysfunction (4 females, mean age 38 ± 10.1 years) was used.

RESULTS

A strong improvement effect between pre and post phases was found for number of errors on the Cooking Task for 6/7 participants; four participants showed significant improvement immediately after the program and at 3 and 6 months post. Six out of seven participants improved significantly on the Instrumental Activities of Daily Living Profile and four participants improved between the post and 6 month follow-up. Four out of seven participants showed significantly improved Life Habits scores pre- versus post-program.

CONCLUSIONS

Significant improvements were observed in activity and participation outcomes related to preparing a meal in adults with ABI and executive dysfunction who participated in a 7-week multidisciplinary rehabilitation out-patient program. Treatment gains were maintained for the majority of participants at 3 and 6 months following the program. Implication of Rehabilitation A 7-week multidisciplinary rehabilitation out-patient program appears to improve activities and participation; the effects are sustainable after 6 months. A detailed description of the therapeutic interventions provided during the cooking activity should help clinicians better understand what specific functions are solicited or required during a particular activity. Knowledge from this study may help guide clinicians in their work within this complex area of rehabilitation.

Increasing Social Integration for College Students with Autism Spectrum Disorder

Increasing numbers of individuals with Autism Spectrum Disorder (ASD) are entering postsecondary education; however, many report feeling lonely and isolated. These difficulties with socialization have been found to impact students' academic success, involvement within the university, and overall well being. Therefore, the purpose of this study was to assess, within the context of a multiple-baseline across participants design, whether a structured social planning intervention would increase social integration for college students with ASD. The intervention consisted of weekly meetings to plan social activities around the student with ASD's interests, improve organizational skills, and target specific social skills. Additionally, each participant had a peer mentor for support during the social activities. The results showed that following intervention all participants increased their number of community-based social events, extracurricular activities, and peer interactions. Furthermore, participants improved in their academic performance and satisfaction with their college experience. Results are discussed in regards to developing specialized programs to assist college students with ASD.

Improving Empathic Communication Skills in Adults with Autism Spectrum Disorder

The literature suggests that many individuals diagnosed with Autism Spectrum Disorder (ASD) experience challenges with recognizing and describing emotions in others, which may result in difficulties with the verbal expression of empathy during communication. Thus, there is a need for intervention techniques targeting this area. Using a multiple baseline across participants design, this study examined the effectiveness of a video-feedback intervention with a visual framework component to improve verbal empathetic statements and questions during conversation for adults with ASD. Following intervention, all participants improved in verbal expression of empathetic statements and empathetic questions during conversation with generalization and maintenance of gains. Furthermore, supplemental assessments indicated that each participant improved in their general level of empathy and confidence in communication skills.

Assessment and Training in a 3-Dimensional Virtual Environment With Haptics: A Report on 5 Cases of Motor Rehabilitation in the Chronic Stage After Stroke

Objective. This exploratory study assessed the possible effectiveness of hemiparetic upper extremity training in subjects with chronic stroke with computer instrumentation (haptic force feedback) and 3-dimensional visualization applied to computer games, as well as to evaluate concurrent computer-assisted assessment of the kinematics of movements and test whether any improvement detected in the computer environment was reflected in activities of daily living (ADLs).

Methods. A single-subject repeated-measures experimental design (AB) was used. After baseline testing, 5 patients were assigned to the therapy 3 times a week for 45 min for 5 weeks. Velocity, time needed to reach, and hand path ratio (reflecting superfluous movements) were the outcome measures, along with the Assessment of Motor and Process Skills and the Box and Block test. The follow-up phase (C) occurred 12 weeks later.

Results. Improvements were noted in velocity, time, and hand path ratio. One patient showed improvement in occupational performance in ADLs.

Conclusions.The application of this strategy of using virtual reality (VR) technologies may be useful in assessing and training stroke patients. The results of this study must be reproduced in further studies. The VR systems can be placed in homes or other nonclinical settings.

The impact of an in-class sensory activity schedule on task performance of children with autism and intellectual disability: A pilot study

Introduction

There is limited evidence to support use of sensory interventions by teachers in the classroom. The purpose of this pilot study is to determine the effectiveness of sensory activity schedule intervention in supporting participation and increasing classroom task performance in students with autism.

Method

A non-concurrent, AB single system research design across multiple baselines was used with four students with autism who attended an autism-specific school. Students demonstrated atypical sensory processing, which negatively affected their school performance. Repeated baseline and intervention data were collected by school staff using video recording during classroom tasks. Tasks performed were designated by the child’s teacher. Stage one of the Perceive, Recall, Plan, Perform System of Task Analysis was used as a repeated measure of student performance. Ratings were carried out by independent raters who were blinded to the condition of performance.

Results

Results revealed three out of four students achieved significant improvements in classroom task performance following the use of sensory activity schedule intervention developed in consultation with an occupational therapist as measured by the task analysis.

Conclusion

This study provides emerging evidence for the use of sensory activity schedule intervention in the classroom for students with autism.

Blue Prescription: A single-subject design intervention to enable physical activity for people with stroke

Background/Aims:

Adherence to long-term physical activity is low in stroke survivors despite evidence supporting the benefits of regular physical activity on health and wellbeing. The aims of this single-subject design study were to: i) determine whether Blue Prescription, a physiotherapy approach to increase physical activity, enabled adults with chronic stroke living in the community to engage in a physical activity of their choice for three months; ii) explore the benefits of the Blue Prescription intervention on self-reported quality of life, physical function and self-efficacy.

Methods:

A multiple-participant, two-phase (baseline followed by treatment) single-subject design study was repeated with adults (n=5) with chronic stroke. The time of baseline testing, follow-up outcome measurement and Blue Prescription visits were randomly assigned to each participant. Due to randomisation, the baseline phase spanned four to six weeks. The intervention phase had a duration of three months. Engagement in physical activity was recorded in a physical activity diary. Secondary outcome measures used included the European Quality of Life Scale, Stroke Impact Scale and Stroke Self-Efficacy Questionnaire, which were completed at 15 random intervals over four and a half months.

Results:

All five participants maintained engagement in their chosen activity for three months. Participant 2 mostly showed significant improvements in the secondary outcome measures (p<0.05), while participant 4 showed a significant decline in the European Quality of Life Scale (p<0.05). No other significant results were found, although observable trends in secondary outcome measure scores were present.

Conclusions:

Blue Prescription appears feasible for engaging chronic stroke survivors in physical activity, although its effects on quality of life, physical function and self-efficacy are variable.

Effects of tracking technology on daily life of persons with dementia: three experimental single-case studies

OBJECTIVES

To investigate the effects of using tracking technology on independent outdoor activities and psychological well-being in 3 persons with dementia (PwDs) and their spouses.

METHODS

Three experimental single-case studies with an A1B1A2B2 design. The intervention entailed access to a passive positioning alarm and technical support. Continual daily measures of independent outdoor activities among PwDs' and spouses' worries about these activities were made during all phases.

RESULTS

Access to a tracking technology consistently increased the independent outdoor activities of 2 PwDs. One of the spouses consistently reported decreased worry during B phases, another's worry decreased only in B2, and the third showed little variability in worrying across all phases.

CONCLUSION

Tracking technology may support PwDs to engage in independent outdoor activities and decrease spouses' worries; however, randomized controlled group studies are needed to investigate whether these results can be replicated on a group level.

A therapeutic skating intervention for children with autism spectrum disorder

PURPOSE

The purpose of this study was to evaluate the effects of a highly structured therapeutic skating intervention on motor outcomes and functional capacity in 2 boys with autism spectrum disorder aged 7 and 10 years.

METHODS

This multiple-baseline, single-subject study assigned participants to three 1-hour skating sessions per week for 12 weeks focusing on skill and motor development. Multiple data points assessed (a) fidelity to the intervention and (b) outcomes measures including the Pediatric Balance Scale, Timed Up and Go, floor to stand, Six-Minute Walk Test, goal attainment, and weekly on-ice testing.

RESULTS

Improvements were found in balance, motor behavior, and functional capacity by posttest with gains remaining above pretest levels at follow-up.

CONCLUSIONS

Therapeutic skating may produce physical benefits for children with autism spectrum disorder and offer a viable, inexpensive community-based alternative to other forms of physical activity.

The Use of Peer Networks to Increase Communicative Acts of First Grade Students with Autism Spectrum Disorders

Peer networks including social groups using typical peers, scripted instruction, visual text cues, and reinforcement were examined with students with autism spectrum disorders (ASD). A multiple baseline design across four participants was used to measure students’ use of communication acts with peers during free play following instruction. Peer Network groups occurred over a 3-month period for 30 min 3 times per week. Visual inspection of trends and TauU effect size calculations showed significant changes in total communication acts for all four participants during peer network sessions and increased initiations for three of the four participants. Generalization probes during classroom centers indicated increased communications following interventions for three of the four participants.

Myofascial treatment for patients with acetabular labral tears: a single-subject research design study

STUDY DESIGN

Single-subject research design using 4 consecutive patients.

OBJECTIVE

To assess whether treatment using soft tissue therapy (ART or Active Release Technique), stretching, and strengthening of the hip abductors, hip external rotators, and tensor fascia latae muscles reduces pain and improves self-reported hip function in patients with acetabular labral tears who also have posterolateral hip pain of suspected myofascial origin.

BACKGROUND

Acetabular labral tears cause pain in some but not all patients. Pain commonly presents anteriorly but may also present posteriorly and laterally. The standard of care is arthroscopic repair, which helps many but not all patients. It is possible that these patients may present with extra-articular contributions to their pain, such as myofascial pain, making their clinical presentation more complex. No previous study has assessed soft tissue therapy as a treatment option for this subset of patients.

METHODS

This A-B-A design used repeated measures of the Hip Outcome Score and visual analog scale for pain. Four patients were treated for 6 to 8 weeks, using a combination of soft tissue therapy, stretching, and strengthening for the hip abductors, external rotators, and tensor fascia latae. Data were assessed visually, statistically, and by comparing mean differences before and after intervention.

RESULTS

All 4 patients experienced both statistically significant and clinically meaningful improvement in posterolateral hip pain and hip-related function. Three patients also experienced reduction in anteromedial hip pain.

CONCLUSION

Myofascial hip pain may contribute to hip-related symptoms and disability in patients with acetabular labral tears and posterolateral hip pain. These patients may benefit from soft tissue therapy combined with stretching and strengthening exercises targeting the hip abductors, tensor fascia latae, and hip external rotator muscles. Level of Evidence Therapy, level 4.

Pelvic joint fusion in patients with severe pelvic girdle pain - a prospective single-subject research design study

BACKGROUND

The fusion of the pelvic joints in patients with severe pelvic girdle pain (PGP) is a controversial and insufficiently studied procedure. The aims of this study were to evaluate physical function and pain after sacroiliac joint (SIJ) fusion.

METHODS

A single-subject research design study with repeated measurements was conducted; pre-operatively and at 3, 6 and 12 months post-operatively. The outcome measures considered were the Oswestry disability index (ODI), visual analogue scale (VAS), and SF-36. Eight patients with severe PGP received open-accessed unilateral anterior SIJ fusion and fusion of the pubic symphysis.

RESULTS

Seven patients reported positive results from the surgery. At 1 year post-operation, significant (p < 0.001) reductions in ODI (54 to 37) and VAS (82 to 57) were reported. The physical functioning, bodily pain, and social functioning scores in the SF-36 were also improved.

CONCLUSION

Positive and significant changes in disability and pain at 1 year after SIJ fusion were observed. Despite these positive results, open accessed anterior fusion of the SIJ was associated with adverse events and complications such as infection and nerve damage.