The Single-Case Reporting Guideline In BEhavioural Interventions (SCRIBE) 2016 Statement

Artificial Intelligence-Assisted Speech Therapy for /ɹ/: A Single-Case Experimental Study

PURPOSE

This feasibility trial describes changes in rhotic production in residual speech sound disorder following ten 40-min sessions including artificial intelligence (AI)-assisted motor-based intervention with ChainingAI, a version of Speech Motor Chaining that predicts clinician perceptual judgment using the PERCEPT-R Classifier (Perceptual Error Rating for the Clinical Evaluation of Phonetic Targets). The primary purpose is to evaluate /ɹ/ productions directly after practice with ChainingAI versus directly before ChainingAI and to evaluate how the overall AI-assisted treatment package may lead to perceptual improvement in /ɹ/ productions compared to a no-treatment baseline phase.

METHOD

Five participants ages 10;7-19;3 (years;months) who were stimulable for /ɹ/ participated in a multiple (no-treatment)-baseline ABA single-case experiment. Prepractice activities were led by a human clinician, and drill-based motor learning practice was automated by ChainingAI. Study outcomes were derived from masked expert listener perceptual ratings of /ɹ/ from treated and untreated utterances recorded during baseline, treatment, and posttreatment sessions.

RESULTS

Listeners perceived significantly more rhoticity in practiced utterances after 30 min of ChainingAI, without a clinician, than directly before ChainingAI. Three of five participants showed significant generalization of /ɹ/ to untreated words during the treatment phase compared to the no-treatment baseline. All five participants demonstrated statistically significant generalization of /ɹ/ to untreated words from pretreatment to posttreatment. PERCEPT-clinician rater agreement (i.e., F1 score) was largely within the range of human-human agreement for four of five participants. Survey data indicated that parents and participants felt hybrid computerized-clinician service delivery could facilitate at-home practice.

CONCLUSIONS

This study provides evidence of participant improvement for /ɹ/ in untreated words in response to an AI-assisted treatment package. The continued development of AI-assisted treatments may someday mitigate barriers precluding access to sufficiently intense speech therapy for individuals with speech sound disorders.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.26662807.

Treating taboo thoughts on a psychiatric intensive care unit: a four-phase mixed methods single case experimental design

BACKGROUND

Well-designed evaluations of psychological interventions on psychiatric intensive care units (PICUs) are a rarity.

AIMS

To evaluate the effectiveness of cognitive behaviour therapy for intrusive taboo thoughts with a patient diagnosed with bipolar affective disorder admitted to a PICU due to significant ongoing risk of harm to self.

METHOD

This was a four-phase ABC plus community follow-up (D) mixed methods n=1 single case experimental design. Four idiographic measures were collected daily across four phases; the baseline (A) was during PICU admission, the first treatment phase (B) was behavioural on the PICU, the second treatment phase (C) was cognitive on an acute ward and the follow-up phase (D) was conducted in the community. Four nomothetic measures were taken on admission, on discharge from the PICU, discharge from the acute ward and then at 4-week follow-up. The participant was also interviewed at follow-up using the Change Interview.

RESULTS

Compared with baseline, the behavioural and the cognitive interventions appeared effective in terms of improving calmness, optimism and rumination, but the effects on sociability were poor. There was evidence across idiographic and nomothetic outcomes of a relapse during the follow-up phase in the community. Eleven idiographic changes were reported in the interview and these tended to be unexpected, related to the therapy and personally important.

DISCUSSION

Single case methods can be responsive to tracking the progress of patients moving through in-patient pathways and differing modules of evidence-based interventions. There is a real need to implement robust outcome methodologies on PICUs to better evaluate the psychological aspects of care in this context.

Multiple oppositions intervention: effective phonological treatment of two children with cleft lip and palate and severe speech sound disorder

The purpose of this study was to investigate if multiple oppositions intervention (MOI) generated widespread change in the phonological systems of two children with cleft lip and palate (CLP) and severe speech sound disorders (SSD). We treated two children (ages 5;4 and 5;6) with CLP and severe SSD using MOI for 24 and 29 sessions. We measured the percentage consonants correct (PCC) for target consonants and untreated consonants in non-treatment single words, as well as PCC for connected speech. Data points were collected in the baseline, intervention, and maintenance phase with post-tests conducted immediately after intervention and at 1, 3, 6 and 12 months. Two speech and language therapists (SLTs) unfamiliar with the children performed phonetic transcriptions, and we calculated intra- and inter-rater agreement. We graphed the data, and used permutation tests to analyse the probability that the observed increases in PCC were due to random chance. Both children experienced considerable improvements in PCC across all measures at the first post-test, supporting the impact of MOI on their entire phonological system. The PCC continued to increase during the maintenance phase. By the final post-test, the PCC in connected speech exceeded 90% for both children, reducing their SSD classification to mild. Our findings support that a phonological, contrastive intervention approach targeting multiple consonants simultaneously can create system-wide phonological change for children with CLP and severe SSD. Further research with more participants is needed to strengthen these findings.

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

BACKGROUND

Residents in nursing homes are prone to cognitive decline affecting memory, visuospatial cognition, and executive functions. Cognitive decline can lead to dementia, necessitating prioritized intervention.

METHODS

The 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.

RESULTS

Visual 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.

CONCLUSIONS

The results suggest that the use of digital games may be effective for preserving and improving cognitive function among residents of nursing home.

TRIAL REGISTRATION

This 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).

Therapist guided, parent-led cognitive behavioural therapy (CBT) for pre-adolescent children with obsessive compulsive disorder (OCD): a non-concurrent multiple baseline case series

BACKGROUND

Cognitive behavioural therapy (CBT) including exposure and response prevention (ERP) is an effective treatment for preadolescent children with obsessive compulsive disorder (OCD); however, there is a need to increase access to this treatment for affected children.

AIMS

This study is a preliminary evaluation of the efficacy and acceptability of a brief therapist-guided, parent-led CBT intervention for pre-adolescent children (5-12 years old) with OCD using a non-concurrent multiple baseline approach.

METHOD

Parents of 10 children with OCD were randomly allocated to no-treatment baselines of 3, 4 or 5 weeks before receiving six to eight individual treatment sessions with a Psychological Wellbeing Practitioner. Diagnostic measures were completed prior to the baseline, 1-week post-treatment, and at a 1-month follow-up, and parents completed weekly measures of children's OCD symptoms/impairment.

RESULTS

Seventy percent of children were 'responders' and/or 'remitters' on diagnostic measures at post-treatment, and 60% at the 1-month follow-up. At least 50% of children showed reliable improvements on parent-reported OCD symptoms/impairment from pre- to post-treatment, and from pre-treatment to 1-month follow-up. Crucially, the intervention was acceptable to parents.

CONCLUSIONS

Brief therapist-guided, parent-led CBT has the potential to be an effective, acceptable and accessible first-line treatment for pre-adolescent children with OCD, subject to the findings of further evaluations.

Evaluating the impact of movement tracking feedback on engagement with home exercise programmes of children with cerebral palsy using a new therapy app: a protocol for a mixed-methods single-case experimental design with alternating treatments

INTRODUCTION

Children with cerebral palsy (CP) are prescribed home exercise programmes (HEPs) to increase the frequency of movement practice, yet adherence to HEPs can be low. This paper outlines the protocol for a single-case experimental design (SCED) with alternating treatments, using a new home therapy exercise application, Bootle Boot Camp (BBCamp), offered with and without movement tracking feedback. This study will explore the impact of feedback on engagement, movement quality, lower limb function and family experiences to help understand how technology-supported HEPs should be translated and the added value, if any, of movement tracking technology.

METHODS AND ANALYSIS

In this explanatory sequential mixed-methods study using a SCED, 16 children with CP (aged 6-12 years, Gross Motor Function Classification System levels I-II) will set lower limb goals and be prescribed an individualised HEP by their physiotherapist to complete using BBCamp on their home television equipped with a three-dimensional camera-computer system. Children will complete four weekly exercise sessions over 6 weeks. Children will be randomised to 1 of 16 alternating treatment schedules where BBCamp will provide or withhold feedback during the first 4 weeks. The version of BBCamp that results in the most therapeutic benefit will be continued for 2 final weeks. Goals will be re-evaluated and families interviewed. The primary outcome is adherence (proportion of prescribed exercise repetitions attempted) as a measure of behavioural engagement. Secondary outcomes are affective and cognitive engagement (smiley face ratings), exercise fidelity, lower limb function, goal achievement and participant experiences. SCED data will be analysed using visual and statistical methods. Quantitative and qualitative data will be integrated using joint displays.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the Research Ethics Boards at Bloorview Research Institute and the University of Toronto. Results will be distributed through peer-reviewed journals and scientific conferences.

TRIAL REGISTRATION NUMBER

NCT05998239; pre-results.

Behavioral Management of Respiratory/Phonatory Dysfunction for Dysarthria Associated With Neurodegenerative Disease: A Systematic Review

PURPOSE

This systematic review represents an update to previous reviews of the literature addressing behavioral management of respiratory/phonatory dysfunction in individuals with dysarthria due to neurodegenerative disease.

METHOD

Multiple electronic database searches and hand searches of prominent speech-language pathology journals were conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards.

RESULTS

The search yielded 1,525 articles, from which 88 met inclusion criteria and were reviewed by two blinded co-investigators. A large range of therapeutic approaches have been added to the evidence base since the last review, including expiratory muscle strength training, singing, and computer- and device-driven programs, as well as a variety of treatment modalities, including teletherapy. Evidence for treatment in several different population groups-including cerebellar ataxia, myotonic dystrophy, autosomal recessive spastic ataxia of Charlevoix-Saguenay, Huntington's disease, multiple system atrophy, and Lewy body dementia-were added to the current review. Synthesis of evidence quality provided strong evidence in support of only one behavioral intervention: Lee Silverman Voice Treatment Program (LSVT LOUD) in people with Parkinson's disease. No other treatment approach or population included in this review demonstrated more than limited evidence, reflecting that these approaches/populations require urgent further examination.

CONCLUSION

Suggestions about where future research efforts could be significantly strengthened and how clinicians can apply research findings to their practice are provided.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24964473.

What Information Do Neuropsychologists Use to Guide their Clinical Decisions? A Survey on Knowledge and Application of Evidence-Based Practice in a French-Speaking Population

OBJECTIVE

Evidence-based practice (EBP) is an approach that encourages clinicians to base their practice on evidence to improve the quality of patient care and reduce uncertainty in their clinical decisions. However, the state of knowledge and practice of neuropsychologists in French-speaking countries is still unknown. This study aimed to find out what these neuropsychologists know about EBP and whether they use it.

METHOD

A questionnaire with 39 questions for French-speaking neuropsychologists was distributed. The questions focused on neuropsychologists' knowledge and use of EBP and information that guide their clinical decisions.

RESULTS

A total of 392 respondents started the survey. The data show that only 35% correctly defined EBP and there was confusion between this practice and the strict use of research data. In practice, their decisions are influenced by multiple factors, including the patient's difficulties and advice from peers. Regarding the research, a significant proportion of the sample stated that they did not search the scientific literature frequently. Barriers to accessing scientific information and ineffective article-reading behavior were highlighted.

CONCLUSION

A lack of knowledge of EBP among French-speaking neuropsychologists was observed. Furthermore, the factors influencing their decision-making do not clearly fit the definitions of EBP. Information-seeking behaviors show several weaknesses and barriers to the integration of scientific evidence into practice. These results are like those of other studies conducted among psychologists or in other health professions. We will discuss possible courses of action that could be implemented to improve the knowledge and use of EBP.

Varying Syntax to Enhance Verb-Focused Intervention for 30-Month-Olds With Language Delay: A Concurrent Multiple Baseline Design

PURPOSE

The purpose of this study is to determine if 2.5-year-olds with language delay would learn verbs (spill) when presented with varying syntactic structure ("The woman is spilling the milk"/"The milk is spilling"; milk = patient or theme) in a therapeutic context. Children with language delay have proportionally small inventories of verbs, which limits expressive language development. Children who have typical language development learn verbs more robustly when presented with alternating arguments than with a single argument structure.

METHOD

Three toddlers with expressive language delay (29-30 months of age) participated in a verb-focused treatment study using a concurrent multiple baseline design. Participants were shown action videos accompanied by sentences with varied argument structure for each target verb. To assess learning pre- and posttreatment, participants were asked to demonstrate actions corresponding to each verb.

RESULTS

Visual inspection and tau analyses reveal significant posttreatment gains of target verbs taught with varying argument structures.

CONCLUSIONS

Our results indicate that learning verbs with high variability of argument roles may facilitate a strong link between lexical representations of verbs and their syntactic structures. Using argument structure variability to teach verbs as an intervention strategy has great potential and should be tested further in larger group studies.

Development, implementation and evaluation of a dental hygienist supported daily toothbrushing programme in Irish pre-schools: A single-case experimental design

INTRODUCTION

Many pre-school children in Ireland experience dental caries in their primary dentition. The rate of dental caries varies, impacted by the levels of fluoride in the water and socio-economic status (18%-55%). This article reports on a novel initiative in which dental hygienists (DHs) supported pre-school teachers (PST) to implement a toothbrushing programme for children attending pre-schools in Ireland. It was hypothesised that such an initiative would create an environment in pre-schools that would improve the oral hygiene skills and habits of children and increase the oral health knowledge of parents and PST.

METHODS

A storybook (Brushing our teeth with Brush Bunny), a toothbrushing song and information leaflets were developed. DHs were provided with specific online training for the programme. The resources, including toothbrushes and toothpastes, were delivered to the pre-schools and training was provided by the DHs to the PST to prepare for and implement daily toothbrushing sessions. The standards for the toothbrushing programme followed the ChildSmile© programme. Before and after questionnaires gathered quantitative and qualitative data from the parents and PST. The toothbrushing programme was implemented by PST for 3 months.

RESULTS

Sixteen DHs and PST from 19 classes in 17 schools successfully delivered the programme to 331 children, and 227 parents completed both pre- and post-questionnaires. Poor baseline knowledge in relation to the 'spit don't rinse' message increased from 29% to 48%. However, there was no improvement in awareness of the benefits of fluoride in toothpaste. Awareness of the best brushing routines in relation to frequency and length was good at baseline and remained so after the programme. Most parents (90%) felt the programme had impacted positively on their child's toothbrushing routine.

CONCLUSION

This experimental study suggests that the logistics of implementing a daily toothbrushing routine to improve the oral hygiene skills and habits of pre-school children are possible in Irish pre-school settings when PST are supported by DHs. Parents' oral health knowledge may be improved, and it may impact positively on the children's daily toothbrushing routine. A larger study is required to confirm these findings.

Respiratory function in healthy long-term meditators: a systematic review

BACKGROUND

There is a paucity of data on effects of long-term meditation on respiration. This systematic review summarized selected respiratory function parameters in healthy long-term meditators (LTMs) at rest, during meditation and their associations with meditation practice variables.

METHODS

A systematic search of PubMed, EMBASE (Ovid), Scopus, Proquest Dissertation and Thesis Global databases, CENTRAL, and Google Scholar was performed from year 1950 to August 15th, 2023. Keywords "meditation," "long-term meditation," and respiratory/pulmonary/lung function and spirometry were used. Controlled-trials and observational studies exploring respiratory parameters in healthy LTMs published in English were included. Two independent reviewers selected studies, extracted data, and assessed the quality of the evidence. The Joanna-Briggs Institute Critical Appraisal Tools and the Single-Case Reporting Guideline In BEhavioural Interventions Statement were used to assess the methodological quality of the included studies. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Effect estimates of some outcomes were synthesized using alternative methods and data for other outcomes synthesized narratively as a meta-analysis was not possible.

RESULTS

Nine studies comprising 3 case-control, 3 cross-sectional, and 3 single-subject study designs, involving 433 participants that met the eligibility criteria, were included. Two studies reported slower resting RR among LTMs compared to controls [SMD = - 2.98, 95% CI (- 4.48 to - 1.47), overall-effect (z-score) = 3.88 (p < 0.001), I2 = 69%] with similar trend reported in the third study (MD = - 1.6, p = 0.053). Three studies reported slower RR in LTMs during meditation compared to baseline. Slower resting RR and mean RR change during meditation compared to baseline significantly negatively associated with meditation experience. PEFR was significantly higher in LTMs than controls [MD = 1.67, 95% CI (0.19-3.15), z-score = 2.21 (p = 0.03)]. No significant difference was observed in tidal volume [SDM = 0.93, 95% CI (- 1.13 to 2.99), z-score = 0.89 (p = 0.37), I2 = 96%] and vital capacity [SDM = 1.25, 95% CI (- 0.45 to 2.95), z-score = 1.44 (p = 0.15), I2 = 94%] of LTMs compared to controls.

CONCLUSIONS

Long-term meditation appears to be associated with slower baseline RR, and immediate reduction in RR during meditation, where greater practice amplifies the effects. Evidence on spirometry parameters in LTMs with ≥ 3 years of practice was limited.

Activity-Based Therapy for Mobility, Function and Quality of Life after Spinal Cord Injuries-A Mixed-Methods Case Series

(1) Background: Despite inconclusive evidence on the benefits of activity-based therapies (ABTs) in people with spinal cord injuries, implementation has occurred in clinics worldwide in response to consumers' requests. We explored the clinical changes and participants' perceptions from engaging in an ABT program in the community. (2) Methods: This mixed-methods study involved a pragmatic observational multiple-baseline design and an evaluation of participants' perceptions. Fifteen participants were included. Outcome measures were balance in sitting using the Seated Reach Distance test, mobility using the Modified Rivermead Mobility Index and quality of life using the Quality of Life Index SCI version pre- and post-participation in an ABT community-based program. Linear mixed models and logistic regressions were used to analyse the effects of intervention. Semi-structured interviews explored participants' perceptions using inductive thematic analysis. (3) Results: There was an increase of 9% in the standardised reach distance (95% CI 2-16) for sitting balance, 1.33 points (95% CI: 0.81-1.85) in mobility and 1.9 points (0.17-2.1) in quality of life. Two themes emerged from the interviews: (1) reduced impact of disability and an increased sense of life as before, and (2) the program was superior to usual rehabilitation. No adverse events related to the intervention were observed. (4) Conclusion: ABT delivered in the community improved clinical outcomes in people with a chronic SCI. High levels of satisfaction with the program were reported.

Internet-Delivered Therapy for Parents With Health Anxiety by Proxy: Protocol for a Single-Case Experimental Design Study

BACKGROUND

Health anxiety (HA) by proxy is described as parents' obsessive worries that their child is severely ill although this is not medically confirmed. Research on HA by proxy suggests that it is highly distressing for the parent and that the child may be at risk of developing maladaptive symptom coping strategies. No targeted treatment for this group exists. We developed PROXY, an 8-week psychological internet-delivered treatment for parents with HA by proxy. The treatment components of PROXY are informed by cognitive behavioral therapy as well as acceptance and commitment therapy, and it was developed in collaboration with parents experiencing HA by proxy and clinical experts.

OBJECTIVE

This paper describes the protocol for a study investigating the potential effects of PROXY on parents' worries about their children's health using a single-case experimental design (SCED).

METHODS

Five parents clinically evaluated as experiencing HA by proxy will be included. A replicated randomized SCED study will be conducted in which each participant will be randomized to receive treatment after a baseline period of between 7 and 26 days (phase A). The treatment phase duration is 8 weeks for all participants (phase B), followed by a follow-up phase lasting between 14 and 33 days (phase C), ensuring that all participants remain in the study for 96 days. Participants will report daily anxiety level by SMS text message throughout the study. They will also answer self-report questionnaires, including questions on HA by proxy and own HA, 4 times during the study. Data will be submitted to structured visual analysis to inspect anxiety level, the variability of anxiety, trends, the overlap of data points among phases, when effects occur, and the consistency of data patterns across participants. Furthermore, randomization tests will be conducted for each participant to test the null hypothesis that PROXY will have no effect on participants' anxiety.

RESULTS

The recruitment of parents began in June 2022. As of March 2, 2023, a total of 4 parents have been included in the study. Data collection was expected to cease in April 2023.

CONCLUSIONS

To the best of our knowledge, this protocol describes the only study of treatment for HA by proxy. As the prevalence of this condition is still unknown, a SCED was chosen because this method allows the inclusion of very few participants while still providing information on effects and treatment courses. Conducting the study with a replicated randomized phase design enables methodologically sound testing despite the inclusion of very few participants. The results will inform researchers on individual treatment courses and effects, which may direct future research in terms of the possible mechanisms of change, ideas for how to refine the treatment content, and how the treatment may be offered to patients in the future.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04830605; https://clinicaltrials.gov/study/NCT04830605.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/46927.

Interdisciplinary rehabilitation for persisting post-concussion symptoms after mTBI: N=15 single case experimental design

BACKGROUND

Despite clinical guidelines recommending an interdisciplinary approach to persisting post-concussion symptom (PPCS) management, evaluations of interdisciplinary interventions remain scant.

OBJECTIVES

This pilot study aimed to explore the feasibility and preliminary efficacy of an interdisciplinary intervention for PPCSs.

METHOD

A single-case experimental design with randomisation to multiple baselines (2, 4, or 6 weeks) was repeated across 15 participants (53% female) with mild traumatic brain injury (mean age 38.3 years, SD 15.7). The 12-week treatment incorporated psychology, physiotherapy, and medical interventions. Feasibility outcomes included recruitment and retention rates, adverse events, treatment adherence and fidelity. Patient-centred secondary outcomes included the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), assessed 3 times per week during the baseline and treatment phases, and at the 1- and 3-month follow-ups. Other secondary outcomes included measures of mood, sleep and fatigue, physical functioning, health-related quality of life, illness perceptions, and goal attainment. Changes in PPCSs were evaluated using systematic visual analysis and Tau-U. Clinically significant changes in secondary outcomes were explored descriptively.

RESULTS

16/26 individuals assessed for eligibility were enroled (61% recruitment rate); 15 completed the post-treatment follow-ups, and 13 completed the 1- and 3-month follow-up assessments (81% retention rate). High treatment adherence and competence in delivering treatments was observed. Moderate-large effect sizes for reducing PPCSs were observed in 12/15 cases, with 7/15 reaching statistical significance. Improvements were maintained at the 1- and 3-month follow-ups and were accompanied by reductions in fatigue, sleep difficulties, and mood symptoms, and changes in illness perceptions. All participants had clinically significant improvements in at least 1 outcome, with 81% of individual therapy goals achieved.

CONCLUSIONS

This pilot study provided preliminary support for a subsequent randomised controlled trial (RCT), with satisfactory recruitment, retention, treatment compliance, and treatment fidelity. Improvement was evident on participant outcomes including symptom reduction and goal attainment, suggesting that progressing to a phase-II RCT is worthwhile. Findings highlight the potential benefit of individualized interdisciplinary treatments.

How to Evaluate a Tailor-made Social Work Intervention? Some Practice-Based Solutions with Single-Case Designs

PURPOSE

With the increased attention to the principles of evidence-based practice (EBP), social workers are challenged to adapt their daily interventions accordingly when treating clients. They usually work with individual clients, all with their own specificities. Single-Case Experimental Designs (SCEDs) can be used to inform a social worker about the effectiveness of an intervention at the individual client level. In everyday social work practice, however, it is difficult to meet methodological requirements of SCEDs to find causal explanations. A concern is that repeated measurements prior to an intervention are required in most situations. This study aims to provide researchers with alternatives to repeated measurement when using the logic of SCED to apply EBP in their everyday practice.

METHODS

In this study, we reviewed published single-case designs between January 1 and December 31, 2019, on types of SCEDs in the social domain, and how is dealt with baseline conditions.

RESULTS

SCEDs and quasi-experimental alternatives are hardly published in situations when baseline data are not available. Four underused quasi-experimental strategies that can be employed when repeated measurement during baseline is not possible are as follows: retrospective baselines, theoretical inference, multiraters, and triangulation with qualitative data.

DISCUSSION AND CONCLUSION

The suggestions to work with single-case designs with quasi-experimental elements are meant to enable social workers to evaluate their interventions in a way that enhances mere narrative evaluations of the experiences of an intervention.

How did the Treatment Work for Robin? And for Dylan? Studying Individual Youth Treatment Mediators Using Single-Case Experimental Designs

Study of individual treatment mechanisms in youth interventions facilitates evidence-based development, selection and implementation of treatment components that are most effective for each individual child. This position paper aims to bring together two important topics from the area of youth intervention research: mediators of treatment outcomes and single-case experimental design methodology. We start by outlining the benefits of studying within-person mechanisms and propose how statistical mediation analysis and single-case methods can be integrated to enable this type of research. Further, we review existing methodology for the study of individual youth treatment mechanisms and provide recommendations for the clinical practice research.

Intramuscular Electrical Stimulation for the Treatment of Trigger Points in Patients with Chronic Migraine: A Protocol for a Pilot Study Using a Single-Case Experimental Design

Background and Objectives: Trigger points (TrPs) are prevalent in patients with migraine headaches. Needling interventions targeting TrPs in migraine patients may reduce the intensity and frequency of headaches, yet systematic reviews reveal a lack of robust evidence. Intramuscular electrical stimulation (IMES) is a modality that delivers electrical current into muscles and TrPs, with recent studies suggesting it may amplify the therapeutic effects of dry needling peripherally and centrally. This could be advantageous for patients with migraine and symptomatic TrPs. Materials and Methods: This study will implement a multiple baseline single-case experimental design (SCED). In a clinical setting, a SCED study lends itself to conducting research with only a few patients that each serve as their own controls. In this SCED study, four participants with chronic migraine will be enrolled in a non-concurrent manner and randomized to one of four baseline measurement periods (4, 5, 6 or 7 weeks), leading to four potentially different start dates for each participant in the intervention phase. During the intervention phase, patients will receive five sessions of dry needling with IMES, one session per week for five weeks. The primary outcome measure will be headache frequency, i.e., the reduction in the number of headache days over a one-month period using electronic headache diary data from the Migraine Buddy smartphone application. Secondary outcome measures will be changes in mean migraine pain intensity using a numeric pain rating scale (NPRS), migraine disability using the Migraine Disability Assessment Test (MIDAS), the Headache Impact Test (HIT-6), and changes in selected cervical musculoskeletal impairments including pressure pain thresholds (PPTs) over TrPs, the craniocervical flexion test (CCFT), and cervical active range of motion (AROM). Primary and secondary outcome measures will be analyzed separately using both visual and statistical analyses. Results: Actively recruiting participants. This project was approved by the Mass General Brigham Institutional Review Board (protocol #2023P000931) and is registered with ClinicalTrials.gov (NCT05893914). Conclusions: This study will seek to determine the effects of a five-week intervention period of IMES to TrPs in the posterior cervical muscles of subjects with chronic migraine.

Effectiveness of training in expressing positive emotions, reacting to change and greeting peers after childhood traumatic brain injury: a single-case experimental study

Background

Social cognitive deficits are common after traumatic brain injury (TBI). The participant in this single-case experimental design (SCED) was 7 years old when he sustained a severe TBI. After 2 years in rehabilitation, he continues to show deficits in social cognition.

Objective

To determine the effectiveness of three interventions, each aimed at improving a behavior altered by social cognition deficits. These behaviors were: (1) expression of positive emotions, (2) reacting to changes in plans, and (3) greeting classmates.

Method

An A-B-A' design was used for each behavior. In addition, each behavior was targeted with a rehabilitation program applied over 10 sessions.

Results

For the first behavior, changes between phases B-A' (NAP = 0.712) and A-A' (NAP = 0.864) indicated improvements in the child's ability to express positive emotions. In the second behavior, changes in the intensity of reactions between phases B and A' (NAP = 0.815) and A vs. A' (NAP = 0.834) indicated that the child adapted to changes in a plan and to unexpected situations in a more adaptive way. For the third behavior, changes in the number of greetings between phases A and B (NAP = 0.883) and A vs. A' (NAP = 0.844) suggested that during the third phase of the study, the participant fully acquired the habit of greeting peers and increased his interactions with others.

Conclusion

While the participant showed improvements in all three targeted behaviors, due to the complexity of the third behavior, it is recommended that in future research, the intervention targeting social interactions should be applied over a longer timeframe to ensure that improvements are more stable in the long term.

Goal Attainment Scaling in rehabilitation: An educational review providing a comprehensive didactical tool box for implementing Goal Attainment Scaling

CONTEXT

Goal Attainment Scaling (GAS) is a person-centered and collaborative approach, allowing to assess the effectiveness of an intervention on personally relevant goals. However, GAS is not a "scale" but a heterogeneous group of methodologies, including many variations and lack of consensus on high quality GAS.

OBJECTIVE

The aim of this communication is to: 1. provide updated didactical information on GAS use in PRM practice and research; 2. increase awareness of GAS methodological challenges; 3. guide use of GAS as an integrated process of rehabilitation after goal setting and; 4. provide updated resources for self-directed learning and extensive supplemental material to increase knowledge and practical skills in GAS use.

METHODS

Educational literature review about current GAS applications relevant to PRM fields.

RESULTS

Practical advice is provided regarding clinical challenges in GAS: definition of 0 level, time-frame and means employed to attain the goal, dealing with unforeseen pattern of improvement, synthesizing the numerous significations of "SMART" goal acronym to guide best use of GAS, and thinking flexibility on the type of relevant goals that can be set. Challenges with GAS in rehabilitation research are presented in order to promote researcher's and reviewer's awareness on reliable use of GAS and encouraging best-use of GAS.

Functional correlates of subliminal stimulation in Posttraumatic Stress Disorder: Systematic review and meta-analysis

Patients with Post-traumatic stress disorder (PTSD) exposed to traumatic reminders show hyperreactivity in brain areas (e.g., amygdala) belonging or related to the Innate Alarm System (IAS), allowing the rapid processing of salient stimuli. Evidence that IAS is activated by subliminal trauma-reminders could shed a new light on the factors precipitating and perpetuating PTSD symptomatology. Thus, we systematically reviewed studies investigating neuroimaging correlates of subliminal stimulation in PTSD. Twenty-three studies were selected from the MEDLINE and Scopus® databases for a qualitative synthesis, 5 of which allowed a further meta-analysis of fMRI data. The intensity of IAS responses to subliminal trauma-related reminders ranged from a minimum in healthy controls to a maximum in the PTSD patients with the most severe (e.g., dissociative) symptoms or the least responsiveness to treatment. Comparisons with other disorders (e.g., phobias) revealed contrasting results. Our findings demonstrate the hyperactivation of areas belonging or related to IAS in response to unconscious threats that should be integrated in diagnostic as well as in therapeutic protocols.

Simultaneous assessment and training of an upper-limb amputee using incremental machine-learning-based myocontrol: a single-case experimental design

BACKGROUND

Machine-learning-based myocontrol of prosthetic devices suffers from a high rate of abandonment due to dissatisfaction with the training procedure and with the reliability of day-to-day control. Incremental myocontrol is a promising approach as it allows on-demand updating of the system, thus enforcing continuous interaction with the user. Nevertheless, a long-term study assessing the efficacy of incremental myocontrol is still missing, partially due to the lack of an adequate tool to do so. In this work we close this gap and report about a person with upper-limb absence who learned to control a dexterous hand prosthesis using incremental myocontrol through a novel functional assessment protocol called SATMC (Simultaneous Assessment and Training of Myoelectric Control).

METHODS

The participant was fitted with a custom-made prosthetic setup with a controller based on Ridge Regression with Random Fourier Features (RR-RFF), a non-linear, incremental machine learning method, used to build and progressively update the myocontrol system. During a 13-month user study, the participant performed increasingly complex daily-living tasks, requiring fine bimanual coordination and manipulation with a multi-fingered hand prosthesis, in a realistic laboratory setup. The SATMC was used both to compose the tasks and continually assess the participant's progress. Patient satisfaction was measured using Visual Analog Scales.

RESULTS

Over the course of the study, the participant progressively improved his performance both objectively, e.g., the time required to complete each task became shorter, and subjectively, meaning that his satisfaction improved. The SATMC actively supported the improvement of the participant by progressively increasing the difficulty of the tasks in a structured way. In combination with the incremental RR-RFF allowing for small adjustments when required, the participant was capable of reliably using four actions of the prosthetic hand to perform all required tasks at the end of the study.

CONCLUSIONS

Incremental myocontrol enabled an upper-limb amputee to reliably control a dexterous hand prosthesis while providing a subjectively satisfactory experience. The SATMC can be an effective tool to this aim.

A Multilevel Meta-analysis of Single-Case Research on Interventions for Internalizing Disorders in Children and Adolescents

The effectiveness of interventions for internalizing disorders in children and adolescents was studied using a review and meta-analysis of published single-case research. Databases and other resources were searched for quantitative single-case studies in youth with anxiety, depressive, and posttraumatic stress disorders. Raw data from individual cases were aggregated and analyzed by means of multilevel meta-analytic models. Outcome variables were symptom severity assessed across baseline and treatment phases of the studies, and diagnostic status at post- and follow-up treatment. Single-case studies were rated for quality. We identified 71 studies including 321 cases (M^age = 10.66 years; 55% female). The mean quality of the studies was rated as below average, although there were considerable differences between the studies. Overall, positive within-person changes during the treatment phase in comparison to the baseline phase were found. In addition, positive changes in the diagnostic status were observed at post- and follow-up treatment. Yet high variability in treatment effects was found between cases and studies. This meta-analysis harvests the knowledge from published single-case research in youth-internalizing disorders and illustrates how within-person information from single-case studies can be summarized to explore the generalizability of the results from this type of research. The results emphasize the importance of keeping account of individual variability in providing and investigating youth interventions.

Measuring Emotion Regulation Skill Use During Treatment: A Promising Methodological Approach

Emotion regulation has become ubiquitous in the study of psychopathology and a growing number of treatment outcome studies are collecting data on emotion regulation skill use. However, traditional measures of emotion regulation fail to capture important nuances in emotion regulation processes, their relationship to psychopathology, and how individuals use emotion regulation skills over time and across contexts. Novel methodologies are particularly needed for measuring emotion regulation in the context of treatment studies. In this article, we discuss a proposed methodology, the combination of ecological momentary assessment (EMA), and single-case experimental design (SCED), for measuring emotion regulation strategy use in the context of treatment outcome studies. To inform this discussion, we provide a brief overview of common approaches to assessing emotion regulation skill use in the context of treatment outcome research. We then describe the utility of intensive data capture (EMA) in the context of idiographic treatment studies (SCED), present a case study to illustrate the different uses of data collected through EMA in the context of a SCED study, and discuss considerations for implementing this method in clinical practice.

Speech and Language Therapy for Acquired Central Dysgraphia in Neurological Patients: A Systematic Review to Describe and Identify Trainings for Clinical Practice

PURPOSE

Acquired central dysgraphia is a heterogeneous neurological disorder that usually co-occurs with other language disorders. Written language training is relevant to improve everyday skills and as a compensatory strategy to support limited oral communication. A systematic evaluation of existing writing treatments is thus needed.

METHOD

We performed a systematic review of speech and language therapies for acquired dysgraphia in studies of neurological diseases (PROSPERO: CRD42018084221), following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist with a search on several databases for articles written in English and published until August 31, 2021. Only methodological well-designed studies were included. Further assessment of methodological quality was conducted by means of a modified version of the Downs and Black checklist.

RESULTS

Eleven studies of 43 patients in total were included. For each study, we collected data on type of population, type of impairment, experimental design, type of treatment, and measured outcomes. The studies had a medium level of assessed methodological quality. An informative description of treatments and linkages to deficits is reported.

CONCLUSIONS

Although there is a need for further experimental evidence, most treatments showed good applicability and improvement of written skills in patients with dysgraphia. Lexical treatments appear to be more frequently adopted and more flexible in improving dysgraphia and communication, especially when a multimodal approach is used. Finally, the reported description of treatment modalities for dysgraphia in relation to patients' deficits may be important for providing tailored therapies in clinical management.

Twenty-Three Months Repetitive Transcranial Magnetic Stimulation of the Primary Motor Cortex for Refractory Trigeminal Neuralgia: A Single-Case Study

Treatment refractory or recurrent trigeminal neuralgia (TN) is a severe chronic pain illness. Single-session repetitive transcranial magnetic stimulation (rTMS) has been shown to elicit analgesic effects in several craniofacial pain syndromes, including TN. However, the safety and long-term effect of multi-session rTMS for TN have yet to be fully explored. In this study, we present a case of a patient with medical treatment-refractory TN after microvascular decompression. The patient volunteered to undergo 73 sessions of 10 Hz rTMS over 23 months. Neurovagination was used for precise localization and stimulation of the hand and face representation at the left motor cortex. The numeric pain intensity scores derived using the visual analog scale served as a daily index of treatment efficacy. The patient experienced a significant weekly reduction in pain scores, cumulating in 70.89% overall pain relief. The medication dosages were reduced and then discontinued toward the end of the intervention period. No severe adverse events were reported. From our results, we can conclude that the longitudinal multi-session application of rTMS over the hand and face area of M1 is a safe and effective method for producing long-lasting pain relief in TN. Using rTMS may thus prove helpful as an adjunct to conventional methods for treating pain in TN.

Implementation of an Early Communication Intervention for Young Children with Cerebral Palsy Using Single-Subject Research Design

The implementation of an intervention protocol aimed at increasing vocal complexity in three pre-linguistic children with cerebral palsy (two males, starting age 15 months, and one female, starting age 16 months) was evaluated utilising a repeated ABA case series design. The study progressed until the children were 36 months of age. Weekly probes with trained and untrained items were administered across each of three intervention blocks. Successive blocks targeted more advanced protophone production and speech movement patterns, individualised for each participant. Positive treatment effects were seen for all participants in terms of a greater rate of achievement of target protophone categories and speech movement patterns. Tau coefficients for trained items demonstrated overall moderate to large AB phase contrast effect sizes, with limited evidence of generalisation to untrained items. Control items featuring protophones and speech movements not targeted for intervention showed no change across phases for any participant. Our data suggest that emerging speech-production skills in prelinguistic infants with CP can be positively influenced through a multimodal intervention focused on capitalising on early periods of plasticity when language learning is most sensitive.

The development of Cognitive Behavioural Therapy (CBT) for chronic loneliness in children and young people: Protocol for a single-case experimental design

Loneliness is a significant problem for young people and is associated with a range of physical and mental health difficulties. Meta-analyses have identified that interventions aimed at young people who report loneliness as their primary problem are lacking within the literature. In adults, the most effective interventions for loneliness are those which target the underlying maladaptive social cognitions. Therefore, we have developed a modular Cognitive Behavioural Therapy (CBT) intervention for children and young people. The aim of this study is to conduct a multiple baseline single-case experimental design (SCED) to assess the efficacy, feasibility and acceptability of this intervention. In total 6-8 11-18-year-olds and their families will be recruited. The design consists of AB+ post-intervention, where A is the baseline phase, B is the intervention phase and then a post-intervention phase. Participants will complete a baseline assessment, before being randomised to one of four different baseline lengths (12 days, 19 days, 26 days or 33 days). Participants will then complete an average of 12 sessions of CBT, with the aim being to reduce their feelings of loneliness. Participants will then complete a 12-day post-intervention phase. Participant loneliness will be repeatedly assessed throughout the three phases of the intervention using the Three-item Loneliness Scale, which will be the primary outcome. Secondary outcomes will be reliable and clinically meaningful change on the UCLA Loneliness Scale, Revised Child Anxiety and Depression Scale (RCADS) and Strengths and Difficulties Questionnaire (SDQ). Feasibility and participant satisfaction will also be assessed and reported. Trial registration: ClinicalTrails.gov trial registration number: NCT05149963 (Date registered: 07.12.2021). https://www.clinicaltrials.gov/ct2/show/NCT05149963?term=cbt&cond=loneliness&draw=2&rank=1.

A preliminary examination of unified protocol for transdiagnostic treatment of emotional disorders in patients with panic disorder: a single-case experimental design in Iran

BACKGROUND AND OBJECTIVES

The majority of patients suffering from anxiety disorders in low- and middle-income countries do not receive evidence-based treatments. The Unified Protocol (UP) for the Transdiagnostic Treatment of Emotional Disorders is an evidence-based cognitive-behavioral intervention designed to treat the range of emotional disorders.

DESIGN AND METHODS

Using a single-case experimental design five patients with panic disorder were assigned to a 3-week baselines assessment phase followed by eight sessions of UP treatment and 4-week follow-up phases. Multiple outcome measures of panic severity, anxiety sensitivity, affectivity, and overall anxiety severity and impairment were administered weekly during the baseline, intervention, and follow-up phases.

RESULTS

At post treatment, all participants showed significant reductions in outcome measures, with changes functionally related to treatment and most improvements maintained at 4-week follow-up.

CONCLUSION

Findings provide preliminary cross-cultural support for UP and add to the growing body of literature showing UP can be useful for patients with anxiety disorders in low- and middle-income countries with non-Western cultures.

Interdisciplinary Rehabilitation for Concussion Recovery (i-RECOveR): protocol of an investigator-blinded, randomised, case series with multiple baseline design to evaluate the feasibility and preliminary efficacy of a 12-week treatment for persistent post-concussion symptoms

BACKGROUND

Up to 25% of concussed individuals experience persistent post-concussion symptoms (PPCSs) which may interfere with the return to pre-injury activities and cause significant stress. Given that multiple etiological factors are thought to contribute to PPCSs, an interdisciplinary approach is recommended. This pilot study aims to primarily investigate the feasibility of a novel interdisciplinary treatment for PPCSs. Given this intervention is novel, uncertainty exists in terms of potential recruitment and retention rates, adverse events, and treatment adherence and fidelity. These factors will be explored to inform the feasibility of a phase-2 randomised controlled trial. Preliminary efficacy of this intervention will also be explored.

METHODS

Fifteen individuals with mild traumatic brain injury and PPCSs will receive up to 12 weeks of interdisciplinary treatments including psychology, physiotherapy, and medical interventions. Primary feasibility outcomes including data on recruitment and retention rates and treatment adherence will be explored descriptively. The cognitive therapy rating scale will be used to assess treatment fidelity. A single-case series with multiple baseline design will be used to explore preliminary efficacy. Participants will be randomly assigned to baseline phases of 2, 4, or 6 weeks. Regarding patient-centred secondary outcomes, the Rivermead Post-Concussion Symptoms Questionnaire will be assessed three times a week during baseline and treatment phases. Secondary outcomes also include measures of mood, sleep and fatigue, physical functioning, return to activity, and health-related quality of life. Patient-centred outcomes will be assessed at baseline, pretreatment, post-treatment, and one- and three-month follow-up. Thematic analysis of participant experiences will be explored through qualitative interviews.

DISCUSSION

Results from this trial will inform the feasibility and preliminary efficacy of this interdisciplinary concussion intervention and whether proceeding to a future definitive phase-2 randomised controlled trial is worthwhile. Understanding the end-user perspective of the treatment will also enable modifications to the treatment protocol for future trials to best suit the needs of individuals with PPCSs after mTBI. Outcomes from this trial can be directly translated into community rehabilitation programmes.

TRIAL REGISTRATION

ANZCTR, ACTRN12620001111965. Registered 27 October 2020, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379118.

Impact of Sensory Afferences in Postural Control Quantified by Force Platform: A Protocol for Systematic Review

Older adults’ postural balance is a critical domain of research as balance deficit is an important risk factor for falls that can lead to severe injuries and death. Considering the effects of ageing on sensory systems, we propose that posturographic evaluation with a force platform exploring the effect of sensory deprivation or perturbation on balance could help understand postural control alterations in the elderly. The aim of the future systematic review and meta-analysis described in this protocol is to explore the capacity of older adults to maintain their balance during sensory perturbations, and compare the effect of perturbation between the sensory channels contributing to balance. Seven databases will be searched for studies evaluating older adults’ balance under various sensory conditions. After evaluating the studies’ risk of bias, results from similar studies (i.e., similar experimental conditions and posturographic markers) will be aggregated. This protocol describes a future review that is expected to provide a better understanding of changes in sensory systems of balance due to ageing, and therefore perspectives on fall assessment, prevention, and rehabilitation.

Protocol of comparison of the effects of single plasma exchange and double filtration plasmapheresis on peripheral lymphocyte phenotypes in patients with Chronic Inflammatory Demyelinating Polyradiculoneuropathy: a monocentric prospective study with single-case experimental design

BACKGROUND

Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP), a rare disorder affecting young adults, causes gradual weakness of the limbs, areflexia and impaired sensory function. New CIDP phenotypes without pathogenic antibodies but with modified cell profiles have been described. Treatments include corticotherapy, intravenous immunoglobulins, and plasmapheresis but the latter's action mechanisms remain unclear. Plasmapheresis supposedly removes toxic agents like antibodies from plasma but it is uncertain whether it has an immune-modulating effect. Also, the refining mechanisms of the two main plasmapheresis techniques-single plasma exchange and double filtration plasmapheresis (DFPP) - are different and unclear. This study aims to compare the evolution of peripheral lymphocyte profiles in patients with CIDP according to their treatment (single centrifugation plasmapheresis or DFPP) to better grasp the action mechanisms of both techniques.

METHOD

In this proof-of-concept, monocentric, prospective, Single-Case Experimental Design study, 5 patients are evaluated by alternating their treatment type (single plasma exchange or DFPP) for 6 courses of treatment after randomization to their first treatment type. Each course of treatment lasts 2-4 weeks. For single plasma exchange, 60 ml/kg plasma will be removed from the patient and replaced with albumin solutes, with a centrifugation method to avoid the immunological reaction caused by the membrane used with the filtration method. For DFPP, 60 ml/kg plasma will be removed from the patient with a plasma separator membrane, then processed via a fractionator membrane to remove molecules of a greater size than albumin before returning it to the patient. This technique requires no substitution solutes, only 20 g of albumin to replace what would normally be lost during a session. The primary outcome is the difference between the two plasmapheresis techniques in the variation of the TH1/TH17 ratio over the period D0H0-D0H3 and D0H0-D7. Secondary outcomes include the variation in lymphocyte subpopulations at each session and between therapeutic plasmapheresis techniques, the clinical evolution, tolerance and cost of treatments.

DISCUSSION

Understanding the action mechanisms of single plasma exchange and DFPP will help us to offer the right treatment to each patient with CIPD according to efficacy, tolerance and cost.

TRIAL REGISTRATION

ClinicalTrials.gov under the no. NCT04742374 and date of registration 10 December 2020.

Who Benefits Most? Interactions between Personality Traits and Outcomes of Four Incremental Meditation and Yoga Treatments

Mind-Body Medicine (MBM) includes a broad range of interventions with proven preventive and clinical value, such as yoga and meditation. However, people differ in their preferences and response to different MBM treatments and it remains unclear who benefits most from what type of practice. Thus, finding moderators of treatment outcome seems to be a promising approach. This was the aim of the present study. We conducted a single-case multiple-baseline study investigating the outcomes and moderators of four different MBM treatments. Fifty-seven healthy participants with no prior experience were randomly assigned to three baselines (7, 14, and 21 days) and four eight-week treatments: mantra meditation alone, meditation plus physical yoga, meditation plus ethical education and meditation plus yoga and ethical education. We analysed the data using effect size estimation, multiple regression and cluster analyses. High anxiety, high absorption, low spirituality, low openness and younger age were associated with a range of positive outcomes, such as increased wellbeing or decentering and decreased mind wandering. Receiving ethical education consistently improved wellbeing, while engaging in physical yoga reduced mind wandering. In the cluster analysis, we found that participants with a more maladaptive personality structure enhanced their emotion regulation skills more. Consequently, people do differ in their response to MBM interventions and more vulnerable people, or those high in absorption, seem to benefit more. These findings could support the development of custom-tailored MBM interventions and help clinicians to make scientifically sound recommendations for their patients.

Verbal interaction pattern analysis in clinical psychology

Recent developments in pattern analysis research have made this methodology suitable for the study of the processes that are set in motion in psychological interventions. Outcome research, based on the comparison between clinical results from treatment and control groups, has leveraged our empirical knowledge about the efficacy of psychological interventions. However, these methods of research are not precise enough for the analysis of these processes. On the contrary, pattern analysis could be a powerful tool to study moment-to-moment interactions typical of psychological interventions. This is methodology is relevant because clinical psychology is experiencing a paradigm shift from a protocol for syndrome perspective to a principle-based and person-centered intervention. This evidence-based, theory-grounded, and process-oriented paradigm of clinical intervention needs new research methods to thrive (i.e., pattern analysis). The analysis of the therapeutic relationship built into the verbal interaction between the clinician and the client is one of the cornerstones of this new era of research. So, the purpose of this article is three-fold: (1) to discuss the role of the verbal interaction pattern analysis in the clinical context to the development of the principle-based clinical psychology, (2) to analyze the patterns of verbal interaction in a clinical case, and (3) to compare the results using two different methods. To reach these purposes, using the observational methodology, we have coded the verbal interaction of 16 clinical sessions with a person diagnosed with a borderline personality disorder. We have analyzed the data using sequential analysis (GSEQ) and pattern recognition algorithms (i.e., T-Pattern detection). We have been able to detect typical patterns during different phases of psychological intervention (i.e., evaluation, explanation, treatment, and consolidation). Finally, the conceptual, methodological, and empirical implications of this study will be discussed within the realms of pattern analysis research and principle-based clinical psychology.

Evaluating a Novel Treatment Adapting a Cognitive Behaviour Therapy Approach for Sexuality Problems after Traumatic Brain Injury: A Single Case Design with Nonconcurrent Multiple Baselines

There has been little progress in development of evidence-based interventions to improve sexuality outcomes for individuals with traumatic brain injury (TBI). This study aimed to evaluate the preliminary efficacy of an individualised intervention using a cognitive behaviour therapy (CBT) framework to treat sexuality problems after TBI. A nonconcurrent multiple baseline single-case design with 8-week follow-up and randomisation to multiple baseline lengths (3, 4, or 6 weeks) was repeated across nine participants (five female) with complicated mild–severe TBI (mean age = 46.44 years (SD = 12.67), mean post-traumatic amnesia = 29.14 days (SD = 29.76), mean time post-injury = 6.56 years (median = 2.50 years, SD = 10.11)). Treatment comprised eight weekly, individual sessions, combining behavioural, cognitive, and educational strategies to address diverse sexuality problems. Clinical psychologists adopted a flexible, patient-centred, and goal-orientated approach whilst following a treatment guide and accommodating TBI-related impairments. Target behaviour was subjective ratings of satisfaction with sexuality, measured three times weekly. Secondary outcomes included measures of sexuality, mood, self-esteem, and participation. Goal attainment scaling (GAS) was used to measure personally meaningful goals. Preliminary support was shown for intervention effectiveness, with most cases demonstrating sustained improvements in subjective sexuality satisfaction and GAS goal attainment. Based on the current findings, larger clinical trials are warranted.

Brief and Telehealth Acceptance and Commitment Therapy (ACT) Interventions for Stress in Inflammatory Bowel Disease (IBD): A Series of Single Case Experimental Design (SCED) Studies

Psychological intervention targeting distress is now considered an integral component of inflammatory bowel disease (IBD) management. However, significant barriers to access exist which necessitate the development of effective, economic, and accessible brief and remote interventions. Acceptance and commitment therapy (ACT) is a therapy with demonstrated acceptability and a growing evidence base for the treatment of distress in IBD populations. The present paper trialled two brief ACT interventions via randomized multiple baseline designs. Study 1 trialled a single-session ACT intervention (delivered face-to-face and lasting approximately two hours) targeting stress and experiential avoidance, respectively. Participants were seven people with an IBD diagnosis who presented with moderate to extremely severe stress (five females, two males; M age = 39.57, SD = 5.74). The findings of study 1 indicate that a single-session ACT intervention represented an insufficient dosage to reduce stress and experiential avoidance. Study 2 investigated a brief telehealth ACT intervention (delivered via a video conferencing platform and lasting approximately four hours) targeting stress and increased psychological flexibility. Participants (N = 12 people with an IBD diagnosis and mild to extremely severe stress) completed baselines lasting from 21 to 66 days before receiving a two-session ACT telehealth intervention supplemented by a workbook and phone consultation. Approximately half of participants experienced reduced stress, increased engagement in valued action, and increased functioning. Despite shortcomings such as missing data and the context of COVID-19, the present findings suggest that brief ACT interventions in this population may be effective and economic, though further research and replications are necessary.

Development, evaluation and implementation of a digital behavioural health treatment for chronic pain: study protocol of the multiphase DAHLIA project

INTRODUCTION

Chronic pain affects about 20%-40% of the population and is linked to mental health outcomes and impaired daily functioning. Pharmacological interventions are commonly insufficient for producing relief and recovery of functioning. Behavioural health treatment is key to generate lasting benefits across outcome domains. However, most people with chronic pain cannot easily access evidence-based behavioural interventions. The overall aim of the DAHLIA project is to develop, evaluate and implement a widely accessible digital behavioural health treatment to improve well-being in individuals with chronic pain.

METHODS AND ANALYSIS

The project follows the four phases of the mHealth Agile Development and Evaluation Lifecycle: (1) development and pre-implementation surveillance using focus groups, stakeholder interviews and a business model; (2) iterative optimisation studies applying single case experimental design (SCED) method in 4-6 iterations with n=10 patients and their healthcare professionals per iteration; (3) a two-armed clinical randomised controlled trial enhanced with SCED (n=180 patients per arm) and (4) interview-based post-market surveillance. Data analyses include multilevel modelling, cost-utility and indicative analyses.In October 2021, inter-sectorial partners are engaged and funding is secured for four years. The treatment content is compiled and the first treatment prototype is in preparation. Clinical sites in three Swedish regions are informed and recruitment for phase 1 will start in autumn 2021. To facilitate long-term impact and accessibility, the treatment will be integrated into a Swedish health platform (www.1177.se), which is used on a national level as a hub for advice, information, guidance and e-services for health and healthcare.

ETHICS AND DISSEMINATION

The study plan has been reviewed and approved by Swedish ethical review authorities. Findings will be actively disseminated through peer-reviewed journals, conference presentations, social media and outreach activities for the wider public.

TRIAL REGISTRATION NUMBER

NCT05066087.

Praxisorientierte Forschung in der Psychotherapie

Zusammenfassung. In den letzten Jahrzehnten hat sich durch randomisiert-kontrollierte Studien (RCTs) eine breite Evidenzbasis von Psychotherapie mit mittleren bis großen Effekten für verschiedene psychische Störungen gebildet. Neben der Bestimmung dieser Wirksamkeit („Efficacy“) ebneten Studien zur Wirksamkeit unter alltäglichen Routinebedingungen („Effectiveness“) historisch den Weg zur Entwicklung eines praxisorientierten Forschungsparadigmas. Im Beitrag wird argumentiert, dass im Rahmen dieses Paradigmas praxisbasierte Studien eine wertvolle Ergänzung zu RCTs darstellen, da sie existierende Probleme in der Psychotherapieforschung adressieren können. In der gegenwärtigen praxisorientierten Forschung liefern dabei neue Ansätze aus der personalisierten Medizin und Methoden aus der ‚Computational Psychiatry‘ wichtige Anhaltspunkte zur Optimierung von Effekten in der Psychotherapie. Im Kontext der Personalisierung werden bspw. klinische multivariable Prädiktionsmodelle entwickelt, welche durch Rückmeldeschleifen an Praktiker_innen kurzfristig ein evidenzbasiertes Outcome-Monitoring ermöglicht und langfristig das Praxis-Forschungsnetzwerk in Deutschland stärkt. Am Ende des Beitrags werden zukünftige Richtungen für die praxisorientierte Forschung im Sinne des ‘Precision Mental Health Care’ -Paradigmas abgeleitet und diskutiert.

Advancing the Application and Use of Single-Case Research Designs: Reflections on Articles from the Special Issue

This special issue of Perspective on Behavior Science is a productive contribution to current advances in the use and documentation of single-case research designs. We focus in this article on major themes emphasized by the articles in this issue and suggest directions for improving professional standards focused on the design, analysis, and dissemination of single-case research.

Methods for Modeling Autocorrelation and Handling Missing Data in Mediation Analysis in Single Case Experimental Designs (SCEDs)

Single-Case Experimental Designs (SCEDs) are increasingly recognized as a valuable alternative to group designs. Mediation analysis is useful in SCEDs contexts because it informs researchers about the underlying mechanism through which an intervention influences the outcome. However, methods for conducting mediation analysis in SCEDs have only recently been proposed. Furthermore, repeated measures of a target behavior present the challenges of autocorrelation and missing data. This paper aims to extend methods for estimating indirect effects in piecewise regression analysis in SCEDs by (1) evaluating three methods for modeling autocorrelation, namely, Newey-West (NW) estimation, feasible generalized least squares (FGLS) estimation, and explicit modeling of an autoregressive structure of order one (AR(1)) in the error terms and (2) evaluating multiple imputation in the presence of data that are missing completely at random. FGLS and AR(1) outperformed NW and OLS estimation in terms of efficiency, Type I error rates, and coverage, while OLS was superior to the methods in terms of power for larger samples. The performance of all methods is consistent across 0% and 20% missing data conditions. 50% missing data led to unsatisfactory power and biased estimates. In light of these findings, we provide recommendations for applied researchers.

Introduction to the Special Section: Translating Advanced Quantitative Techniques for Single-Case Experimental Design Data

The articles in this special section offer strategies to single-case experimental design (SCED) researchers to interpret their outcomes, communicate their results, and compare the results using common, quantitative results. Advancing quantitative methods applied to SCED data will facilitate communication with scientists and other professionals that do not typically interpret graphed data of the dependent variable. Horner and Ferron aptly note that innovative statistical procedures are improving the precision and credibility of SCED research as disseminate our findings to an increasingly diverse audience. This special section promotes the translation of these quantitative methods to encourage their adoption in research using single case experimental designs.

Individualized therapy trials: navigating patient care, research goals and ethics

'Individualized therapy' trials (sometimes called n-of-1 trials) use patients as their own controls to evaluate treatments. Here we divide such trials into three categories: multi-crossover trials aimed at individual patient management, multi-crossover trial series and pre-post trials. These trials all customize interventions for patients; however, the latter two categories also aim to inform medical practice and thus embody tensions between the goals of care and research that are typical of other types of clinical trials. In this Perspective, we discuss four domains where such tensions play out-clinical equipoise, informed consent, reporting and funding, and we provide recommendations for addressing each.

Sex-based differences in the prevalence of and risk factors for depression in adult patients with epilepsy in Northeast China

OBJECTIVES

To confirm whether the prevalence of depression in patients with epilepsy (PWE) is different between the sexes, whether risk factors for depression vary between the sexes, and whether the association between cognitive function and depression in PWE is influenced by patient sex.

METHODS

A cohort of consecutive PWE from the First Hospital of Jilin University (Changchun, China) was recruited. Depressive symptoms were evaluated using the Chinese version of the Neurological Disorders Depression Inventory for Epilepsy scale, and multivariate logistic regression analyses were used to identify independent risk factors for depression in both male and female PWE.

RESULTS

Female PWE experienced more serious depressive symptoms (p = 0.001) than male PWE. Risk factors affecting comorbid depression varied according to sex. Among male PWE, per capita monthly family income (odds ratio [OR] 0.515 [95% confidence interval (CI) 0.311-0.851]; P = 0.01), seizure frequency over the past year (OR 1.586 [95% CI 1.019-2.468], P = 0.041), polytherapy (OR 0.446 [95% CI 0.214-0.931]; P = 0.032), and Montreal Cognitive Assessment (MoCA) scale score (OR 0.926 [95% CI 0.873-0.982]; P = 0.011) were independent risk factors for depression. Among female PWE, educational level (OR 0.604 [95% CI 0.364-1]; P = 0.05) and MoCA scale score (OR 0.921 [95% CI 0.859-0.987]; P = 0.02) were independent risk factors for depression.

CONCLUSION

Depression was a common psychiatric comorbidity among PWE, and the prevalence of and risk factors for depression differed between males and females.

A single-case experimental evaluation of a new group-based intervention to enhance adjustment to life with acquired brain injury: VaLiANT (valued living after neurological trauma)

Adjustment to life with acquired brain injury (ABI) requires self-identity and behaviour to be updated, incorporating injury-related changes. Identifying and enabling new values-consistent behaviours could facilitate this process. We evaluated the feasibility, acceptability, and preliminary efficacy of VaLiANT, a new group intervention that aims to enhance "valued living" following ABI. We used a non-concurrent multiple baseline single-case experimental design (SCED) with an 8-week follow-up phase and randomization to multiple baseline lengths (5-7 weeks). Eight participants (50% women, aged 26-65; 4 Stroke, 3 Traumatic Brain Injury, 1 Epilepsy) attended eight group sessions with assessments before, during, and after the group. Target behaviour was valued living, assessed weekly by the Valued Living Questionnaire. Secondary outcomes included measures of wellbeing, mood, psychological acceptance, self-efficacy regarding ABI consequences, cognitive complaints, and intervention acceptability. Target behaviour was analysed through visual and statistical analysis while secondary outcome data were analysed via reliable change indices and descriptive statistics. Target behaviour data displayed no convincing patterns of improvement. Reliable improvements were found for most participants on secondary outcomes, particularly subjective wellbeing and anxiety. Intervention delivery was feasible with high acceptability ratings. Further investigation of VaLiANT is warranted, based on the feasibility and acceptability of intervention delivery and signals of efficacy identified across adjustment-related secondary outcomes.

A Storytelling Approach on Vocabulary, Reading, and Letter Sound Fluency of Struggling First Graders With German as Second Language With and Without Behavioral Problems

The number of students learning German as a second language (L2) is steadily increasing. Unfortunately, studies reveal that less-proficient school performance affects a larger proportion of these students and additional behavioral problems can create even greater learning barriers. In order to master a language, the focus is not only on vocabulary, but also on reading, and studies show that multi-component intervention in reading and L2 acquisition is particularly promising. Therefore, this multiple baseline study focuses on a multi-component storytelling intervention on vocabulary, reading, and letter sound fluency of low-achieving first graders with German as L2 with and without behavioral problems (N = 7). The intervention was implemented 3 times a week over a 6-week period. Results show significant large to very large effects on vocabulary and moderate to large effects on letter sound fluency and reading, providing indication for the positive impact of storytelling on multiple aspects simultaneously for the focused sample.

Dismantling Anti-Ageing Medicine: Why Age-Relatedness of Cardiovascular Disease is Proof of Robustness Rather Than of Ageing-Associated Vulnerability

Ageing is perceived to be the common culprit behind the most prevalent noncommunicable chronic diseases (NCD) such as cardiovascular disease (CVD). Treating ageing as a means to prevent its downstream pathologies has become the logical extension of this idea, and the defining criterion of anti-ageing medicine (evidence-based early detection, prevention, and treatment of age-related diseases). Challenging the underlying rationale, we here argue that the disease's late-in-life occurrence is proof of a genetically conserved robustness that helps us resist disease long enough for it to masquerade as a consequence of living long rather than of living wrong. Robustness is an acknowledged hallmark phenomenon of all complex systems (while there exists no universally adopted definition, a hallmark of complex systems is that they consist of many networked components whose interactions may give rise to system behaviors which cannot be derived or predicted from a reductionist knowledge of the interacting parts, even if this knowledge is complete) and a key concept in the complexity sciences (a relatively new branch of science that attempts to find and understand the common mechanisms and patterns shared by all complex systems). To reconceptualise the age-relatedness of chronic diseases in this sense has important implications for medical research and practice. The goal of our essay is to open a discussion that may enhance the overall understanding of robustness and prevent a misguided redirection of funding away from established disease specific research and towards anti-ageing medicine. This essay is timely, as the forthcoming 11^th version of the International Classification of Diseases (ICD) will be the first to recognise ageing as a condition, thereby legitimising anti-ageing medical research. On a more pragmatic note, and for the benefit of people alive today, we propose a practical strategy to remedy the mismatch between heritable robustness and the lifestyle challenges that gradually overwhelm it.

Multidisciplinary Tinnitus Research: Challenges and Future Directions From the Perspective of Early Stage Researchers

Tinnitus can be a burdensome condition on both individual and societal levels. Many aspects of this condition remain elusive, including its underlying mechanisms, ultimately hindering the development of a cure. Interdisciplinary approaches are required to overcome long-established research challenges. This review summarizes current knowledge in various tinnitus-relevant research fields including tinnitus generating mechanisms, heterogeneity, epidemiology, assessment, and treatment development, in an effort to highlight the main challenges and provide suggestions for future research to overcome them. Four common themes across different areas were identified as future research direction: (1) Further establishment of multicenter and multidisciplinary collaborations; (2) Systematic reviews and syntheses of existing knowledge; (3) Standardization of research methods including tinnitus assessment, data acquisition, and data analysis protocols; (4) The design of studies with large sample sizes and the creation of large tinnitus-specific databases that would allow in-depth exploration of tinnitus heterogeneity.

Systematic Review of Studies on Subliminal Exposure to Phobic Stimuli: Integrating Therapeutic Models for Specific Phobias

We systematically review 26 papers investigating subjective, behavioral, and psychophysiological correlates of subliminal exposure to phobic stimuli in phobic patients. Stimulations were found to elicit: (1) cardiac defense responses, (2) specific brain activations of both subcortical (e.g., amygdala) and cortical structures, (3) skin conductance reactions, only when stimuli lasted >20 ms and were administered with intertrial interval >20 s. While not inducing the distress caused by current (supraliminal) exposure therapies, exposure to subliminal phobic stimuli still results in successful extinction of both psychophysiological and behavioral correlates: however, it hardly improves subjective fear. We integrate those results with recent bifactorial models of emotional regulation, proposing a new form of exposure therapy whose effectiveness and acceptability should be maximized by a preliminary subliminal stimulation. Systematic Review Registration: identifier [CRD42021129234].