ABSTRACT
Multiple-baseline designs are an extension of the basic single-case AB phase designs, in which several of those AB designs are implemented simultaneously to different persons, behaviors, or settings, and the intervention is introduced in a staggered way to the different units. These designs are well-suited for research in the behavioral sciences. We discuss the advantages and limitations for valid inferences, and suggest a statistical technique--randomization tests--for use with multiple-baseline data, to complement visual analysis. In addition, we provide an extension of our SCRT-R package (which already contained means for conducting randomization tests on single-case phase and alternation designs), for multiple-baseline AB data.
Subject(s)
Random Allocation , Research Design/statistics & numerical data , Algorithms , SoftwareABSTRACT
Vaginismus is commonly described as a persistent difficulty in allowing vaginal entry of a penis or other object. Lifelong vaginismus occurs when a woman has never been able to have intercourse. A replicated single-case A-B-phase design was used to investigate the effectiveness of therapist-aided exposure for lifelong vaginismus. A baseline period (Phase A) was contrasted with exposure + follow-up (Phase B), using random switching between phases. The main outcome measure (intercourse ability) was assessed daily for 24 weeks. Ten women participated. The exposure consisted of a maximum of three 2-hr sessions during 1 week at a university hospital. The participant performed vaginal penetration exercises on herself, in the presence of a female therapist. Two follow-up sessions were scheduled over a 5-week period. Nine of the 10 participants reported having intercourse after treatment, and in 5 of the 9, intercourse was possible within the 1st week of treatment. The results remained at 1-year follow-up. Furthermore, exposure was successful in decreasing fear and negative penetration beliefs posttreatment and at 3-month and 1-year follow-ups. Therapist-aided exposure appears to be an effective treatment for lifelong vaginismus.
Subject(s)
Cognitive Behavioral Therapy/methods , Professional-Patient Relations , Vaginismus , Adolescent , Adult , Aged , Case-Control Studies , Female , Humans , Middle Aged , Severity of Illness Index , Sexual Dysfunctions, Psychological/psychology , Vagina/physiopathology , Vaginismus/physiopathology , Vaginismus/psychology , Vaginismus/therapy , Young AdultABSTRACT
UNLABELLED: For patients with acute post-traumatic neck pain (PTNP), pain-related fear has been identified as a potential predictor of chronic disability. If such is the case, fear reduction should enhance the prevention of further pain disability and distress after traumatic neck pain disability. However, exposure-based treatments have not been tested in patients with PTNP. Using a replicated single-case crossover phase design with multiple measurements, this study examined whether the validity of a graded exposure in vivo, as compared with usual graded activity, extends to PTNP. Eight patients who reported substantial pain-related fear were included in the study. Daily changes in pain intensity, pain-related fear, pain catastrophizing, and activity goal achievement were assessed. Before and after each intervention, and at 6-month follow-up, standardized questionnaires of pain-related fear and pain disability were administered, and, to quantify daily physical activity level, patients carried an ambulatory activity monitor. The results showed decreasing levels of self-reported pain-related fear, pain intensity, disability, and improvements in physical activity level only when graded exposure in vivo was introduced, and not in the graded activity condition. The results are discussed in the context of the search for customized treatments for PTNP. PERSPECTIVE: This is the first study showing that the effects of graded exposure in vivo generalize to patients with chronic PTNP reporting elevated levels of pain-related fear. This could help clinicians to customize treatments for PTNP.
Subject(s)
Cognitive Behavioral Therapy , Fear/psychology , Neck Pain/psychology , Neck Pain/therapy , Accidents, Traffic , Activities of Daily Living , Adult , Conditioning, Operant/physiology , Cross-Over Studies , Desensitization, Psychologic , Disability Evaluation , Female , Humans , Male , Middle Aged , Motor Activity/physiology , Neck Pain/etiology , Pain Measurement/methods , Patient Education as Topic/methods , Secondary Prevention , Surveys and Questionnaires , Time Factors , Treatment OutcomeABSTRACT
Randomization tests are nonparametric statistical tests that obtain their validity by computationally mimicking the random assignment procedure that was used in the design phase of a study. Because randomization tests do not rely on a random sampling assumption, they can provide a better alternative than parametric statistical tests for analyzing data from single-case designs. In this article, an R package is described for use in designing single-case phase (AB, ABA, and ABAB) and alternation (completely randomized, alternating treatments, and randomized block) experiments, as well as for conducting statistical analyses on data gathered by means of such designs. The R code is presented in a step-by-step way, which at the same time clarifies the rationale behind single-case randomization tests.
