Hostname: page-component-54dcc4c588-gwv8j Total loading time: 0 Render date: 2025-10-01T07:23:22.777Z Has data issue: false hasContentIssue false
  • English
  • Français

Bringing Single-case Methodology into the Clinic to Enhance Evidence-based Practices

Published online by Cambridge University Press:  17 January 2013

Robyn L. Tate ,
Vanessa Aird  and
Christine Taylor
Robyn L. Tate*
Affiliation:
Rehabilitation Studies Unit, Northern Clinical School, Sydney Medical School, University of Sydney, Australia Royal Rehabilitation Centre Sydney, Australia
Vanessa Aird
Affiliation:
Cortex Communication Partners, Sydney, Australia
Christine Taylor
Affiliation:
Cortex Communication Partners, Sydney, Australia Department of Linguistics, Faculty of Human Sciences, Macquarie University, Sydney, Australia
*
Address for correspondence: Professor Robyn Tate, Rehabilitation Studies Unit, c/- Royal Rehabilitation Centre Sydney, PO Box 6 RYDE NSW 1680, Australia. E-mail: rtate@med.usyd.edu.au
Get access

Abstract

There are many challenges in incorporating an evidence-based approach into clinical practice and a large literature exists on various barriers and facilitators. Within this context, we have developed a framework to advocate an empirical approach to therapeutic interventions, using our Model to Assess Treatment Effect (MATE). The MATE is designed to characterise how an intervention is delivered to an individual patient/client. It is organised hierarchically into seven levels, from low levels of capacity to demonstrate treatment effect (e.g., Level 1: treatment commenced without pre-intervention assessment) to high levels where cause–effect relationships can be established between the intervention and the behaviour being treated (e.g., Level 6: implementation of a well-designed single-case experimental design). Consequently, the MATE captures all levels of clinical intervention and can be applied readily to an individual patient, as well as an entire clinical setting. In this paper, we present a decision tree in the form of a detailed flow-chart which assists the clinician to classify treatment delivery on the MATE. We believe that the MATE has the capacity not only to document current clinical practice, but also to provide a model whereby future treatments can be planned and implemented with greater scientific rigour and hence accountability in relation to treatment outcomes.

Keywords

rehabilitationtreatmentevidence-based practicesingle-subject designn-of-1 trialmethodology

Information

Type
Articles
Information
Brain Impairment , Volume 13 , Issue 3 , December 2012 , pp. 347 - 359
Copyright
Copyright © The Authors 2013

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Backman, C.L., Harris, S.R., Chisholm, J.-A.M., & Monette, A.D. (1997). Single-subject research in rehabilitation: a review of studies using AB, withdrawal, multiple baseline, and alternating treatments designs. Archives of Physical Medicine and Rehabilitation, 78, 1145–1153.CrossRefGoogle ScholarPubMed
Barlow, D.H., & Hersen, M. (1984). Single case experimental designs. Strategies for studying behaviour change (2nd ed.). Boston: Allyn & Bacon.Google Scholar
Barlow, D.H., Nock, M.K., & Hersen, M. (2009). Single case experimental designs. Strategies for studying behaviour change (3rd ed.). Boston: Pearson.Google Scholar
Beeson, P.M., & Robey, R.R. (2006). Evaluating single-subject treatment research: Lessons learned from the aphasia literature. Neuropsychology Review, 16, 161–169.CrossRefGoogle ScholarPubMed
Bornhofen, C., & McDonald, S. (2008). Treating deficits in emotion perception following traumatic brain injury. Neuropsychological Rehabilitation, 18 (1), 22–44.CrossRefGoogle ScholarPubMed
Bouwens, S.F.M., van Heugten, C.M., & Verhey, F.R.J. (2009). The practical use of goal attainment scaling for people with acquired brain injury who receive cognitive rehabilitation. Clinical Rehabilitation, 23 (4), 310–320.CrossRefGoogle ScholarPubMed
Bovend'Eerdt, T.J.H., Dawes, H., Izadi, H., & Wade, D.T. (2011). Agreement between two different scoring procedures for goal attainment scaling is low. Journal of Rehabilitation Medicine, 43 (1), 46–49.CrossRefGoogle ScholarPubMed
Cabana, M.D., Rand, C.S., Powe, N.R., Wu, A.W., Wilson, M.H., Abboud, P.-A.C., . . . Rubin, H.R. (1999). Why don't physicians follow clinical practice guidelines? A framework for improvement. Journal of the American Medical Association, 282, 1458–1465.CrossRefGoogle ScholarPubMed
Callahan, C.D., & Barisa, M.T. (2005). Statistical process control and rehabilitation outcome: the single-subject design reconsidered. Rehabilitation Psychology, 50 (1), 24–33.CrossRefGoogle Scholar
Cicerone, K.D., Langenbahn, D.M., Braden, C., Malec, J.M., Kalmar, K., Fraas, M., . . . Ashman, T. (2011). Evidence-based cognitive rehabilitation: updated review of the literature from 2003 through 2008. Archives of Physical Medicine and Rehabilitation, 92, 519–530.CrossRefGoogle ScholarPubMed
Dahlberg, C.A., Cusick, C.P., Hawley, L.A., Newman, J.K., Morey, C.E., Harrison-Felix, C.L., . . . Whiteneck, G.G. (2007). Treatment efficacy of social communication skills training after traumatic brain injury: a randomized treatment and deferred treatment controlled trial. Archives of Physical Medicine and Rehabilitation, 88, 1561–1573.CrossRefGoogle ScholarPubMed
Davis, D., Davis, M.E., Jadad, A., Perrier, L., Rath, D., Ryan, D., . . . Zwarenstein, M. (2003). The case for knowledge translation: shortening the journey from evidence to effect. British Medical Journal, 327 (7405), 33–35.CrossRefGoogle ScholarPubMed
Ertzgaard, P., Ward, A.B., Wissel, J., & Borg, J. (2011). Practical considerations for goal attainment scaling during rehabilitation following acquired brain injury. Journal of Rehabilitation Medicine, 43 (1), 8–14.CrossRefGoogle ScholarPubMed
Evidence-based Medicine Working Group. (1992). Evidence-based medicine: a new approach to teaching the practice of medicine. Journal of the American Medical Association, 268, 2420–2425.CrossRefGoogle Scholar
Fucetola, R., Tucker, F., Blank, K., & Corbetta, M. (2005). A process for translating evidence-based aphasia treatment into clinical practice. Aphasiology, 19 (3–5), 411–422.CrossRefGoogle Scholar
Gravel, K., Légaré, F., & Graham, I.D. (2006). Barriers and facilitators to implementing shared decision-making in clinical practice: a systematic review of health professionals’ perceptions. Implementation Science, 1 (16), 1–12.CrossRefGoogle ScholarPubMed
Grimshaw, J., Eccles, M., & Tetroe, J. (2004). Implementing clinical guidelines: current evidence and future implications. Journal of Continuing Education in the Health Professions, 24 (S1), S31–S37.CrossRefGoogle ScholarPubMed
Hart, T., & Evans, J. (2006). Self-regulation and goal theories in brain injury rehabilitation. Journal of Head Trauma Rehabilitation, 21 (2), 142–155.CrossRefGoogle ScholarPubMed
Haynes, B., & Haines, A. (1998). Barriers and bridges to evidence based clinical practice. British Medical Journal, 317 (7153), 273–276.CrossRefGoogle ScholarPubMed
Helffenstein, D.A., & Wechsler, F.S. (1982). The use of interpersonal process recall (IPR) in the remediation of interpersonal and communication skill deficits in the newly brain-injured. Clinical Neuropsychology, IV (3), 139–143.Google Scholar
Hersh, D., Worrall, L., Howe, T., Sherratt, S., & Davidson, B. (2012). SMARTER goal setting in aphasia rehabilitation. Aphasiology, 26 (2), 220–233.CrossRefGoogle Scholar
Horner, R.H., Carr, E.G., Halle, J., McGee, G., Odom, S., & Wolery, M. (2005). The use of single-subject research to identify evidence-based practice in special education. Exceptional Children, 71 (2), 165–179.CrossRefGoogle Scholar
Kazdin, A.E. (2011). Single-case research designs. Methods for clinical and applied settings (2nd ed.). New York: Oxford University Press.Google Scholar
Kratochwill, T.R., Hitchcock, J., Horner, R.H., Levin, J.R., Odom, S.L., Rindskopf, D.M., . . . Shadish, W.R. (2010). Single-case designs technical documentation. Retrieved from What Works Clearinghouse website: http://ies.ed.gov/ncee/wwc/pdf/wwc_scd.pdfGoogle Scholar
Lane-Brown, A.T., & Tate, R.L. (2010). Evaluation of an intervention for apathy after traumatic brain injury: a multiple-baseline, single case experimental design. Journal of Head Trauma Rehabilitation, 25 (6), 459–469.CrossRefGoogle ScholarPubMed
Levack, W.M.M., Taylor, K., Siegert, R.J., Dean, S.G., McPherson, K.M., & Weatherall, M. (2006). Is goal planning in rehabilitation effective? A systematic review. Clinical Rehabilitation, 20 (9), 739–755.CrossRefGoogle ScholarPubMed
Malec, J.F. (1999). Goal attainment scaling in rehabilitation. Neuropsychological Rehabilitation, 9 (3–4), 253–275.CrossRefGoogle Scholar
McDonald, S., Tate, R., Togher, L., Bornhofen, C., Long, E., Gertler, P., . . . Bowen, R. (2008). Social skills treatment for people with severe, chronic acquired brain injuries: a multicentre trial. Archives of Physical Medicine and Rehabilitation, 89, 1648–1659.CrossRefGoogle Scholar
McGraw-Hunter, M., Faw, G.D., & Davis, P.K. (2006). The use of video self-modelling and feedback to teach coaching skills to individuals with traumatic brain injury: a pilot study. Brain Injury, 20 (10), 1061–1068.CrossRefGoogle Scholar
McMillan, T., & Sparkes, C. (1999). Goal planning and neurorehabilitation: the Wolfson neurorehabilitation centre approach. Neuropsychological Rehabilitation, 9 (3–4), 241–251.CrossRefGoogle Scholar
Metcalfe, C., Lewin, R., Wisher, S., Perry, S., Bannigan, K., & Moffett, J.K. (2001). Barriers to implementing the evidence base in four NHS therapies: Dieticians, occupational therapists, physiotherapists, speech and language therapists. Physiotherapy, 87 (8), 433–441.CrossRefGoogle Scholar
Ottenbacher, K.J., & Cusick, A. (1990). Goal attainment scaling as a method of clinical service evaluation. The American Journal of Occupational Therapy, 44 (6), 519–525.CrossRefGoogle ScholarPubMed
Perdices, M., & Tate, R.L. (2009). Single-subject designs as a tool for evidence-based clinical practice: are they unrecognised and undervalued? Neuropsychological Rehabilitation, 19 (6), 904–927.CrossRefGoogle ScholarPubMed
Playford, E.D., Siegert, R., Levack, W., & Freeman, J. (2009). Areas of consensus and controversy about goal setting in rehabilitation: a conference report. Clinical Rehabilitation, 23 (4), 334–344.CrossRefGoogle ScholarPubMed
Sackett, D.L., Straus, S.E., Richardson, W.S., Rosenberg, W., & Haynes, R.B. (2000). Evidence-based medicine. How to practice and teach EBM (2nd ed.). Edinburgh: Churchill-Livingstone.Google Scholar
Siegert, R.J., & Taylor, W.J. (2004). Theoretical aspects of goal-setting and motivation in rehabilitation. Disability and Rehabilitation, 26 (1), 1–8.CrossRefGoogle ScholarPubMed
Stineman, M.G., Lollar, D.J., & Üstün, T.B. (2005). The International Classification of Functioning, Disability, and Health: ICF empowering rehabilitation through an operational bio-psycho-social model. In DeLisa, J.A., Gans, B.M., Walsh, N.E., Bockenek, W.L., Frontera, W.R., Geiringer, S.R., . . . Zafonte, R.D. (Eds.), Physical medicine and rehabilitation: Principles and practice (4th ed., pp. 1099–1108). Philadelphia: Lippincott, Williams and Wilkins.Google Scholar
Struchen, M.A., Davis, L.C., Bogaards, J.A., Hudler-Hull, T., Clark, A.N., Mazzei, D.M., . . . Caroselli, J. S. (2011). Making connections after brain injury: development and evaluation of a social peer-mentoring program for persons with traumatic brain injury. Journal of Head Trauma Rehabilitation, 26 (1), 4–19.CrossRefGoogle ScholarPubMed
Stucki, G., Cieza, A., & Melvin, J. (2007). The International Classification of Functioning, Disability and Health: A unifying model for the conceptual description of the rehabilitation strategy. Journal of Rehabilitation Medicine, 39, 279–285.CrossRefGoogle ScholarPubMed
Tate, R.L., Aird, V., & Taylor, C. (submitted). Using single-case methodology to treat social-pragmatic communication disorders. In: McDonald, S., Togher, L. & Code, C. (Eds.), Social and communication disorders following traumatic brain injury (2nd ed.).Google Scholar
Tate, R.L., & Perdices, M. (2008). Applying the International Classification of Functioning Disability and Health (ICF) to clinical practice and research in acquired brain impairment. Brain Impairment, 9, 282–292.CrossRefGoogle Scholar
Tate, R.L., Taylor, C., & Aird, V. (in press). Applying empirical methods in clinical practice: Introducing the Model for Assessing Treatment Effect (MATE). Journal of Head Trauma Rehabilitation DOI: 10.1097/HTR.0b013e31824e103eGoogle Scholar
Togher, L., McDonald, S., Code, C., & Grant, S. (2004). Training communication partners of people with traumatic brain injury: a randomised controlled trial. Aphasiology, 18 (4), 313–335.CrossRefGoogle Scholar
Turner-Stokes, L. (2009). Goal attainment scaling (GAS) in rehabilitation: a practical guide. Clinical Rehabilitation, 23 (4), 362–370.CrossRefGoogle ScholarPubMed
Turner-Stokes, L., & Williams, H. (2010). Goal attainment scaling: a direct comparison of alternative rating methods. Clinical Rehabilitation, 24 (1), 66–73.CrossRefGoogle Scholar
Üstün, T.B, Chatterji, S., Bickenbach, J., Kostanjsek, N., & Schneider, M. (2003). The International Classification of Functioning, Disability and Health: A new tool for understanding disability and health. Disability and Rehabilitation, 25, 565–571.CrossRefGoogle ScholarPubMed
Wade, D.T. (2005). Applying the WHO ICF framework to the rehabilitation of patients with cognitive deficits. In Halligan, P.W. & Wade, D.T. (Eds.), Effectiveness of rehabilitation for cognitive deficits (pp. 31–42). Oxford: Oxford University Press.CrossRefGoogle Scholar
Wade, D.T. (2009). Goal setting in rehabilitation: an overview of what, why and how. Clinical Rehabilitation, 23 (4), 291–295.CrossRefGoogle ScholarPubMed
WHO (2001). International classification of functioning, disability and health. Geneva: World Health Organization.Google Scholar
Wilson, B.A. (2003). Goal planning rather than neuropsychological tests should be used to structure and evaluate cognitive rehabilitation. Brain Impairment, 4 (1), 25–30.CrossRefGoogle Scholar
Worrall, L.E., & Hickson, L. (2008). The use of the ICF in speech-language pathology research: Towards a research agenda. International Journal of Speech-Language Pathology, 10, 72–77.CrossRefGoogle Scholar
Youse, K.M., & Coelho, C.A. (2009). Treating underlying attention deficits as a means for improving conversational discourse in individuals with closed head injury: A preliminary study. NeuroRehabilitation, 24 (4), 355–364.CrossRefGoogle ScholarPubMed