Review: Single-subject clinical-outcome research: designs, data, effect sizes, and analyses

In the last 20 years, single-subject research designs have become important forms of aphasia-treatment research for assessing the effectiveness of treatment on a subject-by-subject (or patient-by-patient) basis. In that time, several important developments in the statistical literature centring on the reliability and validity of single-subject research have occurred. This work assesses the state of aphasia-treatment single-subject research in the context of that scholarship and proposes recommendations for future applications through a tutorial-like presentation. This paper details the analysis of published single subject results and proposes recommendations concerning future applications of single-subject designs. The work focuses on four domains: designs, data, effect sizes, and analyses. The findings indicate that aphasia-treatment singlesubject studies, which are well designed for the most part, yield a short series of autocorrelated data manifesting generally large treatment effects. However, only on...

[1]  Kenneth J. Ottenbacher,et al.  COMPARISON OF VISUAL INSPECTION AND STATISTICAL ANALYSIS OF SINGLE‐SUBJECT DATA IN REHABILITATION RESEARCH , 1998, American journal of physical medicine & rehabilitation.

[2]  Joseph W. McKean,et al.  Autocorrelation estimation and inference with small samples. , 1991 .

[3]  T. Scruggs,et al.  The utility of the PND statistic: a reply to Allison and Gorman. , 1994, Behaviour research and therapy.

[4]  A. Raymer,et al.  Effects of Verbal plus Gestural Treatment in a Patient with Aphasia and Severe Apraxia of Speech , 1991 .

[5]  K J Ottenbacher,et al.  Trend line influence on visual analysis of single-subject data in rehabilitation research. , 1991, International disability studies.

[6]  D. Campbell,et al.  EXPERIMENTAL AND QUASI-EXPERIMENT Al DESIGNS FOR RESEARCH , 2012 .

[7]  B. E. Huitema.  Autocorrelation: 10 Years of confusion , 1988 .

[8]  Randall R. Robey,et al.  Optimizing theories and experiments , 1993 .

[9]  Larry E. Toothaker,et al.  N = 1 Designs: The Failure of ANOVA-Based Tests , 1983 .

[10]  Eugene S. Edgington,et al.  Randomized Single-Subject Experiments and Statistical Tests. , 1987 .

[11]  S. Siegel,et al.  Nonparametric Statistics for the Behavioral Sciences , 2022, The SAGE Encyclopedia of Research Design.

[12]  Scott E. Maxwell,et al.  Designing Experiments and Analyzing Data: A Model Comparison Perspective , 1990 .

[13]  W W Tryon,et al.  A simplified time-series analysis for evaluating treatment interventions. , 1982, Journal of applied behavior analysis.

[14]  John E. Hunter,et al.  Methods of Meta-Analysis: Correcting Error and Bias in Research Findings , 1991 .

[15]  Thomas R. Kratochwill,et al.  Meta-analysis for single-case consultation outcomes: Applications to research and practice , 1995 .

[16]  K. Kearns.  Response Elaboration Training for Patient Initiated Utterances , 1985 .

[17]  B. Gorman,et al.  Calculating effect sizes for meta-analysis: the case of the single case. , 1993, Behaviour research and therapy.

[18]  Christopher F. Sharpley,et al.  Time-Series Analysis of Behavioural Data: An Update , 1987, Behaviour Change.

[19]  C. Thompson,et al.  Training and generalization of agrammatic aphasic adults' wh-interrogative productions. , 1989, Journal of Speech and Hearing Disorders.

[20]  W. Shadish,et al.  Social Experiments: Some Developments over the Past Fifteen Years , 1994 .

[21]  J. T. Stocks,et al.  Evaluation of Single Subject Data Using Statistical Hypothesis Tests versus Visual Inspection of Charts With and Without Celeration Lines , 1995 .

[22]  Kenneth M. Greenwood,et al.  Problems with the application of interrupted time series analysis for brief single-subject data , 1990 .

[23]  K J Ottenbacher,et al.  Strong quasi-experimental designs for research on the effectiveness of rehabilitation. , 1995, American journal of physical medicine & rehabilitation.

[24]  C. Thompson,et al.  Effects of hypnosis and imagery training on naming behavior in aphasia , 1986, Brain and Language.

[25]  John M. Gottman,et al.  Time Series Analysis: A Comprehensive Introduction for Social Scientists. , 1983 .

[26]  R. R. Jones,et al.  Effects of serial dependency on the agreement between visual and statistical inference. , 1978, Journal of applied behavior analysis.

[27]  Bradley E. Huitema,et al.  Autocorrelation in applied behavior analysis: A myth. , 1985 .

[28]  K J Ottenbacher,et al.  Clinically Relevant Designs for Rehabilitation Research: The Idiographic Model , 1990, American journal of physical medicine & rehabilitation.

[29]  B. Wampold,et al.  Intervention effects and relative variation as dimensions in experts' use of visual inference. , 1982, Journal of applied behavior analysis.

[30]  G. Glass.  Primary, Secondary, and Meta-Analysis of Research1 , 1976 .

[31]  Alan E. Kazdin,et al.  Single-Case Research Designs: Methods for Clinical and Applied Settings , 2010 .

[32]  D. Brock,et al.  Vegetative state and responses to sensory stimulation: an analysis of 24 cases. , 1996, Brain injury.

[33]  Cynthia K. Thompson,et al.  Effects of Phonologically Based Treatment on Aphasic Naming Deficits: A Model-Driven Approach , 1991 .

[34]  Lewis P. Shapiro,et al.  TrainingWh-Question Production in Agrammatic Aphasia: Analysis of Argument and Adjunct Movement , 1996, Brain and Language.

[35]  K J Ottenbacher,et al.  Visual inspection of single-subject data: an empirical analysis. , 1990, Mental retardation.

[36]  W F Velicer,et al.  Times Series Analysis Without Model Identification. , 1984, Multivariate behavioral research.

[37]  Curtis H. Krishef,et al.  Fundamental approaches to single subject design and analysis , 1991 .

[38]  M. McNeil,et al.  The Efficacy of Treatment for Two Globally Aphasic Adults Using Visual Action Therapy , 1991 .

[39]  J. Phillips.  Serially correlated errors in some single-subject designs , 1983 .

[40]  Lewis P. Shapiro,et al.  A Linguistic-Specific Approach to Treatment of Sentence Production Deficits in Aphasia , 1994 .

[41]  A. Raymer,et al.  Phonological treatment of naming deficits in aphasia: Model-based generalization analysis , 1993 .

[42]  K. Ottenbacher,et al.  An Empirical Investigation of Interrater Agreement for Single-Subject Data Using Graphs with and without Trend Lines , 1991 .

[43]  Leija V. McReynolds,et al.  Flexibility of Single-Subject Experimental Designs. Part III , 1986 .

[44]  H. Goldstein,et al.  Experimental analysis of syntax training in Broca's aphasia: a generalization and social validation study. , 1987, The Journal of speech and hearing disorders.

[45]  R. Sokal,et al.  Biometry: The Principles and Practice of Statistics in Biological Research (2nd ed.). , 1982 .

[46]  T. Kratochwill,et al.  Perspectives on Pitfalls and Hassles in Single-Subject Research , 1988 .

[47]  M. Schultz,et al.  A model for conducting clinical-outcome research: An adaptation of the standard protocol for use in aphasiology , 1998 .

[48]  K. Grossmann.  From Idiographic Approaches to Nomothetic Hypotheses , 1986 .

[49]  D. Barlow,et al.  Single Case Experimental Designs: Strategies for Studying Behavior Change , 1976 .

[50]  Robert T. Wertz,et al.  Computer-based visual communication in aphasia , 1989, Neuropsychologia.

[51]  T. Eick,et al.  An unusual indication for a single-subject clinical trial. , 1994, The Journal of nervous and mental disease.

[52]  R. Fukkink.  The internal validity of aphasiological single-subject studies , 1996 .

[53]  S. Harris,et al.  Single-subject research in rehabilitation: a review of studies using AB, withdrawal, multiple baseline, and alternating treatments designs. , 1997, Archives of physical medicine and rehabilitation.

[54]  Russell B. Hilliard,et al.  Single-case methodology in psychotherapy process and outcome research. , 1993, Journal of consulting and clinical psychology.

[55]  K. Ottenbacher,et al.  Empirical investigation of visual-inspection versus trend-line analysis of single-subject data. , 1988, Physical therapy.

[56]  R. R. Robey.  The Efficacy of Treatment for Aphasic Persons: A Meta-analysis , 1994, Brain and Language.

[57]  C K Thompson,et al.  Flexibility of single-subject experimental designs. Part III: Using flexibility to design or modify experiments. , 1986, The Journal of speech and hearing disorders.

[58]  Joel Fischer,et al.  Evaluating Practice: Guidelines for the Accountable Professional , 1994 .

[59]  K P Kearns,et al.  Flexibility of single-subject experimental designs. Part II: Design selection and arrangement of experimental phases. , 1986, The Journal of speech and hearing disorders.

[60]  A. Deprospero,et al.  Inconsistent visual analyses of intrasubject data. , 1979, Journal of applied behavior analysis.

[61]  T. Matyas,et al.  Visual analysis of single-case time series: Effects of variability, serial dependence, and magnitude of intervention effects. , 1990, Journal of applied behavior analysis.

[62]  R. R. Robey.  A meta-analysis of clinical outcomes in the treatment of aphasia. , 1998, Journal of speech, language, and hearing research : JSLHR.

[63]  T. Cook,et al.  Quasi-experimentation: Design & analysis issues for field settings , 1979 .

[64]  C. Sharpley,et al.  Autocorrelation in behavioral data: An alternative perspective. , 1988 .

[65]  Robert E. Potter,et al.  The implementation of laughter as a therapy facilitator with adult aphasics. , 1983, Journal of communication disorders.

[66]  K J Ottenbacher,et al.  Interrater agreement of visual analysis in single-subject decisions: quantitative review and analysis. , 1993, American journal of mental retardation : AJMR.

[67]  W. Velicer,et al.  A Comparison of Alternative Approaches to the Analysis of Interrupted Time-Series. , 1985, Multivariate behavioral research.

[68]  S. Senn.  Suspended judgment n-of-1 trials. , 1993, Controlled clinical trials.

[69]  L. Mcreynolds,et al.  Wh interrogative production in agrammatic aphasia: an experimental analysis of auditory-visual stimulation and direct-production treatment. , 1986, Journal of speech and hearing research.