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Optimising the ingredients for evaluation of the effects of intervention

Nickels, L; Best, W; Howard, D; (2015) Optimising the ingredients for evaluation of the effects of intervention. Aphasiology , 29 (5) 619 - 643. 10.1080/02687038.2014.1000613. Green open access

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Abstract

Background: In Howard, Best and Nickels (2015, this issue) we presented a set of ideas relevant to the design of single case studies for evaluation of the effects of intervention. These were based on experience with intervention research, methodological expertise and a set of simulations. Our discussion and conclusions were not intended as guidelines (of which there are several in the field) but rather had the aim of stimulating debate and optimising designs in the future. Our paper achieved the first aim - it received a set of varied commentaries, not all of which felt we were optimising designs, and which raised further points for debate. Aims: In this paper, respond to the commentaries, and examine the guidelines for evaluation of the design of single case studies proposed by Tate, Perdices, Rosenkoetter, Wakim, Godbee, Togher & McDonald (2013). We aim to further the discussion our target article has started and extend the scope more broadly to issues that were not discussed in our target article (e.g. replication) Main Contributions & Conclusions: It is clear that there is a strong consensus that adequately designed single case studies of intervention are an appropriate and important tool in our quest for effective interventions with people with cognitive disorders. It is also the case that many agree that there is no single design that is appropriate for every intervention, every participant or every question. However, whichever design is used it must be able to discriminate between the true effect of an intervention on behaviour, and other potential reasons for change (e.g. practice effects, spontaneous recovery, Hawthorne effects, placebo effects). We have suggested that, depending on the conditions and question to be addressed, this can be achieved using a combination of design features. These may include: multiple pre-treatment baselines, treated and untreated (or subsequently treated) items/processes/tasks, control tasks (not predicted to be affected by treatment even when generalisation is expected), and a cross-over phase (replication across items/tasks). In addition, the outcome of treatment should be evaluated statistically. We note that generalisation which is clinically desirable, can lead to particular difficulties in attributing change to intervention unless appropriate controls have been included, and that when items are selected on the basis of poor pre-treatment performance, apparent treatment-related gains may in fact be due to regression to the mean and discuss the implications of this for future research.

Type: Article
Title: Optimising the ingredients for evaluation of the effects of intervention
Open access status: An open access version is available from UCL Discovery
DOI: 10.1080/02687038.2014.1000613
Publisher version: http://dx.doi.org/10.1080/02687038.2014.1000613
Language: English
Additional information: This is an Accepted Manuscript of an article published by Taylor & Francis in Aphasiology on 30 January 2015, available online: http://www.tandfonline.com/10.1080/02687038.2014.1000613
Keywords: intervention, effectiveness, single-case experimental design, treatment effectiveness, therapy study design
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences > Language and Cognition
URI: https://discovery.ucl.ac.uk/id/eprint/1462005
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