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Thinking small: research designs appropriate for clinical practice
1Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario. streiner@fhs.csu.mcmaster.ca
Abstract:
Even though some treatments have been shown to be efficacious in clinical trials, there is no guarantee that they are effective with a specific patient. This article outlines some of the methods clinicians can use to evaluate the effectiveness of therapy with individual patients. These methods include 1) the before-after design, 2) the reversal design, 3) interrupted time series, and 4) multiple baselines. This paper recommends that patients who are being treated, whether privately or in hospital, be seen as experiments with a sample size of 1 and that their progress be monitored using 1 of these methods.
Insights
Clinicians can evaluate individual patient treatment effectiveness using single-case experimental designs. Monitoring patient progress ensures therapy is effective for unique cases, not just in trials.
Area of Science:
- Behavioral science
- Clinical psychology
- Evidence-based practice
Background:
- Clinical trials demonstrate treatment efficacy, but individual patient responses vary.
- General treatment effectiveness does not guarantee success for a specific patient.
- A gap exists in evaluating therapy effectiveness at the individual patient level.
Purpose of the Study:
- To outline methods for clinicians to assess individual patient treatment effectiveness.
- To advocate for treating each patient as a unique experiment.
- To promote the use of single-case designs in clinical practice.
Main Methods:
- The article describes four single-case experimental designs.
- Methods include: before-after design, reversal design, interrupted time series, and multiple baselines.
- These designs allow for systematic monitoring of patient progress.
Main Results:
- The discussed methods provide frameworks for evaluating treatment effectiveness in individual patients.
- Implementing these designs allows for data-driven clinical decisions.
- Patient progress can be objectively monitored.
Conclusions:
- Clinicians should view individual patients as experiments with a sample size of one.
- Systematic monitoring using single-case designs is recommended for all treated patients.
- This approach enhances personalized and effective healthcare.