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Thinking small: research designs appropriate for clinical practice

D L Streiner1

  • 1Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario. streiner@fhs.csu.mcmaster.ca

Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie
|October 17, 1998
PubMed
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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.

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  • 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.