create the summary of the findings " 2. Materials and Methods
Study design
A concurrent multiple-baseline design (A-B+C followup) was used in the present study. Such designs eliminate the need to return to baseline and therefore are
particularly suited for evaluation of intervention with
long-lasting effects, such as rehabilitation effects [7, 13].
This study was conducted in Shahid Rajaei Specialized
Hospital, Isfahan City, Iran, in 2020.
Study participants
Krasny-Pacini and Evans [13] stated that “the term
single-case experimental designs (SCEDs) refers to a set
T
Abed M, et al. Bowel Dysfunction in Men With Spinal Cord Injury. IRJ. 2021; 19(3):297-306.
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I ranian Rehabilitation Journal September 2021, Volume 19, Number 3
of experimental methods that can be used to test the efficacy of an intervention using a small number of patients
(typically one to three), and involve repeated measurements” [1]. Therefore, Three male married patients with
SCI were recruited for this study (Table 1). It is noteworthy that before conducting the study, the patients’
informed consent to participate was obtained.
Study measures
Neurogenic Bowel Dysfunction (NBD) was designed
by Krogh et al. [14] to measure how severe colorectal
dysfunction is in patients with SCI. The NBD score
comprises ten items of frequency and time taken for defecation, discomfort, perspiration or headache during defecation, regularly using constipation tablets and drugs,
evacuation of the anorectum or digital stimulation, feces
incontinence frequency, drugs taken for feces incontinence, and problems in perianal skin caused by the quality of life impairment due to bowel symptoms. The total
NBD score is between 0 and 47, with a higher score indicating bowel symptoms that can be more severe.
Procedure and data analysis
The three male patients with SCI participated in an individualized 8-week bowel management training program
inspired by Badiali et al. [15] and Coggrave et al. [16].
One 45-min session was held each week. The training
program was conducted by the first author of the study,
a PhD holder of Health Psychology with many years of
working closely with patients aged with SCI.
Three baseline measures were taken from the patients,
and they were assessed every two weeks. Besides, three
follow-up measurements were taken as well. The first
one was taken three weeks following the end of the intervention, and the subsequent two follow-up measurements were conducted three and six weeks after the
first one. Diet modification (more fiber consumption),
abdominal massage (to instigate the stool movement in
the colon), perianal and anorectal digitation (to instigate
the relaxation of anus/rectum contraction) were included
and taught in this training program. YouTube videos
were also used to visualize the explanations.
Data analysis was conducted by the EXCEL program,
as suggested by scholars of the single-case design studies [17, 18]. To evaluate the effect of such studies, six
features are commonly used to analyze the data patterns
of within- and between phases, namely variability, the
immediacy of the effect, overlap, trend, data patterns
consistency across similar phases and levels.
3. Results
A figure was initially drawn using the data gathered
from the three baselines, four during-intervention, and
three follow-up measurements of each patient to analyze
the data obtained from this single case study. Next, the
in-situation and between-situations analyses were performed, and the changes in different measurement stages
were presented in Tables 2-4.
As shown in Figure 1, no change occurred in the baseline level, yet a decrease was observed from baseline to
the intervention sessions in line with the treatment goals.
The same pattern was also observed in the follow-up
measurements. These findings indicate the efficacy of
the training program of bowel dysfunction management
for the patients. The in-situation and between-situations
analyses and the changes in different measurement stages are presented for each patient in the following tables.
As it is shown in the “in-situation” section of Table 2,
the mean and median values decreased across the three
situations, i.e., A (baseline), B (intervention), and C (follow-up). The decrease was from 31 to 9 for both median
and mean. The trend’s stability, which shows the slope
of the best-fitting line, shows that the trend was stable
at all three phases. In the “between-situations” section,
the three phases were compared. As shown here, the Percentage of Non-overlapping Data (PND) of intervention
and baseline phases was 100%, while this value was zero
for the intervention and follow-up phases. Besides, the
value of 100% for the Percentage of Overlapping Data
(POD) reveals data maintenance after intervention sessions. In general, the findings revealed the efficacy of the
bowel management training program for the first patient.
With regard to the second patient, the median and mean
values of the three situations decreased from 28 to 12,
which indicates a decrease in bowel dysfunction problems of the second patient from baseline to follow-up
(from A to C). In the “between-situations” analysis, the
PND of intervention and baseline phases was 100%, and
the POD reveals data maintenance after intervention sessions. Altogether, the training program was successful at
reducing the bowel problems of the second patient.
The “in-situation” section of Table 4 illustrates that the
median value decreased from 22 to 3, and the mean decreased from 22 to 3.5. These values indicate the efficacy
of the intervention for the patient. The PND of intervention and baseline phases was 75%, and the POD reveals
data maintenance after intervention sessions. As a result,
the training program was effective for the third patient."