Page 42 - Demo

Chapter 240Suggested InferencesIn 9 studies, results were interpreted as generalizable to all patients with the same condition, whereas the authors of 2 studies considered the experiment as evidence for the individual participant only. One study did not report on inference.Quality Assessment and Risk of BiasInternal ValidityThe median of the internal validity score of the included N-of-1 studies as assessed by the RoBiNT was 6.5 of 14 points (range 3–11; Figure 3A). Treatment adherence was not assessed with the exception of 1 study that scored the maximum on treatment adherence by fulfilling the requirements of using a clear rating system, an independent assessor of the participant and sampling of more than 20% of the data, resulting in a minimum of 80% adherence.20 The interrater agreement was adequately evaluated in 3 studies with separate reporting on the dependent variables for each condition.External Validity and InterpretationThe median of the external validity score of the included N-of-1 studies was 9 of 16 points (range 4–11; Figure 3B). The dependent variable (target behavior) was in 8 of 12 studies operationally defined with description of the measuring method. The other 4 studies did define the target behavior, but without clear and precise description of methods of measuring. Also, studies scored relatively high on describing practical matters including equipment, manuals, and procedural details. Although 1 study described the intervention in vague or general terms, 6 studies provided broad but not detailed descriptions of the content of the intervention or lacked one of the procedural’s items including the number, duration, and frequency of periods for each participant. The other 5 studies provided a detailed description of the content of the intervention, the procedure of delivery, and any equipment and manuals used. However, low scores were found on description of baseline characteristics (9/24 points), data analysis (8/24 points), and generalization (0/24 points), referring to the inclusion of generalization measures.Annelieke Muller sHL.indd 40 14-11-2023 09:07