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Small is Beautiful {Again}: An Overview of the Second International Online N=1 Symposium

Author: Livia Guadagnoli

Small is Beautiful {Again}, the second international online N=1 symposium, took place April 14-16, 2021. Over 250 attendees from all over the world (20 different countries to be exact!) gathered to learn from experts, share their research, and connect with others in the field of single-case experimental designs (SCEDs). The first international symposium "Small is Beautiful" was held in Stockholm, Sweden, on October 26, 2018. The online “Small is Beautiful {Again}” symposium sought to build on the success of the first symposium, and expanding it by offering three days of live-streamed exciting and diverse activities. The theme of the symposium was "Single-Case Experimentation Enhancing the Scientist Practitioner Challenge." The Small is Beautiful {Again} was a joint venture between KU Leuven (Belgium) and Karolinska Institutet (Sweden) and was supported by the Research Network PAIN (Pain, Action and INterference) which is part of the Research Foundation Flanders (FWO, Belgium).

Day 1: Live Q&A with Keynote Speakers

The symposium actually ‘started’ before April 14th. The six keynote speakers pre-recorded and uploaded their lectures with accompanying slides to the conference platform in early April, which allowed attendees to review the lectures in advance. Lecture topics were diverse in content. Professor Robyn L. Tate, discussed the scientific quality of single-case research and tools that researchers can use to evaluate and enhance the methodological rigor of their studies. Dr. Suzanne McDonald summarized the literature on stakeholder perspectives of single-case research and discussed future directions for applying SCEDs and N-of-1 designs in healthcare. Associate Professor Rumen Manolov, reviewed statistical inference in single-case research and several additional aspects to consider, such as visual analysis, social validity, and transparent reporting. Professor Kimberly Vannest provided an overview of effect size measures in SCEDs. Dr. Sunita Vohra discussed the “nuts and bolts” of N-of-1 trials, including their benefits and how to balance research and clinical care. Finally, Professor Tom Kratochwill discussed future standards for research and research synthesis in the context of single-case designs.

Day 1 of the symposium opened with a live welcome presentation by Rikard Wicksell (conference co-organizer) who described the origins of the “Small is Beautiful” symposium, as well as the current state and future of SCEDs. The day proceeded with a series of six live 50-minute Question and Answer sessions with each of the keynote speakers. Attendees had a unique opportunity to ask questions to experts related to both their lecture as well as broader topics of interest.

Day 2: Interactive Workshops

The second day featured 10 two-hour interactive online workshop sessions led by some of the keynote speakers and other leaders in the field of SCEDs. The workshops focused on the use of software for the design and analysis of single-case experiments, hands-on exercises, and group discussions of methodological and reporting guidelines. Sessions were limited to around 30 participants to cultivate a more personal experience. Attendees engaged in independent and small-group exercises while receiving feedback and guidance from the workshop leaders.

The ten workshop topics were as follows:

  1. Robyn L. Tate, PhD: Evaluating biases that threaten the scientific quality of single-case experimental designs

  2. Jürgen Wilbert, PhD and Timo Lüke, PhD: Multilevel regression analysis for single-case data with scan

  3. Suzanne McDonald, PhD: Analyzing N-of-1 observational data in health psychology and behavioural medicine: A 10-step SPSS tutorial for beginners

  4. René Tanious, MA: Assessing consistency in single-case experimental data

  5. Tamal Kumar De, MStat: Shiny SCDA: A web app for single-case data analysis

  6. Wim Van den Noortgate, PhD: Using MultiSCED for the multilevel (meta-)analysis of single-case experimental design data

  7. Kimberly Vannest, PhD: Analyzing and reporting results of single-case experimental designs: Objective decision rules for visual analysis and non-parametric effect size indices as measures of treatment effect

  8. Rumen Manolov, PhD: Common and not so common SCED data analysis

  9. Samantha Bouwmeester, PhD: Power of a randomization test in a single-case multiple baseline AB design

  10. John Ferron, PhD and Mariola Moeyaert, PhD: Using the mobile application SCD-MVA for masked visual analysis of single-case studies

Day 3: Poster Presentations

All attendees were welcomed back to the third and final day for poster presentations. The live-streamed and interactive event featured innovative completed, ongoing, and planned research using SCEDs. Presentations were diverse in content, with topics in single-case design / methodology, innovative tools and applications, and behavioral, medical, and nutritional interventions. A panel of three independent reviewers unanimously selected three outstanding posters for the Small is Beautiful {Again} poster award. The recipients were Sara Laureen Bartels, PhD, Joelle Fingerhut, MSEd, and Marc J. Lanovaz, PhD. Congratulations on your well-deserved poster award!

The symposium organizers Johan Vlaeyen, Patrick Onghena, Livia Guadagnoli, and Rikard Wicksell closed the symposium by reflecting on their experience throughout the symposium and thoughts on the future of SCEDs. They thanked the symposium attendees for their enthusiasm and participation throughout the three-day event. Small is Beautiful {Again} solidified the symposium as a tradition that will continue to increase awareness, knowledge, and expertise in using this valuable research methodology.

Key Symposium Take-Home Messages:

  1. The prevalence of SCEDs in the scientific literature is exponentially growing, but it is still vanishingly small as compared to the prevalence of large-scale RCTs.

  2. Providing education to other researchers and healthcare workers is crucial to dispel myths, improve implementation, and reach the patient populations who may benefit the most.

  3. The methodological quality of SCEDs can sometimes be low, but the same holds true when we look at the quality of large-scale RCTs and there are now a number of quality and reporting guidelines that will improve the quality of SCEDs in future.

  4. Analysis of SCED data can vary from simple visual analysis of graphed single-case data to more complex statistical modelling and multilevel approaches.

  5. Some methodological and statistical features of SCEDs are still poorly understood (e.g., the importance of randomization and the impact of serially dependent observations for the calculation and interpretation of effect size measures and inferential tools.

  6. N-of-1 trials are a subset of SCEDs, which are particularly feasible in medical settings. We should always consider the patient perspective when designing and implementing these studies.

  7. Future considerations in the field of SCEDs may include the need for replication research, developing guidelines for negative results, reporting social validity, and options for design-comparable effect sizes.

About the Author

Livia Guadagnoli is a clinical psychology post-doctoral researcher in the Laboratory for Brain-Gut Axis Studies (LaBGAS) within the Translational Center for Gastrointestinal Disorders (TARGID) at KU Leuven. Livia served as a co-organizer of Small is Beautiful {Again}.

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