The effects of person-centred active rehabilitation on symptoms of suspected Chronic Traumatic Encephalopathy: a mixed-methods single case design

Hearn, Rachael, Selfe, James ORCID: https://orcid.org/0000-0001-9931-4998, Cordero, Maria I and Dobbin, Nicholas ORCID: https://orcid.org/0000-0001-7508-1683 (2024) The effects of person-centred active rehabilitation on symptoms of suspected Chronic Traumatic Encephalopathy: a mixed-methods single case design. PLoS One, 19 (5). e0302260. ISSN 1932-6203

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Abstract

Objective The objective was to investigate the effectiveness of a person-centred active rehabilitation programme on symptoms associated with suspected Chronic Traumatic Encephalopathy (CTE). This was accomplished by (1) assessing the effect that a person-centred active rehabilitation programme had on participant symptoms, and (2) exploring how temporal contextual factors affected the participants’ experience with, and perceived effectiveness of, the active rehabilitation programme. Methods A twelve-month mixed-methods single case experimental research design was used with six cases (participants). Individual cases were involved in a 51-week study period including an initial interview and three-week baseline phase. Cases were then randomly allocated to one of two n-of-1 study designs (i.e., A-B, B-A, B-A, A-B or B-A, A-B, A-B, B-A) where A and B represent a non-intervention and intervention phase, respectively. Interviews were conducted regularly throughout the study whilst outcome measures were assessed at each follow-up. Analysis of the data include visual, statistical, and qualitative analysis. Results Visual and statistical analysis of cognitive and executive function, and mindful attention demonstrated trivial-to-large effects with the summary reflecting positive or unclear results. A mixed picture was observed for mood and behaviour with effects considered trivial-to-large, and the summary demonstrating positive, unclear and negative effects. Qualitative analysis indicated a perceived improvement in outcome measures such as memory, attention, anxiety, and emotional control despite mixed quantitative findings whilst a clear impact of contextual factors, such as COVID-19, the political atmosphere, exercise tolerance, programme progression, and motivation were evident during the intervention. Conclusions This study has provided primary-level evidence to suggest active rehabilitation as a potential intervention for the management of suspected CTE symptoms. This study has also demonstrated the benefit of a person-centred approach to both clinical research and practice, particularly by considering contextual factors for a better understanding of an intervention effect.