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eHealth MBSR Method (1000 words) (Design (Threats to internal validity…
eHealth MBSR Method (1000 words)
Design
IV = eHalth MBSR intervention
DV = chronic pain symptoms
Extaneous/confounding variables
age
Working history
Need to constantly monitor to control these
Refer sampling
Reason for eHealth - rural or more disabled
Pain levels
High functioning may introduce bias - therefore can't generalise to wider population
selection bias (internal validity)
Control group - usual treatment
eHealth pain mgt consult
nurse practitioner (blinded)
Treatment group
eHealth MBSR & weekly nurse practitioner support
Nurse (blinded??)
MBSR trainer (blinded)
therapist bias
Relationship of patient & nurse/ MBSR practitioner
What is MBSR?
Ethics
informed consent
Anonymous
Not harmed by participating
Best option available
Resources, skills, personal constraints, feasible, rigorous & valid
Internal validity - association, temporal order, non-spuriousness
Threats to internal validity
Placebo effect
Regression to the mean
Seek assistance when pain @ highest level
Maturation
Elderley patients - change nothing to do with treatment
More impairment, cognitive abilities and senescence
Passive of time
Learnt to adapt
Mortality / attrition
Differential attrition b/w treatment & control group
Concurrent history
Patient may improve if left untreated
Nonblind assessments
Patients or practitioner
Pretest/posttest interactions & treatment
Cost of treatment - higher cost usually provides better outcomes
Sample
Inclusion criteria
Target population
Exclusion criteria
Control confounding variables
Limitation
Sample size = small?
Random errors?
Rural or more disabled - bias as more pain?
Technology abilities of patients
Pain meds
Pain levels & length of suffering
Socio-economic status
Gender / race / cultural / martial status
Working history / current work levels
Ethics
random assignment - how?
Unit of analysis ?
People?
Representative sample of population?
Data collection
Pretest
During program ?
Post test
at end
After 3 months
After 6? months
Limitations
Attrition
Incentives offered / costing
Ineligibility unexpectedly for recruitment
Ethics
Ensure all tests are similarly conducted
Similarly provided b/w groups
Ensure instrument change doesn't impact internal validity
Levels of measurement
Analysis
Ethics
Constant monitoring before, during & after experiment - confounding variables eliminated
Statistical test - match levels of measurement for variables
ANOVA?
IV - nominal
DV - continuous
Assumptions that underpin statistical test
Control
Blocking
Multivariate statistical analysis
Measures of central tendency
Mean (including standard deviation)
Median