A Single-Subject Study of the Impact of Exercise on Pain and Fatigue in an Ostomy Patient

This is one last project from one of our Spring 2014 semester students. 

Our student did a really interesting project focusing on a patient with ulcerative colitis.  The patient, Beth, had had an emergency ileostomy.  Beth’s presenting problems were fatigue and pain.  It was thought that introducing an exercise regimen would address these issues. 

To measure fatigue, Beth responded to the following prompt three days each week:  “How tired do you feel today?”  This was measured with a self-anchoring scale with 0 indicating that she didn’t feel tired at all during the day and 5 indicating that she felt tired most of the time.

Beth’s pain was measured on an 11-point self-anchoring scale on the same days and times as she measured pain.  Zero indicated no pain at all and 10 indicated unbearable pain.  As Beth was primarily concerned with back pain, the prompt she responded to was a rating of her back pain, specifically.

Like our other class projects, this was an A-B design.

In a general analysis of her data, our student noted no significant trend in the baseline data for the fatigue or pain variables.  Autocorrelation was high and significant in the baseline for fatigue; however, there was not a problem with data being autocorrelated for the pain variable.

In the intervention phase, the trend in the fatigue variable was significant as was the level and magnitude of autocorrelation.  There was not a significant trend for the pain variable; however, there was a high and significant level of autocorrelation.

Therefore, to statistically compare phases, our student used the conservative dual criteria (CDC) for both of her variables.  The graph of the CDC for fatigue is shown below:

 Output from SSD for R indicated that eleven data points would be required below both the mean and regression lines in the intervention, but only two were present. 

To determine the effect size, our student used the g-index, as there was a significant trend in one of the phases.  A small effect size was observed and was in concert with Beth’s reported level of fatigue during the intervention.

To examine the pain variable, our student also used the CDC, the graph of which is shown below:

In this case, eleven data points were needed below both lines, and thirteen were obtained, illustrating a statistically significant improvement from baseline to intervention.

Effect size was measured using the d-index, and a 45.1% improvement in pain was noted since the introduction of the intervention.

This study had interesting results.  Introduction of the exercise program coincided with a decrease in back pain, but not a decrease in fatigue.  Therefore, it was suggested that Beth examine other options to relieve her fatigue.

With regard to implications for practice, our student noted that ostomy surgery often takes a toll on patients as body images are altered.  She concluded her study by saying that “more research studies are needed to break down the stigma against ostomies, to show how effective mind-body therapies can be, and to determine the types of exercise that can keep an ostomate in healthy remission.”

Nice work and interesting study!