{"id":1513,"date":"2019-11-01T14:49:04","date_gmt":"2019-11-01T14:49:04","guid":{"rendered":"http:\/\/practicalhealthpsychology.com\/?p=1513"},"modified":"2025-11-04T14:24:18","modified_gmt":"2025-11-04T14:24:18","slug":"n-of-1-studies-what-can-we-learn-by-studying-a-single-case","status":"publish","type":"post","link":"https:\/\/practicalhealthpsychology.com\/cz\/2019\/11\/n-of-1-studies-what-can-we-learn-by-studying-a-single-case\/","title":{"rendered":"P\u0159\u00edpadov\u00e9 studie \u201eN = 1\u201c: Co se m\u016f\u017eeme nau\u010dit z p\u0159\u00edpadov\u00fdch studi\u00ed?"},"content":{"rendered":"

Marie Johnston a Derek Johnston, Univerzita Aberdeen, Skotsko<\/b><\/p>\n

Prakti\u010dt\u00ed l\u00e9ka\u0159i velmi \u010dasto cht\u011bj\u00ed zn\u00e1t p\u0159\u00ed\u010dinu probl\u00e9mu, kter\u00fd tr\u00e1p\u00ed jen jednoho ur\u010dit\u00e9ho pacienta, jeden t\u00fdm zdravotn\u00edk\u016f, jednu nemocnici nebo region atd. Nap\u0159\u00edklad m\u016f\u017ee b\u00fdt d\u016fle\u017eit\u00e9 v\u011bd\u011bt, kdy, kde a jak \u010dasto sva\u010d\u00ed ob\u00e9zn\u00ed mu\u017e, a zda jeho sva\u010den\u00ed zhor\u0161uje stres. Nebo chcete zjistit, jak \u010dasto \u010dlenov\u00e9 zdravotnick\u00e9ho t\u00fdmu vynech\u00e1vaj\u00ed hygienu rukou, zda se situace zhor\u0161uje s\u00a0mal\u00fdm po\u010dtem zam\u011bstnanc\u016f, a zda ji zlep\u0161uj\u00ed reklamy na odd\u011blen\u00ed. Nebo m\u016f\u017eete zkoumat, jak\u00e9 jsou zdroje chyb na pracovi\u0161ti, a zda k\u00a0nim doch\u00e1z\u00ed pouze na ur\u010dit\u00fdch odd\u011blen\u00edch \u010di u ur\u010dit\u00e9ho person\u00e1lu. Na politick\u00e9 \u00farovni m\u016f\u017ee b\u00fdt p\u0159\u00ednosn\u00e9 zkoumat, zda nov\u00e1 regulace jako nap\u0159. z\u00e1kaz kou\u0159en\u00ed na ve\u0159ejn\u00fdch m\u00edstech ovlivnila m\u00edru kou\u0159en\u00ed.\u00a0<\/span><\/p>\n

M\u016f\u017eete se pokusit tyto ot\u00e1zky odpov\u011bd\u011bt t\u00edm, \u017ee se dot\u00e1\u017eete lid\u00ed, co si mysl\u00ed nebo co si pamatuj\u00ed. Je\u0161t\u011b lep\u0161\u00ed by bylo se jich pt\u00e1t \u010di pozorovat je v\u00a0kritick\u00e9 momenty na kritick\u00fdch m\u00edstech, aby nedo\u0161lo ke\u00a0zkreslen\u00ed probl\u00e9mu a zapom\u00edn\u00e1n\u00ed. Aktu\u00e1ln\u00ed v\u00fdvoj v\u00a0digit\u00e1ln\u00edch technologi\u00edch, jako nap\u0159\u00edklad digit\u00e1ln\u00ed monitoring a pou\u017e\u00edv\u00e1n\u00ed mobiln\u00edch telefon\u016f usnad\u0148uj\u00ed mapov\u00e1n\u00ed toho, co se opravdu v\u00a0re\u00e1ln\u00e9m \u010dase d\u011bje. Pr\u00e1v\u011b p\u0159\u00edpadov\u00e9 studie (kdy po\u010det \u00fa\u010dastn\u00edk\u016f N = 1) mohou pomoci odpov\u011bd\u011bt na na\u0161e ot\u00e1zky. P\u0159\u00edpadov\u00e9 studie jsou u\u017eite\u010dn\u00e9, pokud lze probl\u00e9m opakovan\u011b posoudit a zachytit zm\u011bny v\u00a0pr\u016fb\u011bhu \u010dasu. M\u016f\u017eeme probl\u00e9m popsat a prozkoumat, zda se v\u00a0ur\u010dit\u00fdch podm\u00ednk\u00e1ch zlep\u0161uje \u010di zhor\u0161uje. Nebo m\u016f\u017eeme zav\u00e9st novou l\u00e9\u010dbu \u010di intervenci a posoudit, zda m\u00e1 po\u017eadovan\u00fd efekt. Nejjednodu\u0161\u0161\u00ed vyhodnocen\u00ed nasb\u00edran\u00fdch dat je pozorov\u00e1n\u00ed trend\u016f v grafu jako uv\u00e1d\u00edme v\u00a0ilustraci n\u00ed\u017ee. To je st\u011b\u017eejn\u00ed a u\u017eite\u010dn\u00fd krok v\u00a0jak\u00e9koli p\u0159\u00edpadov\u00e9 studii. Dodate\u010dn\u011b existuj\u00ed pro p\u0159\u00edpadov\u00e9 studie statistick\u00e9 metody, a st\u00e1le se vyv\u00edjej\u00ed dal\u0161\u00ed nov\u00e9 komplexn\u011bj\u0161\u00ed metody (nap\u0159. metody pro zhodnocen\u00ed dynamick\u00e9 zm\u011bny).\u00a0\u00a0<\/span><\/p>\n

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Pou\u017e\u00edv\u00e1n\u00ed p\u0159\u00edpadov\u00fdch studi\u00ed pro stanoven\u00ed probl\u00e9mu\u00a0<\/b><\/p>\n

Studie m\u016f\u017ee b\u00fdt prov\u00e1d\u011bna za \u00fa\u010delem stanoven\u00ed z\u00e1va\u017enosti, frekvence nebo vzorce probl\u00e9mu b\u011bhem ur\u010dit\u00e9 doby. V\u00a0grafu 1 se li\u0161ilo hodnocen\u00ed \u00fazkosti v\u00a0r\u016fzn\u00fdch \u010dasech, z \u010deho\u017e je zde mo\u017en\u00e9 vid\u011bt ur\u010dit\u00fd vzorec. V p\u0159\u00edkladu p\u0159\u00edtomnosti \u010dlov\u011bka v\u00a0pr\u00e1ci m\u016f\u017ee vzorec poukazovat na rozd\u00edl mezi v\u00edkendy a 5denn\u00edm pracovn\u00edm t\u00fddnem a nazna\u010dit, \u017ee se osoba c\u00edt\u00ed \u00fazkostn\u011b v\u00a0pr\u00e1ci, ale ne doma. Tato informace m\u016f\u017ee b\u00fdt u dan\u00e9ho pacienta u\u017eite\u010dn\u00e1 pro volbu optim\u00e1ln\u00ed l\u00e9\u010debn\u00e9 metody. Nap\u0159\u00edklad sledov\u00e1n\u00ed n\u00e1lady a denn\u00ed doby u um\u00edraj\u00edc\u00ed \u017eeny uk\u00e1zalo vzorec, kter\u00fd pomohl ke zlep\u0161en\u00ed pochopen\u00ed jej\u00edch depresivn\u00edch stav\u016f.\u00a0<\/span><\/p>\n

Informace nasb\u00edran\u00e9 v t\u011bchto p\u0159\u00edpadov\u00fdch studi\u00edch mohou ud\u011blat daleko v\u00edce ne\u017e jen popsat a vysv\u011btlit probl\u00e9m. V\u00a0n\u011bkter\u00fdch p\u0159\u00edpadech m\u016f\u017ee m\u00edt zdravotn\u00edk teorii o tom, co pozorovan\u00fd probl\u00e9m ovliv\u0148uje a eventu\u00e1ln\u011b otestovat, jak dob\u0159e tato teorie vysv\u011btluje pozorovan\u00fd jev. V\u00a0p\u0159\u00edpad\u011b um\u00edraj\u00edc\u00ed \u017eeny potvrdilo mapov\u00e1n\u00ed jej\u00edch my\u0161lenek a aktivit teorii, \u017ee jej\u00ed n\u00e1lada byla ovlivn\u011bna my\u0161lenkami, a \u017ee kritick\u00e9 my\u0161lenky byly spojeny s\u00a0brzk\u00fdmi rann\u00edmi aktivitami.<\/span><\/p>\n

Graf 1:<\/b>Po\u017e\u00edv\u00e1n\u00ed p\u0159\u00edpadov\u00e9 studie (N = 1) pro popis probl\u00e9mu: ukazuje hladinu \u00fazkosti v\u00a0modr\u00e9 a pracovn\u00ed dny oran\u017eovou b\u011bhem 24 dn\u00ed<\/span><\/p>\n

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Pou\u017e\u00edv\u00e1n\u00ed p\u0159\u00edpadov\u00fdch studi\u00ed k\u00a0posouzen\u00ed, zda ud\u00e1lost nebo jej\u00ed v\u00fdskyt m\u016f\u017ee zlep\u0161it \u010di zhor\u0161it probl\u00e9m<\/b><\/p>\n

Probl\u00e9my se mohou zlep\u0161it \u010di zhor\u0161it d\u00edky p\u0159irozen\u011b se vyskytuj\u00edc\u00edm nebo pl\u00e1novan\u00fdm ud\u00e1lostem jako jsou: \u00famrt\u00ed bl\u00edzk\u00e9 osoby, svatba, medi\u00e1ln\u00ed zdroje informac\u00ed o zdrav\u00ed, zav\u0159en\u00ed tov\u00e1rny nebo dokonce vlivem po\u010das\u00ed. V\u00a0hypotetick\u00e9 ilustraci v\u00a0grafu 2 se po\u010det konzultac\u00ed o zdravotn\u00edm stavu (jako nap\u0159\u00edklad u ch\u0159ipky) zv\u00fd\u0161il v\u00a0t\u00fddnu, kter\u00fd n\u00e1sledoval po odvys\u00edl\u00e1n\u00ed report\u00e1\u017ee na toto t\u00e9ma. To nazna\u010duje, \u017ee tento vzr\u016fst nenastal d\u00edky hroz\u00edc\u00ed epidemii. Zdravotnick\u00e1 za\u0159\u00edzen\u00ed by tak mohla v\u00a0budoucnosti p\u0159edv\u00eddat podobn\u00fd n\u00e1r\u016fst, jestli\u017ee se t\u00e9mata spojen\u00e1 se zdrav\u00edm dostanou do hlavn\u00edho zpravodajstv\u00ed. P\u0159\u00edpadov\u00e1 studie jedn\u00e9 nemocnice ve Velk\u00e9 Brit\u00e1nii statisticky prok\u00e1zala efekt sportovn\u00edch ud\u00e1lost\u00ed na po\u010det p\u0159ijat\u00fdch pacient\u016f \u2013 b\u011bhem sv\u011btov\u00e9ho poh\u00e1ru v\u00a0roce 1998 zaznamenala nemocnice zv\u00fd\u0161en\u00fd po\u010det p\u0159ijat\u00fdch pacient\u016f <\/span>\u00a0se srde\u010dn\u00ed p\u0159\u00edhodou<\/span><\/a>.\u00a0<\/span><\/p>\n

Graf 2:<\/b>Pou\u017e\u00edvan\u00ed p\u0159\u00edpadov\u00fdch studi\u00ed pro vyhodnocen\u00ed efektu ud\u00e1losti: denn\u011b prob\u011bhne zhruba 40 konzultac\u00ed ohledn\u011b ch\u0159ipky, dokud TV vys\u00edl\u00e1n\u00ed (zn\u00e1zorn\u011bno modrou \u0161ipkou) z\u0159ejm\u011b nezp\u016fsob\u00ed zv\u00fd\u0161en\u00ed po\u010dtu konzultac\u00ed\u00a0<\/span><\/p>\n

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Pou\u017e\u00edv\u00e1n\u00ed p\u0159\u00edpadov\u00fdch studi\u00ed ke\u00a0zhodnocen\u00ed, zda intervence \u010di l\u00e9\u010dba dosahuj\u00ed po\u017eaduj\u00edc\u00edho \u00fa\u010dinku\u00a0<\/b><\/p>\n

P\u0159\u00edpadov\u00e9 studie mohou b\u00fdt pou\u017eity ve <\/span>v\u00fdvoji nov\u00fdch intervenc\u00ed<\/span><\/a>, v\u010detn\u011b klinick\u00fdch \u010di zdravotn\u011b-politick\u00fdch intervenc\u00ed. V\u00a0hypotetick\u00e9m p\u0159\u00edkladu v\u00a0grafu 3 je ob\u00e9zn\u00ed pacient, kter\u00fd sva\u010d\u00ed zhruba 7x denn\u011b; intervence je zn\u00e1zorn\u011bna \u010dervenou \u0161ipkou (osobn\u00ed monitoring sva\u010din), a pokud ji dodr\u017e\u00ed, rychle sva\u010dinky zredukuje na 2x za den. Podobn\u00e9 metody mohou b\u00fdt pou\u017eity pro studium <\/span>kou\u0159en\u00ed<\/span><\/a> a pro zhodnocen\u00ed vlivu zm\u011bny z\u00e1kon\u016f, jako nap\u0159\u00edklad z\u00e1kaz kou\u0159en\u00ed na ve\u0159ejn\u00fdch m\u00edstech (p\u0159\u00edklad, jak <\/span>z\u00e1kony ovliv\u0148uj\u00ed kou\u0159en\u00ed<\/span><\/a>).<\/span><\/p>\n

Dobr\u00fd p\u0159\u00edklad praktick\u00e9ho u\u017eit\u00ed metody p\u0159\u00edpadov\u00e9 studie k vyhodnocen\u00ed efektu intervence byl zachycen zdravotn\u00edky p\u0159\u00edmo v\u00a0jedn\u00e9 nemocnici. P\u0159i sledov\u00e1n\u00ed ot\u00e1zky opo\u017ed\u011bn\u00e9ho nahla\u0161ov\u00e1n\u00ed nep\u0159\u00edzniv\u00fdch ud\u00e1lost\u00ed pro obdob\u00ed 2001 a\u017e 2006 zjistili, \u017ee p\u0159esto\u017ee se hl\u00e1\u0161en\u00ed ud\u00e1lost\u00ed r\u016fzn\u011b m\u011bnila, ochrana bezpe\u010d\u00ed pacient\u016f byla problematick\u00e1 a v\u00a0pr\u016fb\u011bhu \u010dasu se neukazovalo zlep\u0161en\u00ed. V\u00a0roce 2007 a 2008 byl p\u0159edstaven program pro uzn\u00e1n\u00ed dobr\u00e9ho v\u00fdkonu, co\u017e v\u00a0n\u00e1sleduj\u00edc\u00edch letech vedlo ke sn\u00ed\u017een\u00ed opo\u017ed\u011bn\u00ed hl\u00e1\u0161en\u00ed a uk\u00e1zalo, jak <\/span>uzn\u00e1n\u00ed v\u00fdkonu zlep\u0161ilo \u010das nahla\u0161ov\u00e1n\u00ed<\/span><\/a>.\u00a0<\/span><\/p>\n

Graf 3: <\/span>Pou\u017e\u00edv\u00e1n\u00ed p\u0159\u00edpadov\u00fdch studi\u00ed pro zhodnocen\u00ed efektu intervence: <\/b>prvn\u00edch 15 dn\u00ed ukazuje frekvenci sva\u010den\u00ed, 16.den vlastn\u00ed monitoring sva\u010den\u00ed a v\u00fdsledek ve sn\u00ed\u017een\u00ed po\u010dtu sva\u010din\u00a0<\/span><\/i><\/p>\n

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V\u00fdzvy<\/b><\/p>\n

Sb\u011br dat m\u016f\u017ee b\u00fdt n\u00e1ro\u010dn\u00fd. \u010cast\u00e1 opakovan\u00e1 m\u011b\u0159en\u00ed mohou b\u00fdt z\u00e1t\u011b\u017e\u00ed a mohou vy\u00fastit v\u00a0chyb\u011bj\u00edc\u00ed data. Sou\u010dasn\u00fd rychl\u00fd v\u00fdvoj dostupn\u00fdch digit\u00e1ln\u00edch a mobiln\u00edch technologi\u00ed v\u010detn\u011b chytr\u00fdch telefon\u016f, nositeln\u00e1 elektronick\u00e1 za\u0159\u00edzen\u00ed a senzory pom\u00e1haj\u00ed sb\u00edrat data snadn\u011bji a spolehliv\u011bji.\u00a0<\/span><\/p>\n

Praktick\u00e1 doporu\u010den\u00ed<\/b><\/p>\n