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Physiological Measurements of Stress Preceding Incidents of Challenging Behavior in People With Severe to Profound Intellectual Disabilities: Longitudinal Study Protocol of Single-Case Studies

BACKGROUND: Clients with severe to profound intellectual disabilities (SPID) and challenging behavior (CB) and the professional caregivers that support them are vulnerable to high stress levels, which negatively impact their well-being and the quality of care. CB is thought to result from an increas...

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Autores principales: Simons, Rianne, Koordeman, Renske, de Looff, Peter, Otten, Roy
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JMIR Publications 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8339975/
https://www.ncbi.nlm.nih.gov/pubmed/34287220
http://dx.doi.org/10.2196/24911
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author Simons, Rianne
Koordeman, Renske
de Looff, Peter
Otten, Roy
author_facet Simons, Rianne
Koordeman, Renske
de Looff, Peter
Otten, Roy
author_sort Simons, Rianne
collection PubMed
description BACKGROUND: Clients with severe to profound intellectual disabilities (SPID) and challenging behavior (CB) and the professional caregivers that support them are vulnerable to high stress levels, which negatively impact their well-being and the quality of care. CB is thought to result from an increase in the intensity and frequency of clients’ stress experiences. In turn, staff members experience stress in dealing with this behavior, and stressed staff members might behave in ways that increase clients’ stress levels, contributing to the origin and maintenance of CB. Research into these dyadic interactions between clients and staff is scarce for people with SPID, especially in real-life situations. The barriers of studying stress in this population include clients’ difficulties in communicating stress experiences and the lack of an objective continuous measure of stress. OBJECTIVE: This paper presents a protocol for studying patterns of physiological stress in 15 client-caregiver dyads in the 30 minutes preceding incidents of CB compared to control periods without CB and the interplay between the stress levels of clients and professional caregivers. METHODS: We will conduct 15 single-case studies to assess patterns of physiological stress in dyads of clients with SPID and professional caregivers prior to CB in several Dutch residential institutes. Client-caregiver dyads will wear the Empatica E4 wristband for 20 sessions of 3 to 8 hours without interruptions of daily routines while caregivers report clients’ CB. The physiological measures obtained will be electrodermal activity (microsiemens) and heart rate (beats per minute). A multilevel model with repeated measures at the incident level nested within the person level will be applied, employing separate models for electrodermal activity and heart rate to compare stress levels in the 30 minutes prior to incidents with control epochs. Covariates in the models include movement, temperature, and gender. In addition, cross-recurrence quantification analyses will be performed to study the synchronization between the stress levels of clients and professional caregivers. RESULTS: The Ethics Committee of the Radboud University (NL-number: NL71683.091.19) approved the study on February 12, 2020. In total, 15 organizations have declared their commitment to participate in the study. The first result is expected in the spring of 2022. CONCLUSIONS: Study results will demonstrate whether changes in patterns of electrodermal activity and heart rate are apparent in the 30 minutes preceding an incident of CB compared to baseline levels when the client does not engage in CB. The synchronization between caregivers’ and clients’ physiological stress levels will be explored with cross-recurrence quantification analyses. Insights into the physiological stress levels of clients and caregivers may contribute to a reduction of CB and an improvement of both clients’ and caregivers’ safety and well-being. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/24911
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spelling pubmed-83399752021-08-25 Physiological Measurements of Stress Preceding Incidents of Challenging Behavior in People With Severe to Profound Intellectual Disabilities: Longitudinal Study Protocol of Single-Case Studies Simons, Rianne Koordeman, Renske de Looff, Peter Otten, Roy JMIR Res Protoc Protocol BACKGROUND: Clients with severe to profound intellectual disabilities (SPID) and challenging behavior (CB) and the professional caregivers that support them are vulnerable to high stress levels, which negatively impact their well-being and the quality of care. CB is thought to result from an increase in the intensity and frequency of clients’ stress experiences. In turn, staff members experience stress in dealing with this behavior, and stressed staff members might behave in ways that increase clients’ stress levels, contributing to the origin and maintenance of CB. Research into these dyadic interactions between clients and staff is scarce for people with SPID, especially in real-life situations. The barriers of studying stress in this population include clients’ difficulties in communicating stress experiences and the lack of an objective continuous measure of stress. OBJECTIVE: This paper presents a protocol for studying patterns of physiological stress in 15 client-caregiver dyads in the 30 minutes preceding incidents of CB compared to control periods without CB and the interplay between the stress levels of clients and professional caregivers. METHODS: We will conduct 15 single-case studies to assess patterns of physiological stress in dyads of clients with SPID and professional caregivers prior to CB in several Dutch residential institutes. Client-caregiver dyads will wear the Empatica E4 wristband for 20 sessions of 3 to 8 hours without interruptions of daily routines while caregivers report clients’ CB. The physiological measures obtained will be electrodermal activity (microsiemens) and heart rate (beats per minute). A multilevel model with repeated measures at the incident level nested within the person level will be applied, employing separate models for electrodermal activity and heart rate to compare stress levels in the 30 minutes prior to incidents with control epochs. Covariates in the models include movement, temperature, and gender. In addition, cross-recurrence quantification analyses will be performed to study the synchronization between the stress levels of clients and professional caregivers. RESULTS: The Ethics Committee of the Radboud University (NL-number: NL71683.091.19) approved the study on February 12, 2020. In total, 15 organizations have declared their commitment to participate in the study. The first result is expected in the spring of 2022. CONCLUSIONS: Study results will demonstrate whether changes in patterns of electrodermal activity and heart rate are apparent in the 30 minutes preceding an incident of CB compared to baseline levels when the client does not engage in CB. The synchronization between caregivers’ and clients’ physiological stress levels will be explored with cross-recurrence quantification analyses. Insights into the physiological stress levels of clients and caregivers may contribute to a reduction of CB and an improvement of both clients’ and caregivers’ safety and well-being. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/24911 JMIR Publications 2021-07-21 /pmc/articles/PMC8339975/ /pubmed/34287220 http://dx.doi.org/10.2196/24911 Text en ©Rianne Simons, Renske Koordeman, Peter de Looff, Roy Otten. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 21.07.2021. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on https://www.researchprotocols.org, as well as this copyright and license information must be included.
spellingShingle Protocol
Simons, Rianne
Koordeman, Renske
de Looff, Peter
Otten, Roy
Physiological Measurements of Stress Preceding Incidents of Challenging Behavior in People With Severe to Profound Intellectual Disabilities: Longitudinal Study Protocol of Single-Case Studies
title Physiological Measurements of Stress Preceding Incidents of Challenging Behavior in People With Severe to Profound Intellectual Disabilities: Longitudinal Study Protocol of Single-Case Studies
title_full Physiological Measurements of Stress Preceding Incidents of Challenging Behavior in People With Severe to Profound Intellectual Disabilities: Longitudinal Study Protocol of Single-Case Studies
title_fullStr Physiological Measurements of Stress Preceding Incidents of Challenging Behavior in People With Severe to Profound Intellectual Disabilities: Longitudinal Study Protocol of Single-Case Studies
title_full_unstemmed Physiological Measurements of Stress Preceding Incidents of Challenging Behavior in People With Severe to Profound Intellectual Disabilities: Longitudinal Study Protocol of Single-Case Studies
title_short Physiological Measurements of Stress Preceding Incidents of Challenging Behavior in People With Severe to Profound Intellectual Disabilities: Longitudinal Study Protocol of Single-Case Studies
title_sort physiological measurements of stress preceding incidents of challenging behavior in people with severe to profound intellectual disabilities: longitudinal study protocol of single-case studies
topic Protocol
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8339975/
https://www.ncbi.nlm.nih.gov/pubmed/34287220
http://dx.doi.org/10.2196/24911
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