EIP 2 midterm

3 components of EIP?
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3 components of EIP?
best evidence, clinical expertise, patient values
Drawing conclusions based on previous held expectations of a clinical outcome
a. confirmation bias
b. recency effect
c. ascertainment bias
ascertainment bias.
ex. PT thinks pt.'s spinal pain is due to catastrophization bc they express job dissatisfaction and doesn't test for joint restriction
clinician selectively focuses on information that confirms a hypothesis
a. confirmation bias
b. recency effect
c. ascertainment bias
confirmation bias
ex. only does tests that confirm joint restriction but doesn't include MLT's that may falsify the hypothesis
clinician believes a particular pt response or presentation is common because it is easily remembered OR clinician believes a particular pt response or presentation is uncommon because it is not easily remembered
a. recency effect
b. representativeness exclusivity
c. value bias
recency effect
ex. PT sees two men w back pain that have w fibromyalgia therefore all men w back pain have fibromyalgia OR PT mistakes a pt w pain from herpes zoster for radicular pain due to vertebral restriction with acute idiopathic onset
Clinician draws conclusion on pt. response or presentation based only on those who return for scheduled treatment
a. recency effect
b. representativeness exclusivity
c. value bias
representativeness exclusivity
ex. PT believes all people with PD benefit from a balance program based on the people who have completed the training and not the people who havent
occurs when the importance of outcome in the clinicians eyes distorts the likelihood of the outcome occurring
a. confirmation bias
b. ascertainment bias
c. value bias
value bias
ex. PT is concerned that acute pain may be a fracture so he has all pt w acute pain get an XRAY.
Barriers or helpful?
time required to keep up to date with current best practices
access to relevant journal articles is lacking
PT skill in searching for evidence
poor ability to appraise research
barriers to practice EIP
What are the various focus areas for evidence in PT?
a. evaluation > examination > diagnosis > interventions > outcomes > prognosis
b. examination > evaluation > interventions > diagnosis > outcomes > prognosis
c. examination > evaluation > diagnosis > prognosis > interventions > outcome
examination > evaluation >diagnosis > prognosis > interventions > outcome
Why does research help with examination, evaluation, and diagnosis?
may help PT select the best technique to identify, quantify and classify a pt.'s problem. Enhances efficiency and effectiveness of the service delivery
Why does research help with determining prognosis?
Evidence may identify the most salient factors that produce the most accurate prediction
Why does research help with interventions?relevant studies may assist in risk benefit analysis by providing information about effectiveness and harmWhy does research help with outcomes?may help PT determine what outcomes are possible and what tool is able to detect change in a consistent and meaningful fashionWhat is the difference between EIP and EBPEBP only takes into account using current best research while EIP inegrates evidence with clinical expertise and patient values5 step process of EIP?Ask, acquire, appraise, apply, assessHow do you acquire the best evidence?Prioritizing the type of study that can give you the most info determine which database will be most useful or efficient for your search identify search terms aim for highest quality articlesMost bias control to least bias control a. quasi-experimental designs > case report/anecdote > nonexperimental designs > experimental designs b. experimental designs > quasi-experimental designs > nonexperimental designs > case report/anecdote c. experimental designs > quasi-experimental designs > case report/anecdote > nonexperimental designsexperimental designs > quasi-experimental designs > nonexperimental designs > case report/anecdoteWhat is bias?systematic deviation from the truth that occurs as a result of uncontrolled or unwanted influences during the studywhat is a single system designsonly studies where one person receives on an alternating bias both the experimental and control conditionswhat are randomized clinical trials?uses a randomization process to assign subjects to either experimental groups or control groups. experimental group receives intervention while control receives no treatment or placeboAn RCT or single system design best answers questions about what?whether an experimental intervention has an effect and whether that effect is beneficial or harmfulwhat is a systematic reviewcomprises original evidence from multiple RCTs that have been selected and critically appraised according to pre-established criteria. meta-analysis increases statistical power of a treatment or intervention based on multiple RCTswhat is the goal of a systematic review?to draw conclusions based on the cumulative weight of studies that individually may not be sufficient to provide a definitive answerunsystematic researchoften labeled anecdotal and put to use when therapists recall from memory prior experiences with pts or clients similar to the person with whome they are currently dealingquasi-experimental designAn experiment that does not require random assignment to conditions. maintains purposeful manipulation of the experimental technique. Involves purposeful manipulation of the subjects by the investigators. May lack a second group.why are quasi-experimental designs usefuluseful for evaluating effectiveness of interventionsnon-experimental designless control than quasi-experimental bc they have the same limitations with respect to their groups but they don't include experimental manipulation of the subjects. observe and collect info.physiologic studieshave a high degree of control for bias but do not focus on person-level function. mainly focuses on specific anatomical or physiological aspects of the body. body function and structure focused, not participation.case reportssimply describe what occured with a pt. or client. unsystematic. occurs daily in PT practice.narrative reviewa paper in which authors describe prior research on a topic without systematic search and critical appraisal process.retrospective designtakes advantage of data that already exists from pt records, insurance claims, and outcome databasesprospective designrequires that new data be collected in real timelongitudinal designstudying a phenomenon over a long period of timecross sectional designresearchers may be interested in a single point in time or limited time intervaldifferent research designs are used depending on the question posed. what is the question here? non-experimental, cross sectional a. diagnosis b. intervention effectiveness, c. risk factors for fallsdiagnosisdifferent research designs are used depending on the question posed. what is the question here? longitudinal study, retrospective study a. diagnosis b. risk factors for falls c. prognosisrisk factors for fallsdifferent research designs are used depending on the question posed. what is the question here? prospective, RCT, systematic review, experimental or quasi-experimental, may be cross sectional or longitudinal. a. prognosis b. diagnosis c. intervention effectivenessintervention effectivenessdifferent research designs are used depending on the question posed. what is the question here? non-experimental, cohort studies, case-control a. prognosis b. diagnosis c. intervention effectivenessprognosiswhat is primary evidence?original research reportswhere are primary sources of evidence found?peer reviewed journals, proceedings from professional meetings, theses and dissertations, websiteswhere are secondary sources of evidence found?systematic and narrative reviews of works of other researchers, textbooks, practice guidelines, websites. basically anything that is an amalgamation of prior researchWhat type of evidence should you choose?evidence that is relevent, consistent, ranks high, peer reviewed, authors are credentialed, discloses funding sources and conflicts of interestWhat type of research design is necessary? effectiveness of joint mobilization in the management of C-spine disordersRCTWhat type of research design is necessary? study to determine falls in two groups of elderly subjectslongitudinal studywhat is the hierarchy of evidence?RCTs, systematic reviews, multiple RCTs, systematic reviews of studies below, cohort or case control studies or larger case series, case reports or smaller case series expert opinionwhat are background questions?who, what, why, when, where, how general knowledge reflect a desire to understand the nature of a problem or need focuses on evolution of a condition focuses on its medical and surgical management rather than on the PT componentexamples of background questions?what are the side effects of steroid treatments for asthma? how long will it take for a TKA incision to heal? what are the S&S of an exacerbation of MS?what do foreground questions help with?helps make decisions about the management of the problem or concern. contains PICOName the P, I, C, and O Will Neer's test help me to detect rotator cuff impingement in a 35 yr old male tennis player w shoulder pain?P: 35 yr old w shoulder pain I: Neer's test C: none O: detect rotator cuff impingementName the P, I, C, and O Is an MMT as. reliable and valid as a handheld dynamometer for measuring quad strength in a 42 year old woman with MS?P: 42 year old woman with MS I: MMT C: handheld dynamometer O: measuring quad strengthName the P, I, C, and O Is LE mm strength a predictor of fall risk in a 76 year old woman with diabetes?P: 76 year old woman with diabetes I: LE mm strength C: none O: fall riskName the P, I, C, and O Is PNF more effective than NDT for restoring core trunk stability in a 7 year old child with right hemiparesis due to stroke?P: 7 year old with right hemiparesis due to stroke I: PNF C: NDT O: restoring core trunk stabilityName the P, I, C, and O Are the Ottawa Ankle Rules a valid CPR to determine need for a radiograph in an 11 year old child with ankle pain after a fall on an icy surface?P: 11 year old child with ankle pain after fall on an icy surface I: Ottawa Ankle Rules C: none O: determine need for a radiographName the P, I, C, and O Does participation in a cardiac rehab program increase the chance of returning to work more than a home walking program for a 58 year old man following an MIP: 58 year old man following an MI I: cardiac rehab program C: home walking program O: return to workWhat does PICO stand for?P: person, problem, population I: intervention, test, measure, CPR, etc. C: comparison O: outcomeOn what sites can you find evidence for interventions? a. PEDro, OT seeker, APTA's hooked on evidence b. PubMed, cochrane CDSR, National Guideline ClearinghousePEDro, OT seeker, APTA's hooked on evidenceWhat does the background section provide?context, summarizes current knowledge, offers rationale for current research, states purpose or research problem, provides framework for study, states hypothesis(es)What is this? The reasonable expectation that the human body could behave in the manner predicted. ex. a research question about the effect of a new therapeutic exercise technique on restoration of normal movements in adults following stroke might reasonably be based on observations about the development sequence of motor patterns in infants and children.biological plausibilityWhat is this? a collection of interrelated concepts or constructs that reflect a common theme, may be the basis of a more formal theory. usually depicted in schematic form. small scale theories.conceptual frameworkwhat is this? a set of relationships among concepts or constructs that is proposed to systematically describe an/or explain a phenomenon of interesttheoretical framework/modelA mental image of an observable phenomenon that can be expressed in words. ex. fatigue, age, pain, flexibility a. concept b. constructconceptA non-observable abstraction created for a specific research purpose; defined by observable measures such as events or behaviors. ex. readiness, motivation, health-related quality of life a. concept b. constructconstructnull/statistical hypothesisprediction that the outcome of an investigation will demonstrate no difference between groups in the study other than what chance alone may createalternate/research hypothesispredicts that a difference or relationship between the groups or variables will be demonstrated by the study's resultswhat are the different types of designs under quantitative research?experimental, quasi-experimental, non-experimentalwhat is an experimental design?the researcher purposefully manipulates some of the subjects and then measures their resulting behaviors using at least two groupsdifferent research designs are used depending on the question posed. what is the question here? non-experimental in design a. CPR b. interventionsCPRdifferent research designs are used depending on the question posed. what is the question here? non-experimental, retrospective, may be cross sectional or longitudinal a. CPR b. OutcomesOutcomeswhat are the different types of secondary analyses?narrative reviews, systematic reviews, meta-analysismeta-analysisa statistical method used to pool data from individual studies included in a measurethe entire set of people in the group of interest a. population b. samplepopulationa subset of the population chosen for study a. extraneous variable b. samplesamplethe outcome of interest in the study a. dependent variable b. independent variable c. extraneous variable d. discrete variable e. dichotomous variable f. continuous variabledependent variablea factor other than the independent variable that is said to influence or confound the dependent variable a. dependent variable b. independent variable c. extraneous variable d. discrete variable e. dichotomous variable f. continuous variableextraneous variabletraditionally defined as the variable that is purposefully manipulated by investigators in an effort to produce a change in outcome a. dependent variable b. independent variable c. extraneous variable d. discrete variable e. dichotomous variable f. continuous variableindependent variablevariables that are on a scale with a theoretically infinite number. ex. distance walked a. dependent variable b. independent variable c. extraneous variable d. discrete variable e. dichotomous variable f. continuous variablecontinuous variablevariables whose possible values are distinct categories ex. weight bearing status, toe touch, foot flat. a. dependent variable b. independent variable c. extraneous variable d. discrete variable e. dichotomous variable f. continuous variablediscrete variablecharacterized as a variable with only two possible values. ex. male-female, disease present-disease absent a. dependent variable b. independent variable c. extraneous variable d. discrete variable e. dichotomous variable f. continuous variabledichotomous variablewhat is this level of measurement? Values are named without mathematical properties. ex. hair color, sex, yes or no a. interval b. ordinal c. nominal d. rationominalwhat is the level of measurement? classifies characteristics without a known equal distance between them; however categories have a rank order relative to one another. a. interval b. ordinal c. nominal d. ratioordinalWhat is the level of measurement? scale that assigns numeric rather than descriptive, values to variables. ex. temperature a. interval b. ordinal c. nominal d. ratiointervalwhat is the level of measurement? have rank order, a known equal distance between them, and a known empirical zero point. ex. ROM, weight a. interval b. ordinal c. nominal d. ratioratiowhat is reliability?the extent to which repeated measures agree with one anotherWhat type of reliability? reliability of a self-report instrument established by testing two versions of the tool that measure the same concepts or constructs a. interrater b. parallel forms c. split half d. intrarater e. test retestparallel formsWhat type of reliability? the stability of repeated measures obtained by two or more examiners a. interrater b. parallel forms c. split half d. intrarater e. test retestinterraterWhat type of reliability? the stability of repeated measures by the same examiner a. interrater b. parallel forms c. split half d. intrarater e. test retestintraraterwhat type of reliability? stability of a measurement as it is repeated over time, a measure of instrument stability. aka: reproducibility a. interrater b. parallel forms c. split half d. intrarater e. test retesttest-retestwhat type of reliability? eliminates the need for two test administrations by combining the two forms of a survey instrument into one longer version. measure of internal consistency of an instrument a. interrater b. parallel forms c. split half d. intrarater e. test retestsplit half reliabilityWhat is validity?The ability of a measure to cpature what it is intended to captureWhat type of validity? The degree to which items in an instrument represent all of the facets of the variable being measured a. discriminant validity b. face validity c. content validity d. criterion validity e. construct validity f. concurrent validity g. predictive validitycontentWhat type of validity? a subjective assessment of the degree to which an instrument appears to measure what it is designed to measure a. discriminant validity b. face validity c. content validity d. criterion validity e. construct validity f. concurrent validity g. predictive validityfaceWhat type of validity? The degree to which a measure of interest relates to a measure which established validity a. discriminant validity b. face validity c. content validity d. criterion validity e. construct validity f. concurrent validity g. predictive validitycriterion validityWhat type of validity? a method of criterion validation that reflects the degree to which the score on a measure predicts a future criterion score a. discriminant validity b. face validity c. content validity d. criterion validity e. construct validity f. concurrent validity g. predictive validitypredictiveWhat type of validity? a method of construct validation that reflects the degree to which an instrument can distinguish between or among different phenomena or characteristics a. discriminant validity b. face validity c. content validity d. criterion validity e. construct validity f. concurrent validity g. predictive validitydiscriminantWhat type of validity? A method of criterion validation that reflects the relationship between a measure of interest and a measure with established validity, both of which have been applied within the same time frame a. discriminant validity b. face validity c. content validity d. criterion validity e. construct validity f. concurrent validity g. predictive validityconcurrentWhat type of validity? a method of construct validation that reflects the degree to which two or more measures of the same phenomenon of characteristic will produce similar scores a. discriminant validity b. face validity c. content validity d. criterion validity e. construct validity f. concurrent validity g. predictive validity h. convergent validityconvergentWhat type of validity? the degree to which a measure matches the operational definition of the concept or construct it is said to represent a. discriminant validity b. face validity c. content validity d. criterion validity e. construct validity f. concurrent validity g. predictive validityconstructwhat does responsiveness to change mean? what does it depend on?ability of a measure to detect change. depends on the fit of the instrument and what its measuring, the number of values on the scale, the standard erroran estimate of the standard deviation of the population of interest; it indicates the degree of error associated with repeated samples from the population a. minimal detectable change b. floor and ceiling effect c. standard error of measurementstandard error of measurementthe amount of change that just exceeds the standard error of measurement of an instrument a. minimal detectable change b. floor and ceiling effect c. standard error of measurementminimal detectable changedoesn't register a further decrease or increase in score for the lowest or highest scoring individuals a. minimal detectable change b. floor and ceiling effect c. standard error of measurementfloor and ceiling effectDescribe mode and when it's often usedthe score that occurs most frequently in a data set. Often used for nominal data because you cant calculate a mean or median in that case.What is the average absolute distance of scores from the mean score of a data set.Standard deviationsWhat allows comparison of the variability in different measures of the same phenomenoncoefficients of variationWhat are the two types of inferential statistical tests?parametric, non-parametricThese tests are ________ tests T-tests, ANOVAs, certain types of correlation and regressions a. parametric b. non-parametricparametricThese tests are ________ tests Chi-square, mann-whitney, wilcoxon rank sum, kruskal-wallis a. parametric b. non-parametricnon-parametricWhat type of inferential statistical test is this? -help us make decisions about what the data indicates relative to clinical phenomenon a. parametric b. non-parametricparametricWhat type of inferential statistical test is this? -uses rank or frequency, deals with nominal and ordinal level measures, don't rely on normal distributions of the data a. parametric b. non-parametricnon-parametricwhat type of test? To compare 2 independent groups a. dependent/paired t-test b. one-way ANOVA c. repeated measures ANOVA d. Independent t-test e. factorial ANOVA f. ANCOVA g. MANOVAdwhat type of test? to compare pre-post intervention values of the same groups a. dependent/paired t-test b. one-way ANOVA c. repeated measures ANOVA d. Independent t-test e. factorial ANOVA f. ANCOVA g. MANOVAawhat type of test? To compare more than 2 independent groups. only one independent variable is examined. a. dependent/paired t-test b. one-way ANOVA c. repeated measures ANOVA d. Independent t-test e. factorial ANOVA f. ANCOVA g. MANOVAbwhat type of test? to compare multiple groups. two or more independent variables examined a. dependent/paired t-test b. one-way ANOVA c. repeated measures ANOVA d. Independent t-test e. factorial ANOVA f. ANCOVA g. MANOVAewhat type of test? one or more independent variable. another intervening covariate is present a. dependent/paired t-test b. one-way ANOVA c. repeated measures ANOVA d. Independent t-test e. factorial ANOVA f. ANCOVA g. MANOVAfwhat type of test? one or more independent variable and more than one dependent variable a. dependent/paired t-test b. one-way ANOVA c. repeated measures ANOVA d. Independent t-test e. factorial ANOVA f. ANCOVA g. MANOVAgwhat type of test? 1 group with more than 2 measurements a. dependent/paired t-test b. one-way ANOVA c. repeated measures ANOVA d. Independent t-test e. factorial ANOVA f. ANCOVA g. MANOVAcWhat is this? The analysis of frequencies. often used in case-controls. Assess relative proportions of subjects with a particular characteristic in each group. a. Chi square b. t-test c. ANOVAaT/F correlation analysis determines cause and effectF. it determines relationships between 2 variablesThe probability that the study's findings occurred due to chance. 0;1 = 10% probability it occurred due to chance a. alpha b. pbpredetermined threshold by researcher to determine if an observed relationship/difference between variables is real or by chance. establishes statistical significance. usually set to 0.05 for 5% probability of type 1 error a. alpha b. paIf p is less than or equal to a a. reject null b. retain nulla. reject null aka accept researchIf p is greater than alpha a. reject null b. retain nullb. retain null aka reject researchfalse positive. identifying a relationship or difference that doesn't exist. a. type 1 b. type 2afalse negative. an error where the situation in whihc the null hypothesis is accepted incorrectly a. type 1 b. type 2bThe smallest treatment effect that would result in a change in pt management, given its side effects, costs, and inconveniences a. MDC b. MCID c. SEbWhat is the probability that a statistical test will detect, if present, a relationship b/w two or more variables or a difference between two or more groups. failure to achieve this will result in type 2 errorStatistical powerPower depends on DAVEdesired alpha level a minimum sample size variance effect size