EBP - Weeks 1-5 Lectures

evidence

evidence based practice implies the use of _____ in clinical decision making rather than using knowledge from experts

clinical expertise

evidence does not replace _____

skills and past experience

clinical expertise is the ability to use ________ to rapidly identify patients’ unique health state and weigh potential interventions

research evidence

clinically relevant research into diagnostic tests, prognostic markers, and interventions is ______

patient characteristics

_______ are unique preferences concerns or expectations of each patient which must be integrated into decision making

evolves

evidence ____ and changes

ex - SSRIs don’t actually help with depression or serotonin levels

examination, diagnosis/assessment, prognosis, intervention, outcomes

EBPT focus areas are ______

statistics phobia
hard to find strong research
need to combine clinical expertise
limited access to evidence
not how it’s done in the real world

perceived barriers to use of EBM

evidence vs. theory

actual data from patients VS. overarching tenets that may or may not be correct AND might not even be applicable

theory

____ is essential for all clinical decisions

evidence

not all _____ is equal

meta analyses
systematic reviews
critically appraised literature
randomized controlled trials
non-randomized controlled trials
cohort studies
case series
individual case reports
background information/expert opinion

order from highest to lowest quality of evidence

peer review

______ is important because it represents a “collective wisdom” and comes closest to approximating truth AND is the GOLD standard for evidence

ask
acquire
appraise
apply
assess

the 5 A’s

PICOS

what describes population, intervention, comparison, outcome, and study design

research questions

____ are statements about what is being researched but it shouldn’t be too broad or too specific

concepts

_____are mental images of observable phenomenon described in words

construct

a non observable abstraction created for a specific purpose that is defined by observable measures

ex - quality of life

age, pain, flexibility

concept examples

patient satisfaction, quality of life, motivation

construct examples

hypotheses

_____ can be directional or non-directional and are predictions on the outcomes of a study

null hypothese

____ are predictions that no difference or relationship between variables will be demonstrated based on research intervention

models of disablement

______ provide conceptual model and context for judging the applicability of evidence

pathology, impairment, function limitations, disability

4 parts of NAGI model

CP, parkinsons, herniated disk, spinal stenosis, etc.

examples of pathology

impairment

problems with body structure or function and a deviation from generally accepted population standards describes _____ which can be temporary or permanent

reduced AROM/PROM, pain, reduced muscle force production

examples of impairment

activity limitation

______ is limitations in performing fundamental physical and mental actions typically used in daily life

abnormal gait pattern, altered ability to sit /lift/stand/carry/push, etc.

examples of activity limitations

activity limitations vs. participation restrictions

basic ADLs vs. social activities/occupational activities

altered ability to work/prepare meals/exercise/attend religious services

examples of participation restrictions

health condition/disorder/disease
body function/structure
activity
participation
environmental
personal

ICF model components

social circumstances

the disablement process considers not only impairments and activity limitations but also _____

1. how the person defines the disablement situation. and reacts to disease state

2. how others perceive the disability and react to it

3. characteristics of the environment

three perspectives to consider with the disablement process

risk factors

the disablement process is heavily influenced by ______

active pathology

interruption with normal processes and effort of the organism to regain normal state - NAGI

impairment

anatomical abnormalities (NAGI)

functional limitations

limitation in performance at the level of the whole person (NAGI)

disability

limitation in performance of socially defined roles and tasks within a sociocultural and physical environment (NAGI)

health condition

diseases, disorders, and injuries (ICF)

ex - patient in MVA with a crash injury to spinal cord

body function/structure

physiological functions of body systems (ICF)

impairments

problem in body function (ICF)

ex - patient has muscle paralysis from MVA

activity limitation

difficulties an individual may have in executing activities (ICF)

ex - patient cannot walk due to muscle paralysis from MVA

participation restriction

problems an individual may experience in involvement in life situations

ex - patient cannot return to walk because he cannot walk

primary evidence

_____ is peer review journals, theses, dissertations, and original research reports

secondary evidence

_____ is systematic and narrative reviews in peer review journals, text books, practice guidelines, and summary review of works

approach
study design
grouping of subjects
control components
time elements

______ are general features of research design (5)

Quantitative Approach

______ is the approach that assumes there is an OBJECTIVE truth that can be revealed by independent investigators and uses statistics

objective reality, measured in numbers

Qualitative Approach

____ is the approach that assumes truth is SUBJECTIVE and relative to interpretation by the individual and does not use statistics but words

subjective reality, measured in words

Experimental design

______ includes randomization, manipulation of a variable, a control group, and a high level of control

Quasi-experimental design

______ includes purposeful manipulation of variables with no random assignment to a group and may only have one group

Non-experimental design

_____ includes observations without manipulating variables with no random assignment to a group, may only have one group

within subject design

_____ compares results of subjects in a single group with the outcome compared to baseline of each subject

between subject design

______ compares results between different groups of subjects with mean scores for each group used in statistical analysis

control

it is necessary to have _____ in a study to minimize bias

most restrictive control

experimental designs have the _____

control in subject randomization

quasi-experimental designs lack ______

control for measurement and collection of data

nonexperimental designs only ______

not controlled

statistical analysis is a method to adjust data to address differences in variable that were ______ in the experiment

cross sectional duration

_____ is when data is collected once from one point in time

longitudinal duration

______ is when data is collected repeatedly over a period of time

retrospective direction

______ includes historical data that has already happened and the subjects cant be randomized

prospective direction

_____ includes data that will happen in the future and is collected in real time

beneficial; harmful

research designs for studying interventions is used to determine ______ effects or _____ consequences of interventions

efficacy

____ is measuring the extent to which an intervention produces a desired outcome under ideal conditions

effectiveness

_____ is measuring the impact of an intervention under usual clinical conditions

target population

_____ is the general group from whom the data will be sought

accesible populations

____ are the potential participants in a group defined by researchers, usually smaller than target populations

primary data

____ is collected from subjects in real time

secondary data

______ is collected during routine business or a prior research activity

inclusion criteria

_____ is the characteristics that individuals from target population must possess to be eligible for study

exclusion criteria

_____ defined in detail the characteristics that will make individuals ineligible for study

probabilistic sampling

____ is a method for RANDOMLY selecting subjects for participation to minimize bias and sampling error

non-probabilistic sampling

_____ is a method where subjects are selected WITHOUT randomization as it is easier to implement with a lower cost but there is GREATER sampling error and bias

assignment processes
balanced groups

_____ are two parts of subject management

equal size and similar characteristics is important

by individual
block
systematic
matched

____ are all random assignment methods (4)

pre-existing groups of interest

_____ is non-random assignment

covariant

_____ is when researchers use statistics to control for something due to the lack of randomization in the study

consistency
control of routines
masking/blinding subjects
masking/blinding investigators

_____ are all other subject management issues and all help to reduce bias

measurement

______ is a numeral assigned to an object, event, or person or the class to which an object, event, or person is assigned according to the rules // process of value assignment

discriminative measurement

_____ distinguish between individuals on the variable of interest when no gold standard exists

predictive measurement

______ distinguishes between individuals on the variable of interest when there is a gold standard present

evaluative measurement

____ is used to measure the magnitude of change over time in an individual on the variable of interest

independent variable

____ is what is manipulated in a study, multiple in factorial designs, can also be called factors or predictors in prognostic studies

dependent variable

_____ is what we measure/the outcome of interest in a study

intervention studies - presumed to happen d/t the manipulation of the IV

prognostic studies - presumed to be predicted by rather than caused by the IV

extraneous variable

______ is a factor other then the IV that may influence or confound the DV, also called the confounding variable

subjects
investigators
equipment
environmental factors

_____ are examples of extraneous variable sources (4)

discrete

____ are values that are distinct categories

ex - how much do you like the class?
1 - hate
2 - kinda hate
3 - neither hate nor like
4 - kinda like
5 - love

dichotomous

_____ is where only two values of the characteristic are possible (di - two)

ex - you like the class, 1 or 2

continuous

_____ is with a scale of increments

ex - on a scale of 1-5, mark where you think you like the class

nominal measurement

____ includes categories with names but without mathematical value

ex - gender, race/ethnicity, religion

ordinal measurement

______ includes characteristics without known equal distance between them

ex - level of assistance required, MMT grades, patient satisfaction

interval measurement

______ involves scales that assign quantitative values

ex - temperature (thermostats), calendar years

ratio measurements

______ are values that have all mathematical properties for manipulation of data

ex - height, weight, blood pressure, speed, distance

norm referenced, criterion referenced

_____ and _____ are two kinds of reference standards

previously tested subjects

norm referenced standards are derived from ______

previously established “absolute” standard

criterion-referenced standards are a comparison to a ______

amount of variability in a measure

measurement reliability is the ______

instrument, rater

measurement reliability has two different forms: ______ and ______

internal consistency, parallel forms, split half

the three kinds of instrument measurement reliability include ________