FEBCP Review Questions: Key Terms & Definitions in English

What is the EBCP Evidence Cycle?

1) Assess

2) Ask (clinically relevant questions)

3) Acquire (best available evidence)

4) Appraise (quality and importance)

5) Apply (evidence in patient care)

6)... BACK TO ASSESS

T/F: Evidence does not make decisions, people do.

TRUE

What is PICO?

Population/Patient/Problem

Intervention

Comparison

Outcome

Which of the 4 types of PICO questions is asking if one treatment is better than another?

Therapy

Format:

In ________ (P), does ___________ (I) compared to ___________ (C) improve __________(O)?

Which of the 4 types of PICO questions is asking what the best way to diagnose your patient?

Diagnosis

Format:

In ________ (P) are/is ___________ (I) compared with ___________ (C) more accurate in diagnosing __________(O)?

Which of the 4 types of PICO questions is asking what the most likely outcome is for the patient?

Prognosis

Which of the 4 types of PICO questions is asking what the impact of a risk factor is?

Harm

Format:

Are ________ (P) who have ___________ (I) compared with those without ___________ (C) at risk for/of __________(O)?

What type of question is this:

Do post-partum women with SI joint pain treated with care stabilization exercises have decreased pain and disability compared with those treated with spinal manipulation?

Therapy PICO

What type of question is this:

Among elderly adults who perform resistance exercise, is there a decreased risk of falling compared to those who don't exercise?

Harm PICO

What type of question is this:

Among adults w/ Type 2 diabetes w/ elevated HbA1c , is there an increased risk of amputation compared to those with lower levels of HbA1c?

Prognosis PICO

What type of question is this:

In adults with low red blood cell count, will serum ferritin blood testing compared to bone marrow biopsy rule out iron deficiency anemia?

Diagnostic test PICO

What type of question is this:

Among adults who are exposed to tobacco smoke, is there an increased risk of lung cancer compared to those with no exposure?

Harm PICO

Which type of question is this an example of: "What is the most common ligament to sprain in an inversion ankle sprain?"

Which type of question si "in adults patients with low back pain is chiropractic more effective than medical care to relieve pain?"

A. Background Question

B. Foreground Question

Background Question

Foreground Question (PICO)

What type of research is this?

Degenerative changes following spinal fixation in a small animal model

"Used metal clips attached to SPs of rats to cause fixation of spinal segments, then examined facet joints for degenerative changes"

Basic Research

What type of research is this?

Effect of walking and resting after three cryotherapy modalities on the recovery of sensory and motor nerve conduction velocity in healthy subjects

"Used 3 different ice protocols and then measured nerve conduction velocity after either walking or resting using people with no healthy complaints or problems"

Basic Research

(NOTE: Measuring physiology of patient not how patient fells... Speed that nerves conduct signals, how does this clinically mean anything for your patients when they have an issue? We don't know... So considered BASIC not clinical)

What type of research is this?

Thoracic spine thrust manipulation improves pain, range of motion, and self-reported function in patients with mechanical neck pain: a systemic review

"Patients with neck pain had improved pain and range of motion after thoracic spine manipulation"

Clinical Research

NOTE: Shows helped the patients directly clinically in the study; you can use that info today in practice with your patients

What is the hierarchy of evidence (from top to bottom) that is the most reliable with least risk of bias, to the least reliable research studies with most risk of bias? (Only including clinical)

1) Systemic Reviews & meta-analysis

2) Randomized Controlled Trials (RCTs)

3) Non-randomized, observational studies (case-control studies, Cohort studies)

4) Case series, case studies, surveys

5) Unsystematic observations (clinical experience)

NOTE:

At bottom most: In-vitro Research & Animal Research (BASIC)

What is systematic deviation from the truth when systematic error is introduced into sampling or testing by selecting or encouraging one outcome or answer over others?

Bias

Which study would you trust more?

- Case report of 2 patients?

- Randomized control trial of 40 patients?

RCT of 40 patients;

NOTE: if only the case report was present, use clinical expertise to judge; always use best found on hierarchy

What type of study is this an example of?

"Kaposi Sarcoma in homosexual men: A report of eight case"

Case Study

NOTE:

- early case studies described novel presentation od diseases

- Recognition of patterns lead to identification of AIDS epidemic & important for informing research

--- FOUNDATION OF THE EVIDENCE (for future controlled trials)

What is the difference between retrospective and prospective studies?

Prospective -- individuals followed over time and data collected as their characteristics or circumstances change. (Birth cohort studies good ex)

Retrospective -- individuals sampled and information is collected about their past.

What study is done starting w/ a patient who has disease (case) & match to controls (people w/o disease who are otherwise identical); ask both groups about their exposure

Case-Control

What are experiments in which individuals are randomly allocated to receive or not receive and experimental diagnostic, preventative, therapeutic, or palliative procedure and then followed to determine the effect of the intervention? Does this show correlation or causation?

Randomized Controlled Trials (RCTs)

-- Best study to show causation (NOT correlation)

What is the most important part of a randomized controlled trial (RCTs)? (TQ)

The RANDOMIZATION

(random assignment into intervention and comparison group)

What is an article that attempts to summarize all clinical trials about a topic utilizing rigorous methods for selection and appraisal of articles to be included? (2) Where is this located on the hierarchy of evidence?

Systemic Review & meta-analysis

-- TOP of the pyramid

What is a sometimes systemic review that statistically combines the results of the included trials?

Meta-analysis

What study is a done for a group of people who share a common experience/defining time period; long studies w/ follow up for years

Cohort

What is the relationship between studies that are higher on the pyramid of heirarchy of evidence and the risk of bias?

A. Inversely proportional

B. Directly proportional?

A. Inverselty proportional

Which study type is the best to answer this question: Does daily exercise reduce the risk of heart disease?

A. case study

B. survey

C. cohort study

D. Randomized control trial

C. Cohort study

-- can't ethically restrict a group from exercise (randomized control)

Which study is a summary of all the research on a specific topic that combines the statistics of the individual studies?

A. Systemic review

B. randomized controlled trial

C. Meta-analysis

D. Cohort analysis

C. Meta-analysis

What is a fallacy?

an error/flaw/mistake in reasoning

What kind of fallacy is when two things (A & Z) are linked through a series of small steps which may not be related and may never happen, such as

"If A happens, then so will Z, because if A happens, then B will happen, then C..... then Z"

Slippery Slope

What fallacy is where someone assumes that since A happened before B, A must cause B?

Post hoc ergo propter hoc

What fallacy are conclusions based on insufficient or biased evidence ("rushing to a conclusion"), and is based on too little data?

Hasty generalization

What fallacy is a person, idea, institute, or theory that is deemed worthy (or unworthy) based on an impression of the character, nature, or worth of its originator?

Genetic fallacy

What fallacy is restating the argument rather than proving it?

Circular argument

What fallacy is the conclusion is proven within the clame or proven in the statement, using key words such as "everyone knows" or "common knowledge"?

Begging the Question

What fallacy is oversimplifying the argument by reducing it to only two sides or choices?

Either / or

What fallacy is attacking the character of the person rather than the argument/idea?

Ad hominem

What fallacy is the diversion that avoids the key issues (misdirection) to switch the argument away from dealing with the original problem and focusing on different issues?

Red Herring

What fallacy is the oversimplifying an opponents viewpoint and then attacking that hollow argument?

Straw Man

What type of fallacy is comparing minor misdeeds with major atrocities?

Moral Equivalence

What type of fallacy is saying:

"My friend had his neck hurt by a chiropractor, therefore chiropractors are dangerous for people with neck pain"

Hasty Generalization

What type of fallacy is saying:

"Everyone knows Dr. Rowells class is the most popular class at Palmer"

Begging the Question

What type of fallacy is saying:

"Senator Johnson proposed that idea but we all know that he is Democrat/Republican, therefore its a bad idea"

Ad hominem

(even if senator proposes something you like, you won't like it)

What type of fallacy is saying:

"Every morning I get up, brush my teeth, and then watch the sun rise; Therefore, brushing my teeth causes the sun to rise"

Post hoc ergo propter hoc

What type of fallacy is saying:

"Why didn't you do your homework?"

"Should I go walk the dog now?"

Red Herring

What type of fallacy is saying:

"Either we ban all cars or we will die like the dinosaurs did"

Either / or

What type of fallacy is saying:

"George bush is a good communicator because he speaks effectively"

Circular argument

What type of fallacy is saying:

"If chiropractors advertise that they are good at helping patients with low back pain, then we will never get to treat anything else"

Slippery Slope

What type of fallacy is saying:

"Senator Johnson wants ______ because he hates babies and puppies. If you vote for Senator Johnson, you must all hate babies and puppies too."

Straw Man

What type of fallacy is saying:

"The city council voted for a 1/2% tax hike to build a children's park therefore they are fascist Nazis"

Moral Equivalence

Which study would hold more weight?

A. RTC with sample size of 25

B. Cohort study w/ sample size of 100

C. RTC with sample size of 100

C. RTC w/ sample size of 100

What type of study is a report of the presentation, treatment, and outcome of a patient that has educational value?

A. Systemic Review

B. RCT

C. Case Control

D. Cohort

E. Case Report

E. Case Report

Why is randomization important in RCTs?

A. To keep patients blinded

B. To equally distribute elderly patients

C. To equalized unknown prognostic factors between groups

C. To equalized unknown prognostic factors between groups

What is the sum of the values in a data set divided by the number of values, also known as the best guess of truth when describing a group?

Mean (average; sometimes called "point estimate")

What is the numeric value separating the higher half of a data set form the lower half?

Median

What is the value that occurs most frequently in a data set?

Mode

What is the minimum to maximum value?

Range

Where can you usually find out if the groups in a RCT were equal at baseline?

A) In methods section

B) In table 1 of results

C) In introduction

D) In conclusion

B) Table 1 of the results

NOTE: Table 1 standard to show what patients look like at beginning of study

Which statement indicates that follow up was complete in an RCT?

A) 60 patients were enrolled and 48 finished the study

B) 1 patient dropped out of the study because he moved away and his data was still included

C) The trial was not stopped early

D) The patients had an average of 10 points of improvement

B) 1 patient dropped out of the study because he moved away and his data was still included

NOTE: D is results; C answers question on if trial stopped early, A tells us how many dropped out but not why or what was done with data

A valid RCT is one in which:

A) the study was done correctly

B) the study had positive results

C) The results of the study were precise

D) The study was not stopped early

A) Study was done correctly

NOTE: validity is HOW THEY DID IT (nothing to do with results)

What is the probability that the statistical result we obtained is due to chance? What number value would be a good indication? Bad indication?

P value

P < 0.05 = GOOD

P > 0.05 = BAD

NOTE: 5% likelihood of the result being due to chance

What is the range of most likely values that contain the true result?

Confidence Interval

When looking at the precision of the results, if we are given a range of numbers with a 95% confidence interval, what would it indicate if the range was narrow? Wide?

Narrow = precise

Wide = impresice

If the confidence interval crosses the line of no change (ex: pain scale where 0 is no change), what would this indicate?

Confidence interval is NOT valid

What does it mean if a study was stopped early?

A. Treatment works too well so waste to study it more

B. Treatment so safe it doesn't need to be studied anymore

C. Trust the treatment use it in practice

D. Should NOT trust the results and should NOT use the treatment

D. NOT trusted

T/F: To answer the question: Were the groups similar at baseline with respect to prognostic factor?; you can be confident they are similar since they all have to have the same complain to get into the study

FALSE

How can you tell if the results of the study are precise or not?

A. By looking at methods

B. By assessing width of confidence interval

C. By seeing how large treatment effect was

B. Width of confidence interval

Choose the correct interpretation of age = 63 (1.7). [mean (SD)]?

A. Average age of study participants is young with wide variability

B. Average age of study participants is old with wide variability

C. Average age of study participants is old with narrow variability

D. Average age of study participants is young with narrow variability

C. Average age OLD & NARROW variablility

Choose the correct interpretation of p=0.07; The result is?

A. Statistically significant since <5% chance result is due to random error

B. NOT statistically significant because >5% chance result is due to random error

B. NOT statistically significant

Interpret: ROM change = +10 degrees (-5, 95). [mean (95% ci)]

A. ROM increased; ci very wide and crosses 0

B. ROM increased; ci narrow

C. ROM increased; ci narrow and crosses 0

D. ci precise because its 95%

E. ci wide because its 95%

A. ROM increased; ci very wide & crosses 0

Choose the correct interpretation of: Mean (95% ci) VAS pain change was -4.5 (-3, 7)?

A. On average, pain decreased by 4.5cm on the VAS, but result NOT statistically significant

B. On average, pain decreased by 4.5cm on the VAS, and result IS statistically significant

A. NOT statistically significant

Which of the following is a way to describe something about the central tendency a group of data?

A. Mean

B. Median

C. Average

D. All the above

D

Which of the following is a way to describe how wide your data is spread out?

A. Standard deviation

B. Range

C. Mean

D. Median

E. A & B

F. C & D

E

What does the squares mean on the forest plot? Lines? Diamond?

Square = point estimate (size based on weight)

Lines = 95% confidence interval

Diamond = Pooled estimate (width = 95% ci)

Patients in a study were recruited from a medical center where they were being treated for terminal cancer. Are the results of that study applicable to patients int he average chiropractic practice?

A. Yes

B. No

B. No

You want to study whether or not a cleaning chemical increases your risk of cancer. What type of study should you do?

A. RCT

B. Observational study

C. Case report

D. Case studies

B. Observational study

If the diamond on a forest plot crosses 0, what are the results?

A. NOT statistically significant

B. Statistically significant

A. NOT statistically significant

NOTE: if the diamond does NOT cross zero, even if the ci of other lines/boxes do, it is significant

What is the probability of a positive test in someone who has the disease?

Sensitivity

(PID, positive in disease)

What is the probability of a negative test in someone who doesn't have the disease?

Specificity

(NIH, negative in health)

What is the probability that a patient with a positive test result really does have the disease?

Positive Predictive Value (PPV)

Ex: 74% chance with positive test patient has condition

What is the probability that a patient with a negative test result really doesn't have the disease?

Negative Predictive Valve (NPV)

Ex: 90% chance with negative test patient does NOT have condition

What is the ratio of a positive test in those WITH the disease to positive tests in those WITHOUT the disease?

Positive Likelihood ratio

( + in disease / + in NO disease)

What is the ratio of negative tests in those WITH disease divided by the ratio of negative tests in those WITHOUT the disease?

Negative Likelihood ratio

( - in disease / - in NO disease)

What would a Positive Likelihood Ratio indiciate if it was >1? 1? <1?

>1 = ___x more likely w/ positive test you HAVE disease

<1 = ___x more likely with positive test you DONT have disease

1 = equal likelihood you have disease or don't

What is defined as: The probability of a positive test in someone who has the disease?

A. Sensitivity

B. Specificity

C. Positive Predictive Value

D. Negative Predictive Value

A. Sensitivity

NOTE: we know they have the disease (the truth; not the positive test), so we are the omniscient being above the columns, looking down the table/columns = specificity & sensitivity; sensitivity is always the + side

What is defined as: The probability that a patient with a positive test result really does have the disease?

A. Sensitivity

B. Specificity

C. Positive Predictive Value

D. Negative Predictive Value

C. Positive Predictive Value

What is defined as: The probability that a patient with a negative test result really doesn't have the disease?

A. Sensitivity

B. Specificity

C. Positive Predictive Value

D. Negative Predictive Value

D. Negative Predictive Value

What is defined as: The probability of a negative test in someone who doesn't have the disease?

A. Sensitivity

B. Specificity

C. Positive Predictive Value

D. Negative Predictive Value

B. Specificity

What is the difference between within-group difference and between-group difference?

Within-group = Difference in SAME patient getting results from beginning to end

Between-group = Difference between DIFFERENT patients who are in different groups

What is the difference between Paired & Unpaired group data

Paired = data from groups can be compared/paired since from the SAME people

-- ex: patients in a chiropractic group's pretreatment & posttreatment

Unpaired = data from different groups and different people that cannot be compared/paired; can still look at difference but need different statistical test

-- ex: Drug group vs Chiropractic group

Choose the correct interpretation for: PPV = 74%

A. There is a 74% chance that someone with the disease will have a positive test

B. With a positive test there is a 74% chance of the patient having the disease

C. The patient is 74% more likely to have the disease than not

B. With a positive test there is a 74% chance of the patient having the disease

What type of study involves putting together a group of people and following them forward in time to see what diseases develop and what exposures may be responsible?

A. Cohort Study

B. Case-control study

C. RCT

D. Systemic Review

A. Cohort Study

What type of study involves assembling a group of people with a disease and matching them to similar people without the disease?

A. Cohort study

B. Case control study

C. RCT

D. Systemic Review

B. Case Control Study

Which statement indicates that follow up was complete in a RCT

A. The study went for the full 12 weeks

B. Data was collected at the beginning and again at 8 weeks

C. Data was collected from all 158 patients except the 2 drop outs who moved away

C. Data was collected from all 158 patients except the 2 drop outs who moved away

What is "intention to treat analysis" in a RCT?

A. All patients finished the study

B. All patient data is analyzed in the groups the patients were assigned to

C. All patient data is analyzed in the group they were treated in even if it was the wrong group

B. All patient data is analyzed in the groups the patients were assigned to

What type of study attempts to summarize all clinical trials about a topic utilizing rigorous methods for selection and appraisal of articles to be included?

A. Case series

B. Cohort study

C. Systemic Review

D. Meta-analysis

E. Randomized Control Trial

C. Systemic Review

NOTE: If said "and combined the stats/numbers" then = meta-analysis

Publication bias is bias in the healthcare literature

A. because trials with negative results often don't get published

B. because not all databases were searched for a systemic review

C. because statistics were combined form trials that were too different

A. because trials with negative results often don't get published

What does the size of the spares in a forest plot represent?

A. the width of the confidence interval

B. the relative size (weighting) of the effect of that study

C. the amount of patient improvement in that study

B. the relative size (weighting) of the effect of that study