W2 - Appraising Systematic Reviews and CPGs

what is a systematic review (SR)

secondary research study to summarize the evidence on a specific topic

what are the 3 types of reviews

narrative, systematic, meta-analysis

what is an “a priori”

defining a specific purpose and methods beforehand to reduce bias

what is the difference between an SR and an MA

an MA includes an additional statistical analysis

what is a CPG

systematically developed statements designed to facilitate evidence-based decision making for the management of specific health conditions

SRs ____ ___, while CPGs ___________

facilitate action, include explicit recommendations

which is more broad, a CPG or an SR

CPG

which includes clinical expertise and patient perspective, CPG or SR

CPG

which is rarely grant funded, CPG or SR

SR

which includes feedback from other stakeholders, CPG or SR

CPG

what is a clinical decision rule (CDR)

a prediction tool that uses an explicit set of criteria about a patient to direct the therapist to a treatment choice

how is a CPG different from a CDR

CPG provides action statements based on diagnoses, CDR provides actions based on how the patient is presenting in front of you

how is a CDR typically represented

as a regression/classification tree

a CDR combines the effects of ___ ___ ___

treatment effect modifiers

what is PRISMA (preferred reporting items for systematic reviews and meta-analysis) used for

used to standardize information reported in a SR

what are the figures to look for in a SR to determine if they checked for bias?

PEDo sclae, risk of bias visual tool, Cochrane collaboration risk of bias tool

what do bias determining scales report?

heterogeneity and homogeneity

what does it mean to assess statistical hetrogeneity?

determines if the data is similar enough to run a meta-analysis

what are the tests oof heeterogeneity to look for?

between study variance (t2), Cochrane’s Q (x2), index of variability (I2)

what do tests of heterogeneity measure?

the likelihood that the variability between primary study results is due to chance

what is “vote-counting” anaylsis

essentially descriptive statistics

what does a meta-analysis do

pools the data

what are the 2 measures of conttinuous variables

mean difference/effect size, standardized mean difference

how do you interpret effect size

Cohen’s criteria, ranging from 0-1 with 1 being 100% different

when do you use standardized mean difference

when using different measures of th same outcome

what does it mean when a forest plot has a line that crosses the center lin

the study did not conclude that one treatment was better than the other, and it is not statistically significant

CPGs enable PTs and PTAs to understand the state of evidence in an effort to: (3)

decrease unwarranted variation in practice, minimize know-do gap, optimize outcomes

what are the 3 parts of an optimal CPG

clinical unity, applicability, quality

what are characteristics to consider when reviewing CPG search resultst

review age, sponsor, topic, info clarity, depth, availability

what is the standard criteria the APTA requires all CPGs to meet

AGREE II

what are the steps in the methodology of creating a CPG

literature search, screen abstract, screen full text, appraisal/extraction, results in master spreadsheet, create evidence table, synthesize/write recommendation

what is the overall objective of the CPG

to provide concise recommendations regarding the efficacy of interventions

why are selected neurological patient populations picked at greater than 6 months post-event?

attempts to minimize contributions of spontaneous neurological resolution and minimizes variability in recovery patterns

what is a level 1 level of evidence

high-quality diagnostic studies

what is a level 2 level of evidence

lesser-quality diagnostic studies

what is a level 3 level of evidence

case controlled or retrospective studies

what is a level 4 level of evidence

case studies and case series

what is a level 5 level of evidence

expert opinion

what language indicates strong obligation to follow the recommendation

must or should

an intervention should be performed it the grade of recommendation is:

A or B

if an intervention is rated grade A or B, it means __% of studies in the CPG showed a benefit

>66

what does grade A recommendation mean

high level of evidence with moderate or better benefit/harm

what does grade B recommendation mean

high level of evidence with slight benefit/harm OR level 2 evidence for moderate benefit/harm

what does a grade C recommendation mean

acceptable quality level 2 evidence for slight benefit OR low-quality evidence for substantial benefit/harm

an intervention may be considered if the grade of the recommendation is:

C

if an intervention is rated grade C, it means ___% of studies in the CPG showed a benefit, and __% showed it was better than nothing

33-66, >66

if an intervention is rated grade A or B with a SHOULD NOT recommendation, it means __% of studies in the CPG showed a benefit

<33

once you’ve appraised a CPG, what are the next steps?

implement action statements and close research gaps

what is an important consideration for applying CPGs?

make sure that your population matches those in the review before applying it

the words used in CPG action statements imply:

the level of obligation the clinician has to carry out/avoid the intervention

what does a grade of recommendation indicate?

confidence with which you believe there will be benefit/no benefit if you implement the recommendation