Exam 3

outcome research

evidence that demonstrates the final result of a treatment, often incorporating patient:

- values/experiences

patient-oriented evidence (POE)

demonstrates effectiveness of treatment from the patient's perspective

disablement

refers to the effect of a health condittion on your patient's body along with:

- their ability to participate in meaningful activities

- their ability to perform their desired roles in society

medical perspective of disability

views the patient's disability as a problem specific to the patient, cuased by their health condition or injury

- problem is attributed to the indivdual, not the environment

social perspective of disability

views society and or the patients environment as the creator of the person's disability

- for the pt. to overcome the disability, the environment and society must change

social perspective of disability model limitation

this model does not allow for the interaction fo the disease and societal/personal factors

biopsychosocial perspective of disability

combination of meidcal and social perspectives

interaction of the health condition/injury, limitations, impairments, and environmental and social factors at the same time

LEVELS examined: origin,organ, person, societal

Nagi disablement model

- Active pathway (origin level)

- Impairment (organ level)

- functional limitations (person level)

- disability ( societal lovel)

active pathology (origin level)

the disruption of normal cellular processes and the simultaneous homeostatic efforts of the organism to regain a normal state

impairment (organ level)

loss or abnormality at the tissue, organ, and body system (clinican-based assessment needed)

functional limitations (person level)

restrictions in the patient's performance related to their ability for ADL and things meaningful to them

disability (societal level)

inability of patient to fulfil the necessary, desired, or expected social or personal roles

World Health Organizations ICF

- international classification of functioning, disability and health

- designed to depict decreases in function of 3 health domains

- body function and structure

- activity

- participation

ICF model

- health condition (origin level)

- body structure (organ level)

-activity (person level)

- participation (societal level)

- environmental and social factors (other domains)

health condition (origin level)

physiological functions of the body

body structure and function (organ level)

anatomical parts of the body

activity (person level)

execution of a task by the individual (no social)

participation (societal level)

invovlement in life situations

environmental and social factors (other domains)

physical, social, attitudinal, personal

patient centered care

descriped as a care that respects differences in patients and appreciates their uniqueness

- what matters most to one patient may be different from what mattes to another patient, even with the same conditiion

clinician-based outcomes

- outcomes reated by, and of most value to, the clinician

- related to impairments and include common measurements (ROM, strength, girth, etc)

patient-related outcomes (PRO's)

- surveys or questionnaires that a patient completes about his/her health status

- most valuable to the patient

include measures such as mortality, morbidity, HRQOL, function, satisfaction, cost

health care outcomes

the end result of care that also considers patient experiences, preferences, and values

generic outcomes measures

-global and applicable to a wide range of people (healthy, injured, ill)

- short form (12, 3)

specific outcomes measures

- narrow in scoe and typicaly related to specific body regions, diseases, or injuries

- FAAM, LEFS, IKDC

single-item PRO

easty to score, usually require no training for us, but narrow

multi-item PRO

several questions are asked about various aspect of health

health related quality of life

multidimensional construct that includes several domains of health:

- physical

- psychological

- social

- spiritual

- economical

common generic PRO instruments

- short form 12

disablement in the physically active scale

- pediatric quality of life inventory

- patient-reported outcomes measurement information system (PROMIS)

single outcome measures

patient rate change in health status compared with a previous time point

single-itme numeric evaluation (SANE)

- a single-itme outcome measure:

"if I had to give my knee a grade from 1-100 with 100 being the best, I would give my knee a______"

satisfaction

a single item outcome measure:

•How satisfied are you with the current level of function of your injured body part? (length of scale varies)

•How satisfied are you with the care you received for your injured body part? (length of scale varies)

numeric pain rating scale (NPRS)

Single- item outcome measures

Was the PRO instrument created in a systematic manner?

logical step by step approach:

- item generation and initial item reduction

- item pilot testing, followed by additional item reduction

- establishment of instrument measurement properties

FACE

does the instrument as kquestions that are intended to assess the construct being examined?

- •eg, Lower extremity injury matches tasks that are affected by the lower extremity.

CONTENT

•Are the constructs of interest comprehensively sampled by the questions in the instrument?

eg, Questions in the instrument capture all aspects of the functional status of the patient, from ADLs to higher-level function

CONSTRUCT

Does the instrument measure a more abstract concept ( things that are not directly observable?

CRITERION

does the instrument correlate with some other previously established measurement tool

- ex. correlation of a short version vs longer version

Responsivness

•The ability of a PRO instrument to capture or measure meaningful change over time

•PRO instruments must be responsive to change in health status

•PRO instruments should be valid for the population of interest

responsivness calculation

•Calculated by various methods:

•Minimally clinically important difference (MCID)

MCID

smallest amount of change that a patient percieves as benefical

expressed in PRO instruments as a certain number of instrument points

ceiling and floor effects

extend to which scores on a PRO instrument cluster near the more desirable (ceiliing) or les desirable (floor) health status extreme

ceiling effects

are seen in the athletic population because although they gave a significant injury, they still score high on the instrument (no room for improvement)

reproductibility

- does the instrument produce the same scorer when a patient completes the instrument on more than one occasion, assuming no change in health status

reproducibility measured with

•Pearson product moment correlation

•Intraclass correlation coefficient

internal consistency

•What is the relationship of a subset of questions that measure the same construct to each other?

•The questions in each subscale should be related.

•Measured with Cronbach's alpha

precision

refers to the types of response option within the instrument

interpretability

•Understanding and explaining the information obtained

•Many guides available to assist you

•MCID assists with interpretation

acceptability

focuses on patient friendliness: does it minmize distress to the patient?

think about the following with acceptability

•Can the PRO instrument be completed quickly?

•Are questions within the PRO instrument clear and easy to understand?

•Are questions within the PRO instrument comfortable for patients to answer?

feasibility

relates to clinician friendliness

feasibility things to think about

•Can you easily administer the PRO instrument to patients?

•Do patients or clinicians complete the PRO instrument?

•What costs are associated with administering or analyzing the PRO instrument?

•Is scoring the PRO instrument time consuming?

•How frequently do you need to administer it?

injury

occurs during organized intercollegiate practice or competition, requires medical attention by an athletic trainer or physician, and resluts in a participation restriction for at least one day

exposure

an opening up to the chance of an incident occuring

- typically during a practice or game

-NCAA ISS defines an exposure as "the participation in a NCAA- sanctioned practice or competition

prevalence

segment of a group that is currently injured at a given time point

prevalence equation

number of injured participants

-------------------------------x 100

number of total participants

prevalence ratio

to determine if the injury prevalence is greater in one sample than another

prevalence ratio formula

prevalence of group 1

___________________________

prevalence of group 2

incidence

the number of new injuries occuring in a sample over a defined time interval

- number of new injuries that occur within a specified time period

EX: one sport season, one academic year

incidence rate formula

# of new injuries

------------------ x 100

total exposure time

incidence rate ratio

to determine if the incidence is greater in one sample than another

incidence rate ratio formula

incidence rate of group 1

---------------------------

incidence rate of group 2

injury risk

determines the chance that an athlete will get an injury

injury risk formula

# newly injured participants

----------------------------- x 100

number of total participants

injury risk ratio

the injury or risk by itself only informs you of the individual risk of injuyr for your sample

clinical prediction rules

decision making tools to help clinicians determine a diagnosis, a prognosis, or a patien's repsonse to treatment

- use algothitims that combine multipe variables (patient characteristics, test results, disease characteristics) to indeicate a successful outcome

interventional

how likely would it be for an indvidual to respon to a particular intervention(s) and have a successful outcome?

- likelihood that a patient with LBP would respond favorably to lumbar manipulation

prognostic

what is the outcome for patients with a certain condition who hve specified characteristic?

- ex. using scoring symptoms for patients with shoulder pain to determine risk of still having pain after 6 weeks

diagnostic

use to determine the probability that a patient has a particular condition of interest

- ex: ottawa ankle rules are using to determine if a patient needs a foot/ankle radiograph following an acute injury

development of CPRS

rigorous 3 step process with multiple patients with a condition of interest and a variety of settings (often uses prospective cohort design to track progress and determine outcome)

- derivation

- validation

- impact analysis

derivation

identification of factors that have a predictive value (predictor variables) for the condition of interest

validation

•Involves implementing the derivation CPR into a different patient sample or different clinical setting

•Used to confirm/validate previous findings

•Validation can be completed using different clinicians, treatment settings, or patient populations

•4 levels of validation studies

level 1 validation

determine he impact the CPR has on outcomes and clinical practice

level 2 validation

determine if the CPR can be used with a variety of patients

level 3

determine stability of CPR

Level 4

confirm findings of original CPR

level 1 research method

prospective study with variety of patients and clinicals that evaluates the impact on clinical practice

level 2 research method

prospective study with a variety of patients and clinicians

level 3 research method

prospective study with similar patients and clinicians to derivation study

level 4 research method

original derivation study or often uses retrospective data

impact analysis

final step in the CPR development process

- this is a study that demonstrates that the CPR has led to to a change:

- behavior

- improved patient outcomes

- reduced cost of care

- improved cost-effectiveness of treatment

impact analysis is conducted in 1 of 3 ways

true RCT

RCT by setting (5 clinics apply CPR, 5 do not)

Norandomized

informatics

the art and science of turning data into information

- improves process efficiency and productivity through the use of information technologies and information management techniques

- assists groups and individuals to make decisions in a more effective and efficient manner

medical informatics

use of information technologies within the health care system

includes fields such as clinical, imaging and public health informatics

health care informatics

the use of health care information technologies to support the efficient and effective delivery of patient care

data

collecting raw numbers that have no apparent meaning

information

interpreting data to provide meaning

knowledge

forming one concept from interrelated information

wisdom

using knowledge at the right place and the right time

clinician as a knowledge worker

roles:

- data gatherer

- information user

- knowledge user

- knowledge builder

data gatherer

must be:

- routine

- systematic

- comprehensive

information user

organize and interpret the collected clinical data and organize information from the available literature

knowledge user

compare clinical data from an individual patient with exisiting knowledge

knowledge builder

compile clinical data across patients to produce a new knowledge

electronic medical record (EMR)

•Allow the clinician to legally record patient care documentation over the course of treatment for an injury

•Usually for one athletic training clinic

electronic health record (EHR)

•Combines the legal medical records from multiple entities (AT, Physician, PT, psychologist)

•Captures the cause and course of one episode of injury from multiple entities

•Entries owned by the entity who created information

personal health record (PHR)

•Subset of information from multiple encounters across multiple entities

•Not a legal record but a comprehensive lifetime record of patient's health

•Created and owned by the patient

HIPPA

health insurance portability and accountability act

•Federal law that encompasses all patient information that is collected and recorded by a health plan, health care clearinghouse, and health care provider

FERPA

Family education rights and privacy act

•Regulates records that are created within the context of an education system, such as a high school or college/university, including health records