DPT Research Methods: Chapter 1-4

meta analyses

pulled info from data creates new data

applied (clinical) research

advances the development of new diagnostic tests, drugs, therapies and prevention strategies, answering questions with direct clinical application

clinical research includes …

patient oriented research
epidemiologic and behavioral studies
outcomes research and health sciences research

patient oriented research

Studies conducted with human subjects to improve our understanding of the mechanisms of diseases and disorders, and of which therapeutic interventions will be most effective in treating them.

control

allows researcher to understand how one phenomenon relates to another

step 1 of research process

identify the research question: formulate a specific question

Step 3 of research process

implement the study: plans from step 1 and 2 are implicated

step 4 of research process

analyze the data: collate the info into useful form of analysis

step 5 of research process

disseminate findings: share findings with appropriate audience so others can apply info

Efficacy

refers to the performance of an intervention under ideal and controlled conditions. It typically involves an RCT with strict protocols and criteria to minimize bias

(effectiveness of intervention under ideal, controlled conditions)

effectiveness

benefits and use of procedures under real world conditions in which circumstances cannot be controlled within an experimental setting

International Classification of Functioning Disability and Health

describe how people live with their health condition, shifting the focus to quality of life.

intraprofessional

members of one profession work together, sharing info through the lens of their own profession

multiprofessional

an additive process whereby members of multiple professions work in parallel alongside each other to provide input, staying within their own professinal boundaries, working seperately ondistinct aspects of the problem

interprofessional

members of multiple professions work together contributing their various skills in an integrative fashion sharing perspectives to inform decision making

transprofessional

a high level cooperation of professionals from multiple fields who understand each others roles and perspectives, share skilles and expertise, and use them to develop new ways of building a problem

scoping reviews

includes a review of literature but with a broader focus on a topic of interest to provide direction for future research and policy considerations.

systematic reviews

all research in an area on a particular topic

Basic Research

directed knowledge torward the acquisition of new knowledge

Epidemiologic and behavioral studies

observational studies focused on describing patterns of disease and disability, as well as on identifying preventive and risk factors

Outcomes research and health services research

studies to determine the impact of research on population health and utilization of evidence-based therapeutic interventions

qualitative research

strives to capture naturally occuring phenomena following a tradition of social constructivism (individual experience)

quantitative research

based on a philosophy of logical positivism in which human experience is assumed to be based on logical and controlled relationships among defined variables (does x effect y)

scientific method

a systematic, empirical, and controlled critical examination of hypothetical propositions about the associations among natural phenomena

systematic

logical sequence that leads from identification of a problem through the organized collection and objective analysis of data

empirical

necessity for documenting objective data through direct observation, minimizing bias

critical examination

researcher must subject findings to empirical testing and to the srutiny of others

step 2 of research process

design the study: plans method of implication

evidence based care

the fundamental principle that the provision of quality care will depend on our ability to make choices that are based on the best evidence currently available

multiple perspectives of evidence based care

research evidence
clinical expertise
patient values
clinical circumstances

translational research

application of basic scientific findings to clinically relevant issues and simultaneously the generation of scientific questions based on clinical dilemmas

Functioning and disability

relationship among health conditions, body functions and structures, activities, and participation

explanatory research

experiemental design (cause and effect) x effecting y

exploratory research

observational (find relationships)

descriptive research

qualitative (describe populations)

Developing a research question step 2

identify the rationale

Developing a research question step 4

define the research question

Developing a research question step 5

state the research question

descripitive

seeking to characterize clinical phenomena or existing conditions in a particular population

comparison

two or more conditions are compared, independent variable

Developing a research question step 1

identify the problem

Developing a research question step 3

identify the type of research

professional literature (1)

Identifying gaps, conflicts, or areas where replication of studies is needed

developing the rationale (2)

review the literature by starting with systematic review or meta analysis and establish a theoretical framework from existing studies

types of clinical research

Explanatory
Exploratory
Descriptive
Methodological

explanatory

cause and effect

exploratory

looking for relationships to determine how clinical phenomena interact

methodological

the process of designing and organizing research methods that have ethical implications.

framing the research question

population or problem
intervention
comparison or control
outcomes

population

what types of patients

intervention

treatment of interest

outcomes

effect of intervention, dependent variable

operational definition

defines a variable according to its unique meaning within a study

characteristics of a good research question

importance
ethical
feasible

clinical experience (1)

clinicians knowledge, experience, and curiosity will influence the types of questions that are of interest

clinical theory (1)

clinicians will often examine theories that govern their practice as a source of research questions

hypothesis

declarative statement that predicts the relationship between the independent and dependent variables

research hypothesis

the researchers true expectation of results, guiding the interpretation of outcomes and conclusions

null hypothesis

no difference or no relationship between the independent and dependent variables

nondirectional hypothesis

do not predict a direction of change

directional hypothesis

not only describe the relationship between variables in terms of a difference, but assign a direction to that difference

simple hypothesis

includes one independent variable and one dependent variable

complex hypothesis

more than one independent or dependent variable

translational research

- refers to the direct application of scientific discoveries into clinical practice
- taking knowledge from bench to bedside

knowledge translation

- a process of identifying clinical problems and accelerating the application of knowledge to imrpove outcomes and change the provision of care
- problems as a clinician and looking for a solution

efficacy

ideal conditions

effectiveness

real world conditions

Randomized Controlled Trial (RCT)

gold standard design to study the efficacy

not the most realistic, results we get are becasue of intervention

pragmatic clinical trial

incorporate measures of function or quality of life that are considered more relevant for patient satisfaction

not randomized, trying to see what happened

explanatory (experimental) trials consists of

controlled design
exclusion criteria
smaller samples
controlled environment
focused outcomes

Pragmatic Trials

flexible design
heterogeneous samples
large samples
diverse practice settings
meaningful outcomes

T0 phase

basic research

focus on theory and mechanisms

T1 phase

Translation to humans

does it work?

T2 phase

translation to patients

can it work under ideal conditions?

T3 phase

translation to practice

will it work in real world conditions?

T4 phase

translating to populations

is it worth it?

comparative effectiveness research

The generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve delivery of care.

pragmatic clinical trials

hypothesis and study design are formulated based on information needed to make a clinical decision

practice based evidence

describe an approach to research that is of high quality but developed and implemented in real world settings

outcomes research

umbrella term to describe studies that forcus on the impact of results of health care practices and interventions

have the practices and interventions changed are people using the knee brace

patient oriented evidence that matters (POEM)

refers to outcomes that measure things that a patient would care about like symptoms, quality of life, function, cost of care, length of stay

primary outcome

used to arrive at a decision on the overall result of the study and that represents the greatest therapeutic benefit

secondary outcomes

endpoint measures that mey also be used to assess the effectiveness of the intervention, as well as side effects, costs, or other outcomes of interest

implementation science

- next step after effectiveness research
- how to put research into practice
- considers the patient, provider, organizational systems, and policy

theory

used to generalize beyond a specific
situation and to make predictions about what should happen in other situations.

allows us to speculate on how and why things work

purpose of theories

- summarize existing knowledge to explain observational events
- allow us to predict what should occur
- development of knew knowledge
- provide the basis for asking a question in applied research

components of theories

- concepts
- contructs
- prepositions

concepts

abstractions that allow us to classify natural phenomena and empirical observations

think variables, height and weight

constructs

abstract concepts that are not obervable (latent traits)

things we cant see but give a definition

stress= cortisol levels

propositions

generalized statements that assert the theoretical linkages between concepts

deductive reasoning

the acceptance of a general proposition and subsequent inferences that can be drawn

broad to specific

inductive reasoning

logic that develops generalization from specific observations

specific to broad

theory

- can never be proven
- not directly testable

hypothesis

- tested to demonstrate if the theory holds in certain circumstances
- facts can support or not support hypothesis; if supported, theory is also supported

theories should be:

- rational
- testable
- economical
- relevant
- adaptable

research

- results of studies can be used to build theories
- theories can be used to develop hypotheses for testing in studies
- implicit and explicit relationships to research questions

practice

- theories guide clinical decisions
- treatment outcomes can support theories

middle range theories

form a bridge between theory and empirical observations

grand theories

more comprehensive; tries to explain phenomena at the societal level

darwins theory of evolution

meta-theory

used to reconcile serveral theoretical perspectives

theories to make theories