Intro to Evidence-Based Practice (DPT 6112 – 2024)

A set of question-and-answer flashcards covering major concepts, definitions, study designs, hierarchies, and practical steps in Evidence-Based Practice as presented in the lecture.

According to Sackett (1996), what three components must be integrated in Evidence-Based Practice (EBP)?

Best research evidence, clinical expertise, and patient values.

What is the core message of Bayes’ Theorem as applied to clinical decision-making?

Start with a prior belief, obtain new information, and update the belief accordingly.

Which four elements are added to traditional decision-making to create evidence-based decisions?

Experience & judgment, clinical circumstances, patient preferences, and scientific evidence.

List two major reasons why the healthcare field needs EBP, as highlighted in the lecture.

1) The overwhelming volume and rapid growth of information. 2) High levels of research waste and mistakes when evidence is ignored.

In the hypertension example, what non-clinical factor influenced treatment decisions?

The physician’s year of graduation from medical school.

What were the top two barriers to EBP identified by the APTA/Section on Research survey?

No time to read research and no research available for the patient population.

How did Turner & Whitfield (1997) show the impact of initial training on PT practice patterns?

Over 90% of PT treatment choices matched what was taught during their initial training, with research literature ranked least important.

Complete the quote: "Not everything that can be counts, and not everything that counts can be ."

counted; counted.

Define the purpose of THEORY in clinical practice.

Provides justification for treatment based on basic or applied research answering why something should work.

Define the purpose of EVIDENCE in clinical practice.

Provides justification for treatment based on applied work in patients answering if something works.

Which level of evidence is ranked 1a in the traditional hierarchy?

Systematic Review of Randomized Controlled Trials (RCTs).

Which study design is best characterized as allocating participants by chance to receive different interventions?

Randomized Controlled Trial (RCT).

State one key advantage and one key disadvantage of RCTs.

Advantage: Good randomization minimizes population bias. Disadvantage: Expensive in time and money.

What is the primary characteristic of a cohort study?

It follows groups with different exposures forward in time to compare outcome incidence.

Why are cohort studies generally cheaper than RCTs?

They do not require randomization or controlled intervention implementation.

In a case-control study, how are participants selected?

Based on the presence (cases) or absence (controls) of an outcome, with past exposures compared retrospectively.

What type of study is especially useful for rare diseases?

Case-control study.

Why are case reports considered the ‘first line’ of evidence despite being lowest on the hierarchy?

They introduce new observations, ideas, or rare conditions that can inspire further research.

What is the main goal of a systematic review?

To comprehensively collect, appraise, and synthesize all relevant studies on a specific clinical question.

How does a meta-analysis build upon a systematic review?

It statistically combines quantitative data from included studies to produce a single, more powerful estimate of effect.

Name one advantage and one disadvantage of meta-analysis.

Advantage: Greater statistical power. Disadvantage: Requires advanced statistical techniques and homogeneous data.

Who typically produces clinical practice guidelines?

Expert panels convened by professional associations, government agencies, or other organizations.

State one advantage of clinical practice guidelines for clinicians.

They provide practical, evidence-based recommendations for patient care.

According to the lecture, what are two fundamental principles showing that ‘evidence is never enough’?

Need to consider benefits/risks/inconvenience/costs AND patient values.

What two hierarchy questions must clinicians ask regarding evidence?

1) Where does an individual article fall on the hierarchy? 2) What does the preponderance of literature say about the question?

Which grading approach downgrades or upgrades evidence quality based on factors such as bias, inconsistency, or large effects?

GRADE (Grading of Recommendations Assessment, Development, and Evaluation).

In GRADE, which study design starts at ‘high’ quality?

Randomized Controlled Trials.

List the five steps in the EBP process.

1) Identify information need & develop a question, 2) Search for best evidence, 3) Critically appraise evidence, 4) Integrate with expertise & patient values, 5) Evaluate effectiveness.

What does the ‘Ask’ step in the Evidence Cycle involve?

Formulating a focused clinical question.

Differentiate background and foreground questions.

Background = general knowledge about a condition; Foreground = specific information to guide management of a particular patient.

Provide an example of a background question from the lecture.

“What is the typical mechanism of injury for an ACL?”

Provide an example of a foreground question from the lecture.

“For individuals aged 35-50 post-surgical ACL repair, does a CPM machine improve return to sports?”

What does each letter in the PICO framework represent?

P: Patient/Problem, I: Intervention, C: Comparison, O: Outcome.

Why did Haynes et al. (2006) argue clinicians need only 20 articles per year?

Because that represents roughly 1–2% of published evidence, enough to stay current if articles are carefully selected.

Which component of evidence-based decision-making often receives the least attention in practice, according to early PT surveys?

Scientific research evidence.

Name two common practitioner barriers to EBP found in stroke rehabilitation research.

Insufficient time and lack of generalizability of research findings.

What does the phrase “Drinking from a fire hydrant” refer to in the context of EBP?

The overwhelming volume of information clinicians face.

Why can volunteer bias threaten the validity of RCTs?

Participants who volunteer may differ systematically from the broader patient population.

Explain ‘recall bias’ in case-control studies.

Cases remember exposures more clearly than controls, distorting associations.

Which PT guideline example in the lecture uses graded recommendations (A, B, C, etc.) for neck pain management?

Neck Pain Clinical Practice Guidelines (Orthopaedic Section, APTA, 2017 revision).

Give one intervention recommended at ‘B’ strength for acute neck pain with mobility deficits.

Thoracic manipulation plus neck ROM exercises and scapulothoracic/upper-extremity strengthening.

What are the three core activities in EBP methodology beyond reading evidence?

Precisely defining questions, accessing/synthesizing evidence, and applying knowledge to patient care.

Why is blinding difficult in cohort studies compared to RCTs?

Exposure is not randomly assigned, so participants and investigators often know group status.

What key message is illustrated by the elephant analogy at the start of the lecture?

Individual perspectives can be biased; comprehensive evidence helps see the ‘whole picture’.