EBM

Question 1

3 main issues address when undergoing critical appraisal

Answer 1

Validity, the results, the clinical relevance

Question 2

validity

Answer 2

how trustworthy the study is, does it measure what its supposed to. Minimising bias improves validity

Question 3

Results

Answer 3

What does this show, is it statistically significant, size of the effect. (only worth thinking about implications of results if study design and methods are valid)

Question 4

Clinical relevance

Answer 4

will the results help you and your patient. Differences between patient and participants identified to see effectiveness.

Question 5

Whats involved in the critical appraisal checklist, what are the 6 questions

Answer 5

Was the study original?(does it add anything to current literature) Who was the study about? (how were Ps recruited/inclusion exclusion criteria) Was the study design sensible? Was bias avoided? (control group used, randomisation, other sources) Was assessment blind? Were preliminary statistical questions addressed? (size of sample, followup) different checklists are used for different study types.

Question 6

Critical appraisal skills programme (CASP)

Answer 6

provides critical appraisal checklists that are designed to help you think about aspects of appraisal systematically.

Question 7

CONSORT

Answer 7

focuses on RCT and aspects that should be included. Can be used to critically evaluate or design.

Question 8

STROBE

Answer 8

helps design and appraise observational studies

Question 9

Hierarchy of evidence

Answer 9

SR and MA. RCT. Cohort. CC. Cross sectional. Ecological. Case reports. Ideas and opinions.

Question 10

GRADE

Answer 10

grading and recommendations assessment, development and evaluation. ranks quality of evidence. GRADE and SIGN take into account more dimensions.

Question 11

PICO

Answer 11

patient, intervention, comparison, outcomes.

Question 12

Reaching a decision about a paper

Answer 12

Reject it, interpret the results cautiously, accept it/trust.

Question 13

Pre trial Bias

Answer 13

selection bias. not representative of the population. groups differ from each other.
Channeling bias - patient prognostic factors or degree of illness dictates the study cohort into which patients are placed

Question 14

During trial bias

Answer 14

information bias. errors in measuring exposure, intervention or outcome.
interviewer. Chronology. Recall. Transfer. Performance

Question 15

Post trial bias

Answer 15

confounding. statistical bias - misleading conclusions.

Citation. Internal/external validity.

Question 16

ANOVA

Answer 16

(Analysis of Variance) is used for more than two treatment groups.

Question 17

unpaired t test

Answer 17

difference between means of 2 groups

Question 18

Chi squared

Answer 18

The Chi-square (χ2) test is used to determine if observed frequency counts differ from expected frequency counts

Question 19

linear and logistic regression

Answer 19

Used to assess how one or more predictor variables can be used to predict a continuous outcome variable.
Allows us to ‘adjust’ for the effects of confounding variables.
“Do age, gender, and comorbidities predict distance walked in 2 minutes following physiotherapy?”
Used to assess the predictive value of one or more variables on a binary outcome variable.
Also allows adjustment for effects of confounders.
“Do age, gender, and comorbidities predict which stroke patients will show improvement following physio?”

Question 20

CAM

Answer 20

therapies/interventions that are: non-standard / unconventional
non-prescription
non-surgical
(can be pharmacological or non-pharmacological)

Question 21

how is CAM not conventional

Answer 21

may not have had rigorous testing. efficacy hasnt been demonstrated, nor safety. Health care professionals wouldnt recommend.

Question 22

Placebo and the placebo effect

Answer 22

Placebo = Any therapy which has no specific activity for the condition being treated e.g., sugar pill: a biologically inert, inefficacious substance.

The placebo effect = Any non-specific psychological or psychophysiological effect produced by placebos.
This non-specific effect can be worked out by excluding the known specific effects of the treatment under investigation.

Question 23

How does the placebo effect work

Answer 23

outcome expectancies. Patiant related self efficacy expectancies. Symbolic effect of treatment. Anxiety reduction.

Question 24

Potential benifits of CAM

Answer 24

can improve non motor symptoms like sleep mood GI. Via placebo effect, stress reduction, improved mood/sleep. greatr locus of control.

Question 25

Potential harmful effects of CAM

Answer 25

Used as an alternative. Unregulated. can be harmful - side effects, interactions with prescribed. Expensive.