Current Concepts- Statistics

Question 1

Interactive Reasoning

Answer 1

Deductive and/or inductive
Involves strategic communication to establish a therapeutic alliance with the patient

Question 2

Collaborative Reasoning

Answer 2

Deductive and/or inductive
Is the communicative process used to ensure that the clinician’s values and beliefs align with the patient’s

Question 3

Diagnostic reasoning

Answer 3

Deductive
Creates a linear relationship between a patient’s presentation of: activity restrictions, physical impairments, pathology of body structures, pain mechanisms, personal factors, environmental factors

Question 4

Narrative reasoning

Answer 4

Inductive
Used to gather info regarding personal and environmental factors relevant to the patient
Open- ended questions, active listening

Question 5

Intervention procedures reasoning

Answer 5

Inductive and/or deductive
Included the choice and execution of interventions that should help the patient if the hypothesis formulated is accurate
Test-retest strategy
Symptom modification process

Question 6

Predictive reasoning

Answer 6

Deductive and/or inductive
Using musculoskeletal pain irritability and the response of the hypothesis testing through intervention during the first visit to establish a prognosis
Involves assessing a patient’s 24-48 hr response to an intervention

Question 7

Patient education reasoning

Answer 7

Formulating different ways to educate a patient and ensuring that the education was received

Question 8

Ethical reasoning

Answer 8

Involves doing what is of best interest of the patient given the best available info

Question 9

Bayesian Reasoning

Answer 9

Involves application of probability theory to deductive and inductive reasoning
As data are progressively collected, it shifts the probability that something is true (cluster testing for diagnosis)

Question 10

PICO question

Answer 10

Patient or Problem
Intervention (cause, diagnostic test, prognosis, treatment)
Comparison
Outcomes

Question 11

Internal validity

Answer 11

An assessment of the quality of the study design to prevent systematic errors or bias

Question 12

External validity

Answer 12

Are the results of the study generalizable to your patient ?
Sample
Randomized ?
Inclusion/exclusion criteria

Question 13

Sensitivity

Answer 13

SNout
Test with high sensitivity that is Negative- can rule something Out
Good for a screening test: rule out serious pathology, rule out conditions by region
Helps determine early on in exam if you should treat, treat and refer, or just refer
Example: Ottawa Ankle Rules

Question 14

Specificity

Answer 14

SPin
Test with high specificity that is Positive can be ruled IN.
Helps verify primary hypothesis at end of exam after completing A/P/RROM

Question 15

Likelihood Ratio

Answer 15

Test’s ability to modify the pre test probability of a diagnosis being present or absent to the post test probability of a diagnosis being present or absent
Post-test probability accounts for test result in addition to subjective, PMHx, etc.

Question 16

Positive Likelihood Ratio
LR +

Answer 16

Positive test -> patient more likely to have disorder
LR >= 10 large shift
LR >= 5 moderate shift
LR >= 2 small shift
LR = 1 no shift

Question 17

Negative Likelihood Ratio
LR -

Answer 17

Negative test -> shifts probability away from disorder
-LR 0.5 SMALL: decreases probability by 15%
-LR 0.2 MODERATE :decreases probability by 30%
-LR 0.1 LARGE: decreases probably by 45%

Question 18

Sampling bias

Answer 18

Only screening patients who are thought to meet the inclusion/exclusion criteria instead of screening all potential participants with the condition

Question 19

Verification bias

Answer 19

When not all participants are assessed by the reference standard in the same fashion

Question 20

Incorporation bias

Answer 20

Reference standard is included in the diagnostic test being studied

Question 21

Spectrum bias

Answer 21

Participants are not representative of the population in which the test is likely to be used