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Evidence Informed Practice > EIP > Flashcards

EIP Flashcards

1
Q

Strategies for finding RCTs

A

1) look for limiters/filters targeting RCTs
2) field searching (targets publication type/RCTs)
3) RCT-related keywords
4) determine if database has special focus on RCTs

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2
Q

Finding RCTs in PubMed

A

1) Randomized Controlled Trial filter (under “customize”)
2) Advanced search -publication type = RCT
3) Clinical Queries- Therapy (category) & Narrow (scope)

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3
Q

finding RCTs in medline & CINAHL

A

RCT limiter under publication type on the limit your results page

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4
Q

finding RCTs in TRIP database

A

controlled trials filter in the refine results by evidence type menu on right

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5
Q

finding RCTs in SportDiscus & AMED

A

these databases do not have a specific limiter/filter for RTCs.
-need to add RTC-related keywords
(try randomized OR randomised OR random*)

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6
Q

finding RCTs in PEDro

A

PEDro has a special focus on RCTs and groups RCTs together in your search results automatically.

  • look for results labeled clinical trial in method column.
  • PEDro pre-appraises RCTs for quality; the quality score shows up in score column
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7
Q

5 Steps to EBP

A

1) Ask
2) Access
3) Appraise (quality)
4) Apply
5) Assess (effect & self assessment)

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8
Q

background Q’s

A
  • general questions

- multiple tangents depending on different patient & dr perspectives

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9
Q

foreground Q’s

A
  • clinical Q’s that will give you a better chance at finding the best available evidence
    1) Therapy -will modality help?
    2) Harm -will there be adverse effects?
    3) Prognosis -what’s the observed outcome?
    4) Diagnosis - will a particular test help?
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10
Q

creating foreground Q’s

A

P: population/problem
I: intervention
C: comparison (not always necessary)
O: outcome of interest

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11
Q

useful sources of pre-appraised literature

A

1) Dynamed
2) Turning research into practice (TRIP)
3) Physiotherapy evidence database (PeDro)

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12
Q

levels of evidence

A

1) systemic review –> meta-analysis** OR qualitative
2) randomized control trial
3) cohort
4) case study/ report

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13
Q

best answer for a therapy Q is found?

A

RCTs

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14
Q

best answer for a risk factor of rare condition is found?

A

case-control studies

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15
Q

best answer for a diagnostic Q is found

A

cross-sectional studies

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16
Q

best answer for a prognosis Q is found

A

cohort studies

17
Q

anecdots

A

he said, she said stories

  • pure observation
  • unpublished
18
Q

case reports/series

A
  • published studies of what happened to a single person or group of people
  • based on observation only
19
Q

cross-sectional studies

A

exposure & outcome are measured at the same time & once like a snapshot in time
-DIAGNOSIS-related Q’s

20
Q

Case-Control Studies

A

people w. disease & people w/o obtained info about past exposure that can be considered a risk for the disease
-HARM-related Q’s

21
Q

cohort studies

A

data is obtained via exposure of 2 groups (tx & control) over time.
–PROspectice = both groups followed forward in time NOT in the past

-RETROspective = both groups followed forward in time but starting at time in the past

22
Q

randomized control trial (RCT)

A

considered the primary study for foreground Q’s about therapy.
-meta-analysis & systematic reviews

23
Q

key components of a RCT =

A
  • subjects = treatment OR control group
  • allocation is done using ransom mechanism
  • baseline measurements are taken
  • intervention is applied in blinded fashion to treatment & control group
  • outcome measured by blind assessors in both groups over a pre-determined follow-up
24
Q

ABCDFIX =

A 
A= allocation / administered
B= blinding
C= comparisons
D= drop outs/ lost data
F= follow up
I= intention to treat (only when there is lost data)
X= everything else
25
Q

Look for ABCDFIX in…

A 
A = methods section
B= methods
C= Table 1/figure 1
D= figure 1
F= figure 1
I= results
X= everywhere!
26
Q

are allocation and randomization the same thing?

A

NO

27
Q

is blinding the same as concealed allocation?

A

NO

28
Q

blinding most important players =

A

1) Dr.
2) Patient
3) Outcome assessor **
- look to see if they asked patient if they thought they knew which group they were in = if blinding actually worked or not

29
Q

Subjective (-) Vs. Objective (*) measures

A
  • pain rating
  • motion palpation
  • dizziness
  • length of time you can sit w/o pain
  • orthopedic tests
  • low back endurance timed
  • questionnaire regarding things you can no longer do at home
  • deep tendon reflexes
  • number of days missing work
30
Q

Comparison

A

after randomization is one group at an advantage

  • comparable start
  • comparable extra help
  • comparable attention
  • comparable compliance
31
Q

Drop Outs why should we care?

A
  • subjects who dropout might be different than those that stay
  • loss of randomization
  • loss of statistical power
32
Q

what we want to know about drop outs

A
  • how many (5-20% rule)
  • how was loss distributed (evenly btw groups)
  • why was data lost? (adverse effects, got well?)
  • was it corrected for?
33
Q

Follow up

A

was it complete/ long enough for the clinical outcome?
SHORT TERM = 4-6 weeks?
LONG TERM= heart 2-10years OR low back pain (6-12m)

34
Q

intention to treat…

A

once randomized always analyzed

**must in RCT = addresses known & unknown prognosis factors

35
Q

5 reasons to like intention to treat

A

1) preserves randomization
2) maintain prognosis balance
3) preserves sample size balance
4) helps prevent an overestimation of how good a treatment really is
5) intention-to-treat better reflects

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