Exam 1 Flashcards

Question

Clinical questions can be asked about what 6 content areas?

Answer 1

- interventions - clinical measures - reliability, validity, responsiveness - diagnostic tests - accuracy, risk, cost, etc - prognostic factors - predict future health and disease - Self-Reported Outcomes - End point of therapeutic intervention with an analysis of how these outcomes can be measured and the relevance of these outcomes to the patient’s activities - Clinical Prediction Rules - Clinical prediction rules are systematically derived indications of what types of patients may most benefit from interventions

Answer 2

a specific prediction of an outcome based upon previous literature or theory/conceptual framework

Answer 3

Speeds up a search: able to combine terms able to eliminate directions you do not want to go AND-Narrow search and retrieve records containing all of the words it separates. OR-Broaden search and retrieve records containing any of the words it separates. NOT-Narrow search and retrieve records that do not contain the term following it. () -Group words or phrases when combining Boolean phrases and to show the order in which relationships should be considered

Answer 4

Narrow the search to certain categories of articles to enhance the efficiency of the search process

Answer 5

Free Comprehensive – but many journals is specific areas of physical therapy Linked to online journal and full text versions of article Rigorous standards for determining which journals will be included (indexed) Medical Subject Headings (MeSH) – systematic way to retreave information OR general keyboard search Search history available Clinical Queries – evidence-based practice database on the home page Related articles function Can personalize it “My NCBI” Tutorials

Answer 6

Peer- reviewed journals – critically reviewed before publication so more sure of quality Non-peer reviewed journals/magazines – no prepublication review so unsure of quality Monographs - Less critical review but reviewed at several levels however information rapidly out-of-date (can be out of date at publication) Conference proceedings – often appearing as monographs related to single topic

Answer 7

News & Current Events – general & specialty sites newspapers & magazines Business & marketing – corporate, selling a product Informational – government CDC & NIH & online encyclopedias – wikis & professional organizations Advocacy - attempt to influence public opinion, online presence of advocacy organizations disease oriented in the health sphere & professional organizations Personal – hobbists, bloggers, specialty topics, clubs Others – entertainment

Answer 8

relevant to question, updated, reliable source, useful? Authority – Who authored site & what are their credentials? Accuracy – Information match other resources? Objectivity – Is the information balanced or have one point of view? Currency – How recent information? Scope – How broad or narrow? Commercialism – Selling something?

Answer 9

``` Complete Citation Purpose Statement/Hypothesis Design Type Sample Information Intervention/Independent Variable/Grouping Outcome/Dependent Variable/Measures ```

Answer 10

Cumulative Index of Nursing & Allied Health Literature (CINAHL): Focuses on Nursing & Allied Health – includes journals not covered in Medline Somewhat less comprehensive Can use limits & returns additional limits Easy to view search history Advanced and basic search options Statistical Analysis Identification of Confounding Variables Threats to Internal Validity

Answer 11

Physiotherapy Evidence Database (PEDro) Characteristics Citations of > 16,000 RCTs, systematic reviews, & clinical practice guidelines Combines citations and ratings of articles Exclusively PT An ability to search by: Therapeutic approach Clinical Problem Body part PT subspecialty Can use Boolean operators Tutorials

Answer 12

Databases of systematic reviews & meta-analysis Limited to clinical questions reviewed Limited to interventions having randomized clinical trials Few trials on other areas than interventions Subscription fees but Armstrong has access

Answer 13

Reviewed by a panel of 2-3 reviewers and an area editor – most often articles are returned to the author for revisions and corrections Research articles – characterized by having intro methods, results & discussion & peer reviewed Short reports – research articles with same parts but often unlabeled

Answer 14

– invited presentations to discuss issues in the field

Answer 15

– address overall questions & compares articles with discussion of limitations, article quality

Answer 16

– summarize results of research articles but not as critical as systematic reviews

Answer 17

– in journals from professional organizations | – statement of that organizations opinion on treatments or other issues

Answer 18

– short reviews/critiques of books, articles from other journals & new equipment/software

Answer 19

1. Philosophical Approach - Quantitative vs Qualitative 2. Design Format 3. Number of Groups 4. Degree of Control of Study Methods 5. Time Elements

Answer 20

non-experimental tend to be cross sectional; may be longitudinal measure or devise instruments

Answer 21

Collection of data is the transition to this level In vitro (test-tube) & animal research But question clinical applicability

Answer 22

Quantitative – evidence arises from large numbers, independence of investigators & subjects, statistical analysis & probability Qualitative – evidence arises from patterns and themes developed from the experiences of individuals or small numbers of individuals & close interaction between investigators and subjects collection of past data

Answer 23

– Active interventional with at least 2 groups with one group being a control group & randomization to groups

Answer 24

– Active intervention but with one or more of these experimental characteristics missing

Answer 25

– Active intervention but study is really descriptive or observational

Answer 26

- No active intervention and study is descriptive or observational

Answer 27

Single – within group designs Multiple – between group designs No Groups – single case studies or single subject experimental designs

Answer 28

Recruitment, assignment, communication & management of subjects Calibration and use of equipment Maintenance of the environment of study Administration of testing and /or training Collection and recording of data Communication among investigators and subjects

Answer 29

– analysis at single time or limited time frame (most experimental studies)

Answer 30

``` Looking forward & collection of new data Allows control of intervention Allows control of measurement Can determine groups Can randomize to groups Can determine cause and effect if true experimental design ```

Answer 31

– following over a long period of time (many observational studies

Answer 32

``` – looking back & collection of past data All data already collected – just find it But unable to control intervention But unable to control data collection But unable to randomize groups ```

Answer 33

Lowest Level – Editorials and commentaries Often are not specifically based on the analysis of data

Answer 34

``` Collection of data from human/patient populations represents the transition to this level Studies included in this level are: Case studies Case series Single group designs ```

Answer 35

Transition to this level occurs where there is more than one group so comparisons between groups can be made Designs in this category include observational retrospective designs: Case control design Retrospective cohort design

Answer 36

Comparison of individuals with a disease to those without the disease (control) Investigate exposures of each to find potential risk factors for the development of the health problem (disease)

Answer 37

Comparison present health of group exposed to a condition in the past to those not exposed Looking at risks of developing health problems (disease) from exposure

Answer 38

– Prospective studies Transition to this level occurs where there is a transition from the retrospective to prospective designs Designs in this category include observational prospective designs such as prospective cohort design

Answer 39

Comparison future health of group exposed to a condition in the past to those not exposed Looking at risks of developing health problems (disease) from exposure

Answer 40

– Studies with and active intervention Transition to this level occurs where there is a transition from observational to interventional designs Designs in this category include designs such as: Pre-experimental designs Quasi-experimental designs

Answer 41

One group with active intervention Reliability studies

Answer 42

Most commonly lacking random assignment to groups Two groups with assignment based upon some characteristics Characteristics matched control groups

Answer 43

Temporal precedence - the intervention ("cause”) precedes the change in outcome measure "effect" in time Co-variation - the "cause" and the "effect" are related Non-spuriousness - there are no plausible alternative explanations for the observed relationship between the “cause” and “effect”

Answer 44

Characteristic of research studies that reflects the degree to which a causal conclusion is appropriate based upon the methodology used in the study The degree to which the study minimizes “bias” or systematic error

Answer 45

When experimental precautions or quality of design of studies are not satisfactory to assure the reduction of bias or or systematic error we have THREATS to internal validity These threats can be corrected or moderated by procedural components of the studies

Answer 46

Use of control group Subjects assigned to get intervention or not (control group) Difference between responses of the two groups is the true effect of the intervention Random assignment to groups Each subject has an equal chance of being assigned to one group or the other Should equalize effect of any inter-subject differences Blinding Making sure that participants in a study do not know the assignment of subjects to groups Making sure that the subjects to not know their assignment – blinding When investigators doing the measurements also do not know group assignment – double blinding

Answer 47

Selection (assignment) bias History Maturation Repeated Testing (Testing Effect) Instrumentation Regression toward the Mean (Statistical Regression) Experimental Mortality/Differential Attrition Experimenter Bias/Compensatory Equalization Diffusion/Imitation of Treatment Compensatory Rivalry OR Resentful Demoralization Placebo Effect

Answer 48

Pre-test differences in characteristics of subjects (age, weight, hearing capability, strength, etc.) between groups exist These differences may interact with the intervention in changing the outcome or by themselves effect the outcome CORRECTION: Control group with random assignment to groups in theory all characteristics have an equal chance of assignment to each group – however with small numbers of subjects randomization of characteristics is not assured CORRECTION 2: Stratified random assignment can be used where characteristics are identified and random assignment is made from each of these characteristics. For example divided into men & women and random assignment is made from first men and then women to assure equal distribution between groups

Answer 49

Events in the subject’s life outside of the study could affect the outcomes having nothing to do with the intervention CORRECTION: Random assignment to groups should equally distribute these factors between groups

Answer 50

Natural changes in the subject’s outcome variables or response to the intervention can occur during the study Children age Diseases wax and wane Subjects naturally have compensatory behaviors to correct problems Fatigue CORRECTION – use of a control group which will exhibit those changes

Answer 51

Repeated testing may condition subjects to the testing procedure and improve their performance Repeated testing may give subjects knowledge that can lead to improved performance Used in all pre-test & post-test designs CORRECTION: use of a control group ore repeated exposure prior to beginning the study

Answer 52

Physical measurement device even though calibrated prior to the study may vary in that calibration during the study Test with any subjectivity the observer (one taking the measurement) may change the way that they assess a change during the study Change in observer Observer may become more attuned to changes Observer may unconsciously changed the criteria they use to make judgments CORRECTION – use of a control group because any changes would be seen in both control and intervention groups

Answer 53

If any single subject repeats a measurement they will have a variety of scores depending upon external factors Repeat enough times see a pattern of scores above and below a central value (the mean) CORRECTION – control group with random assignment so upward & downward regression are equally distributed between the two groups

Answer 54

Inference is only made on those who both start and complete the study Subjects are ethically allowed to withdraw from a study at any time and for any reason – part of the “informed consent” process of participation When people leave a study it is called “experimental mortality” When they leave one group more than the other it is called “differential attrition” When the characteristics of the subjects assigned to each group changes it is a threat to internal validity

Answer 55

Investigators may inadvertently affect the outcome by unconsciously behaving differently to members of control and experimental groups CORRECTION: Blinding is used so that the investigators have no knowledge of the group to which a participant belongs

Answer 56

When subjects in the control group see the intervention and imitate that intervention – so intervention spreads (diffuses) from the treatment group to the control group CORRECTION: Isolate control and intervention groups from one another and blind subjects to the intervention

Answer 57

When subjects in the control group perceive that they are not receiving the intervention and they either: Work harder to prove that they can show the change (compensatory rivalry) Give up and do nothing (resentful demoralization) CORRECTION: Isolate control and intervention groups from one another and blind subjects to the intervention

Answer 58

Definition – extent to which the sample are generalizable to the population Study must be qualified by the limitations of the external validity of the study

Answer 59

Definition – total members of a defined class of people, objects, places or events selected because they are relevant to the research question Must be defined at the beginning of the study – often stated in title of the study but always in the research question

Answer 60

Sampling is the process of selecting a sample of subjects from a target population Investigator will attempt to use results from the sample to generalize to the whole population - inference

Answer 61

Every population member has an equal chance to be selected

Answer 62

It is difficult or impossible to identify all members of any population Even if identified, it is difficult contact all members Even if contacted, subject have the right to refuse to participate and others may be unable to participate

Answer 63

Random groupings of individuals selected rather than random individuals Groups are randomly selected then all individuals in the group are part of the sample It is important that each group (cluster) does not differ greatly from each other or from the population from which the groups are chosen

Answer 64

It is important that each group (cluster) does not differ greatly from each other or from the population from which the groups are chosen

Answer 65

Only those individuals who can be easily identified or located are included Most common form of sampling

Answer 66

Sampling error Differences occur between the sample and the population with certain characteristics that are due to random differences Occur through no fault of the researcher Systematic error Due to a systematic difference between the sample and population rather than random differences Response rate error – when those who participate in the study have specific characteristics that make them different from the population Coverage error – when researchers mistakenly restrict their sampling framework to a subset of the population of interest

Answer 67

(“snowball) sampling – Selection of individuals with specific characteristics Often done when population members are hard to identify

Answer 68

Number of participants required for the study Major decision when planning research Decided in advance, otherwise it may look as if data collected until hypothesis was supported

Answer 69

``` Practical considerations – limited factors Availability of subjects Cost in terms of time and money Representation and generalization Making sure all characteristics of the population represented in the sample More varied characteristics more subject needed When making group comparisons: Variability of the sample Size of the expected difference Population size Types of subjects Purpose of the research Ethical considerations ```

Answer 70

Decided in advance, otherwise it may look as if data collected until hypothesis was supported

Answer 71

Use the formula n= 16(s2/d2)

Answer 72

Those characteristics makes a person part of the population in terms of clinical findings, demographics, or other factors that need to be studied Must reflect the characteristics of the population – if not threatens external validity

Answer 73

Factors that preclude someone from being in a study Includes those factors that may introduce confounding variables If too exclusion criteria too numerous, unreasonable or restricts the sample too much compared to the population can also threaten external validity

Answer 74

Grouping Variable | Manipulated in experimental studies

Answer 75

A variable is a characteristic or feature that varies, or changes within a study The opposite of variable is constant: something that doesn't change The characteristic or feature that varies need to be of interest in the study to be considered variables

Answer 76

Specifically designed intervention is actively imposed on volunteer subjects and controlled by the investigators This is the highest level of independent variables, met by true experimental studies. It has the advantage of having a consistent intervention, where all subjects receive the same treatment under the same conditions, dose, and setting

Answer 77

Variation of the same independent variable are considered levels Example – different intensities of the same form of exercise All the members of one group will have the same level of the independent variable Different groups will have a different level of that same variable

Answer 78

Independent (between groups) grouping variables have different subjects in the different groups to be compared The people who are in the experimental group are different (independent) people than those who are in the control group Allows for between group or independent comparisons

Answer 79

Assignment to groups can raise bias – bias of the characteristics of the subjects & bias of the investigator Random assignment eliminates experimenter or subject preference bias in determining group assignment All variables that are randomly assigned are active, since the investigators must have active control over the variable to randomly assign them to subjects

Answer 80

Single studies frequently have several independent variables. Permits the assessment of multiple variables simultaneously, and permits the assessment of their interaction. The most common usage – 2 group, Pre-test/Post-test Design Combination of active intervention variable (treatment and control) along with a pre-test & post-test assessment of the outcome measure (dependent variable)

Answer 81

Groups were defined by a characteristic of the subjects or chosen by the subjects. Groups are compared, but the grouping variable cannot be chosen and manipulated by the investigators because it is a characteristic of the subjects themselves, or it is unethical to manipulate

Answer 82

Repeated measures are "within groups" variables; have several types

Answer 83

Combination of active intervention variable (treatment and control) along with a pre-test & post-test assessment of the outcome measure (dependent variable) Compare the intervention to the control (independent, independent variable) Compare the effect of time (pre-post) on the outcome variable (repeated measure, independent variable) Used when the hypothesis is that the intervention or treatment will produce improvement in symptoms Investigators would set up the study so that the groups are equivalent at the start of the study Groups are equivalent because subjects are randomly assigned to groups Confirm that the groups are not different at the start of the study by statistically comparing the pre-test scores of the two groups Then after the intervention Post-test would be given to all subjects in both groups, and the change of both groups between the pre and post tests would be compared Since active intervention, a control group & randomly assignment to groups, the investigators could conclude that it was the intervention that was imposed that caused any differences in this pre-post change If not a true experimental design at least could conclude association between intervention and change observed

Answer 84

Pre-test before the intervention & post-test following the intervention - on all subjects The measurements from the pre-test are taken from the same individuals ("within groups") as the post-test Studies can have multiple repeated measures, measuring the dependent variable at "baseline", 3 month, 6 month, 1 year, 5 year follow-up The effect of the independent variable is the change that occurs within the group over the testing times Time of testing variables are always independent variables, and always active Investigators must have control over the testing schedule to have the multiple tests.

Answer 85

Before subjects are assigned to groups, they are matched with another subject based on their age, gender, smoking status, or other variable thought to be a possible confounding variabl; one member of each pair is randomly assigned to the control group, and the other to the experimental group In this case, the effect of the independent variable is considered "within groups" because of the matching of variability between the groups This is a useful strategy because it reduces the "noise" or error in the study, so actual differences can be detected if they are present