Exam 1 Flashcards
(130 cards)
1
Q
what is Systematic
A
methodical process of examining relationships or theories
2
Q
what is empirical
A
results are observable, documented and examined for validity
3
Q
what are 3 scientific paradigm of clinical research
A
Outcomes research
Models of health and disability
Evidence-based practice
4
Q
what are some healthcare quality assessed
outcomes
A
structure
process
outcomes
5
Q
what is structure of healthcare quality
outcomes
A
– what are the organizational standards
the organization of the institution. Who reports to whom?
Example: University, Colleges, Departments, etc.
6
Q
what is the process of healthcare quality
outcomes
A
– quality assurance programs
how do we go about accomplishing our tasks? Reports generated, charges, etc.
7
Q
what are the outcomes of healthcare quality
outcomes
A
– patient related outcomes
patient specific. Morbidity, mortality, length of stay, readmissions, etc.
8
Q
why is a large data based used
A
to have detail insurance coverage, utilization of services, functional outcomes, demographic information, etc
9
Q
what happens to patients after a study
A
they are followed over time after discharge
10
Q
what are some different view of health care
A
biomedical model disablement model ( Nagi) ICF from WHO
11
Q
what is biomedical model
A
this is a linear relationship with pathology and impairment. Health is the absence of disease and that injury or disease can be treated and cured.
12
Q
what is the biomedical model lacking
A
Model generally lacking because successful outcome isn’t always “curing” something.
13
Q
what is the nagi model
A
pathology- impairment- fx limitation- disability
14
Q
what is pathology of that of the nagi model
A
disturbed function. Could be weakness, inflammation, etc. Rotator cuff tear.
15
Q
what is impairment of that of the nagi model
A
abnormality. Can’t elevate arm.
16
Q
what is fx limitation of that of the nagi model
A
can’t perform activity normally. Can’t reach overhead.
17
Q
what is disability of that of the nagi model
A
can’t perform activity in socially defined roles. Can’t works as an electrician.
18
Q
what is the ICF model
A
This is from the WHO !!
Less emphasis on disability, more on how people live with a health condition. this focus is on LIFE
19
Q
what can the ICF be related to
A
the nagi it has many of the same definitions like that of…
health condition- nagi patho
body fx= nagi impairment
participation= nagi disability
20
Q
what set the ICF aside from the nagi
A
capacity
performance
21
Q
what are capacity and performance of the ICF in reference to
A
the environment
- person has the capacity to work but does not have the right environment they cant do anything. but once the environment is fixed so they can work at capacity their performance will go up
22
Q
what is ICF capacity
A
standardized optimum environment which may be real or assumed
23
Q
what is ICF performance
A
current or actual environment in whcih the individual participates
24
Q
what is evidnece based practice
A
Find the best evidence & critically appraise it
Change your behavior
Remember to incorporate patient’s beliefs & values!
Assess results
25
what should EBP be asking
relevant clinical questions
26
what are the components of a good clinical question
PICO
```
P= patients
I= intervention
C= comparison
O= outcomes
```
27
what other things must be consider when making a clinical decision
clinical expertise
best research evidence
patients values
clinical circumstances and settings
28
how do pt know what to do
```
tradition
authority
trial error
logical reasoning
scientific method
```
29
why do you use tradition in PT
it is useful in that it offers a common foundation for communication BUT should not be taken for its knowledge because some traditional things might not be validity or they haven't been tested again
30
why do you use authority in PT
these would be specialist and experts
31
what is trial and error
haphazard, time consuming, potentially harmful, INQUIRY STOPS WHEN “SATISFACTORY” SOLUTION FOUND, NOT NECESSAIRLY THE “BEST”. Usually, unsuccessful attempts are NOT reported
32
what is logical reasoning
experience & critical thought.
deductive
inductive
33
what is deductive
general to specific
34
what is inductive
specific to general.
35
what is the best order of research
```
scientifc method
logical
trial and error
authority
tradition
```
36
what is the element in control
is what sets scientific method apart—attempts to control factors that are not directly related to the variables in question
-- scientific method
37
what is assumption
orderly, regular, consistent and predictable.
38
what is research
Asking questions
Finding answers
Generating more questions
39
research is
Structured
Systematic
Empirical- can be observed
Critical- of self and other
40
what is Quantitative
quantify variables (numbers).
41
what is Qualitative
describe (nouns, verbs, etc.).
42
what is Basic
bench science. Rigid control.
43
what is applied
taking lab research & applying it in the world. Less control, more generalizable. Clinical; applied with patients
44
what is Translational
taking experimental findings (such as with human genome project) and translating these discoveries into practical applications.
45
what is Experimental
variable or variables manipulated
46
what is Non-experimental
natural state”.
47
what is internal validity
issue of control
48
what is external validity
generalizability
49
what is step 1 of research
```
dentify problem (1)
Review literature (2)
Identify variables (3)
State hypotheses (4)
```
50
what is step 2 of research
Design methods (and identify sample) (5)
51
what is step 3 of research
Collect & reduce data (6)
52
what is step 4 of research
```
analyze data (7)
interpret findings (8)
```
53
what is step 5 of research
report findings (9)
54
what need to be minimized in research
bias as it can have a control over your findings
55
what are the 3 principles of research
1 automony
2 beneficence
3 justice
56
what is automony
choice to participate
57
what is beneficence
risk/ benefits needs to be small as possible
58
what is justice
subject shoudl come from population most likely to benefit all shoudl have equal probability of assignment to groups
59
what are control groups
not always not treatment
60
read
about the nurember code
61
what is a exempt ( the review all proposed research )
doesn't need to be reviewed ( no subjects)
62
what is a expedited ( the review all proposed research )
when their is minimal risk and all are adults
63
what is a Full ( the review all proposed research )
with vunerale population
| ( kids, pregs, prisoner, ) AND all IRB needs to be present
64
what is measurements
The process of assigning numerals to objects to represent quantities of characteristics according to certain rules
65
what are numerals
have no mathematical meaning
| 0 = male, 1 = female
66
what are numbers
tell how much of something is present
| 3 grams, 12 seconds
67
what is dichotomous ( number scales)
con only have two values
| yes or no
68
what is continuous ( number scales)
infinite number of values
limited by measurement device (or skill of measurer)
Example: Weight=19 lbs 6.5 oz
69
what is discrete ( number scales)
whole values only
| children, heart rate, etc
70
what is precision
places beyond decimal
none may be best
Example: How important is it to know weight is 19lbs 6.5 oz?
71
what is IQ and temp in relation to measurements
they are very abstract ( indirect)
72
what is height and lenght
these are direct measurements
73
what are constructs
“a function of many interrelated concepts or multiple dimensions”
Examples
Velocity (distance/time)
Work (force x distance)
74
what are some abstract variables in indirect measurements
disability
| injury
75
what is there confidence in measurement
there are different difficulty levels
easy heart rate
hard strength
76
what are some rules of measurements
- must be agreement (ROM” easy / Muscle tone” difficult)
- equality (a = b or a b, but not both)
- rank order (if a > b and b > c, then a > c)
- Permissible” mathematical operations
77
what are the scales of measurement
Nominal
Ordinal
Interval
Ratio
78
what is nominal
```
name only
letter
numeral
symbol
***can change the label and it wouldnt change anything
```
79
what is ordinal
rank order as well as name
-- interval not equal ( fair and good)
strong and weak
-- can have negative values
80
what are the measures of central tendency
mean
median
mode
81
what is mean
—”sum of a set of scores divided by the number of scores (n)”
Basically, the average
82
what is median
divides a rank-ordered distribution into 2 equal halves
83
what is mode
the score that appears most frequently
84
what is interval
equal interval w/o natural zero
( temp)
Can transform but otherwise not directly compare same phenomenon with different scales
16 lbs is not he same as 16kg (or 16 stones?)
85
what is ratio
there is a natural zero
- height mass rom
- - any math operation
86
what is the order of scale of measure in precision
ratio, interval, ordinal, nominal
87
how can you convert the scales of measure
Can convert to less precise, but not more precise
| ratio to ordinal, but not reverse
88
what happens the information when you convert the scale off measure
info is lost
89
what things can be reliable
Person
Instrument
Test
90
what is validity
is the test measuring what it is intended to measure. Need both validity and reliability in clinical practice and research.
91
what is reliable mean
that is consistent and free of error
92
what are some characteristics of reliable
```
Reproducible
Dependable
Repeatable
Consistent
Free from error
```
93
will there ever be a perfect measurement
NO there will always be some error
94
what are sources of error
rater
instrument
inherent variability
95
what does a small error mean
larger reliability
96
what does rater error normally mean
using the instrument incorrectly.
97
what does instrument error normally mean
incorrect calibration, fluctuations in environment causing a change in the reading (voltage fluctuations, temperature changes, etc.).
98
what does inherent variability error normally mean
of the phenomenon being measured; this is the hardest to deal with. Heart rate, time on a functional task, etc. All are subject to variability.
99
how can you reduce errors
protocol
A protocol dictates the methods to be used to measure something; if potential errors can be identified, the protocol can be developed to control for the errors.
100
what is systematic error
wrong calibration of instrument, wrong use of the instrument, etc. A consistent inflation or deflation of the true score. Correct by using the properly calibrated instrument correctly.
101
what is random error
everything else. These are the focus of reliability issues in research.
102
what is the regression toward the mean
slide 7
| The tendency for higher scores to decrease, lower scores to increase
103
how do you estimate reliability
If we measure something (balance, blood pressure, heart rate, height, etc.) multiple times, the scores will vary somewhat. There will be a variance of the true score (inherent variability in the phenomenon), as well as variance of the measured score
104
what is variance
this is an indicator of how variable the data set is
105
can you know a true score for reliability
NO but you can conceptually
| observed score = true + error
106
what happens when error variance approaches 0
reliability increases
107
what happens when true variance approaches 0
reliability decreases
108
what is poor coefficient reliability
less and .5
109
what is moderate coefficient reliability
.50-.75
110
what is good coefficient reliability
greater than .75
111
what is perfect reliability coefficient
1
112
what is correlation
this is an association NOT agreement
113
what are some types of reliability
Test-Retest
Rater
Equivalence
Internal Consistency
114
what is test retest reliability
Measure subjects twice
Calculate coefficient (Pearson, Spearman,
Difference between measurements is considered error
115
what is the testing effect
changes in score in results of the test
| - ROM measured, tissue stretches
116
what are some issues with test retest
Rater bias
| Test-retest interval
117
what is the two type of rater reliability
intrarater
| interrater
118
what is intrarater
relates to a single rater over several measurements (more than two is usually better). Should be established for each study, regardless of the "experience" of the raters.
119
what is interrater
relates to separate raters obtaining the same measurement from a single group of subjects. For some measurements, the desired independence and simultaneous nature of the measurement can be obtained
120
what are some way the rater will mess up
Rater may be the instrument
Rater may observe phenomena
Rater may be part of instrument
Rater may read a gauge or recording
121
what is intraclass correlation coeffiecient
correlation and agreement
122
what is kappa
proportions of correlation by chance
123
what is standard error of measurement
standard deviation of measurement errors
124
when are alternate forms used
when subjects are likely to recall responses to tests
125
what is split half reliability
a test is constructed with twice the needed items, and the score on half the items is correlated with the score on the other half. Don’t want to compare first half to second half (fatigue, etc.). Better to scatter items throughout test. "Lie" score on MMPI.
126
what is test item reliability
examine each item on the examination for reliability with the overall test score. Expectation is that those who do well on the test overall will do well on individual items (if a greater proportion of the subjects who score poorly get an item correct than those who score well, the item probably has something wrong with it).
127
what is the classical reliability theory
true score is fixed, fluctuations due to error
128
what is generalization theory
assumes measurement is specific to conditions when measurement was obtained; variability is in facets
129
what is population specific reliability
can’t take a reliability measurement for a hand-held dynamometer obtained on a population of 25 year old men and apply it to a group of 58 year old women.
130
what is pilot testing
is often used to establish reliability. Want the pilot testing situation to be as close to the real situation as possible.
