Exam 2 / Final Flashcards

Question

You have conducted a study looking at the effects of a new manual therapy technique on shoulder pain. After collecting and analyzing your data, you get a p-value of 0.25 (p=0.25). Which of the following is the most likely explanation for your finding? a. You committed a Type I error, likely because your effect size was too small b. You committed a Type I error, likely because your variance was too large c. You committed a Type II error, likely because your sample size was too small d. You committed a Type II error, likely because your statistical power was too large

Answer 1

Answers: C Rationale: a. With a p-value of 0.25, you would not reject the null hypothesis, meaning you could not commit a Type I error. Further, effect size does not affect statistical significance (p-values) b. With a p-value of 0.25, you would not reject the null hypothesis, meaning you could not commit a Type I error c. Type II error is not rejecting the null hypothesis when it is actually false. Studies with few participants are sometimes unable to detect a change even when there is one d. Type II error is not rejecting the null hypothesis when it is actually false. Type II errors occur when a study does not have enough statistical power

Answer 2

Answers: D Rationale: A. Researchers can reject their null hypothesis if the p value is less than 0.05 B. P values do not indicate if the data is clinically significant. Other values such as effect size or MCID would need to be reported to determine if it is clinically significant. C. The p value is less than 0.05 indicating that it is statistically significant, but there is no information indicating that the research is clinically significant. D. A p value less than 0.05 indicates that the difference between the two groups is statistically significant.

Answer 3

Answers: D Rationale: a. Concurrent is a type of validity that assess whether a test correlates with the gold standard. This has nothing to with the type of reliability demonstrated. b. Content is a type of validity that assess whether or not the measure represents all constructs of the measure. This has nothing to do with the type of reliability demonstrated. c. Intrarater means that the test was administered by a single rater. This test was done by two observes so it is wrong.

Answer 4

Answers: B (f) Rationale: where are you getting your information? d. From the Research Methods textbook, page 144, this is not the right answer because it is the definition of content validity. e. From the Research Methods textbook, page 144, this is the definition of concurrent validity. f. From the Research Methods textbook, page 145, this is not the right answer because it is the definition of interrater reliability g. From the Research Methods textbook, page 144, this not the right answer because it is the definition of face validity

Answer 5

Answers: C Rationale: where are you getting your information? a. From the Research Methods textbook, page 229, these data results cannot definitively rule in the condition of an ACL tear because a negative likelihood ratio of 0.3 means that there is still a small possibility that there is another cause for the knee pain, besides an ACL tear. b. From the Research Methods textbook, page 229, the data given cannot definitely rule out the condition of an ACL tear because the test came back positive, which means there is a high likelihood that the condition does exist. c. From the Research Methods textbook, page 229, a positive likelihood ratio of greater than 10 often means that there is a large likelihood that the condition is present. d. From the Research Methods textbook, page 230, a positive likelihood ratio would need to be around 1 or 2 for there only to be a small likelihood that the condition is present.

Answer 6

Answers: B Rationale: a. Decreased ROM is a body structure/function impairment b. Walking and standing for long periods of time are examples of activity imitations c. Hiking is a participation restriction d. Playing basketball would be a participation restriction

Answer 7

Answers: A Rationale: a. A highly specific test with a positive result means you can confidently rule in a condition b. The test was positive and has a low sensitivity, thus this is not correct c. The 0.02 sensitivity value does not equal the predictive value d. The 0.93 specificity value does not equal the predictive value

Answer 8

Answers: A Rationale: a. Criterion-related validity is a type of concurrent validity that helps determine if a measuring instrument is comparable to a well-established gold-standard measurement. b. Construct validity refers to the ability of an instrument to measure an abstract theory or single idea (ex. amount of ROM related to the ability to perform a task or functional activity). c. Content validity refers to if an instrument measure represents the concept of the variable of interest (ex. functional abilities of the knee joint). d. Face validity refers to whether an instrument measures what it is supposed to measure (ex. knee flexion).

Answer 9

Answers: A Rationale: a. This is correct because there should be daily, low level aerobic activity implemented with patients with fibromyalgia. These patients are more vulnerable to overuse syndromes, so a slower, longer rehab process is key. b. This is incorrect because patients with fibromyalgia fatigue quickly and have a low tolerance for exertion. c. This answer is incorrect because stretching should be included in the exercise regimen. d. This answer is incorrect because patients with fibromyalgia should be started on low intensity exercise programs done once a day throughout the week, not twice a day, three days a week.

Answer 10

Answers: D Rationale: a. This answer is not correct because the patient is not able to give a reading in the first place because of sedation. b. This answer is incorrect because the MCID needs to be 2 points in order to be a significant change in functional status. c. This answer is not correct because this data must be collected from the patient, not the therapist. d. This answer is correct because the MCID is more than 2 points, so the PT can conclude that there is a significant change in functional status.

Answer 11

Answers: C Rationale: a. Concurrent validity is how well a measure correlates with the gold standard (pg 144) b. Construct validity is how well a measure or scale measures a certain item or object (pg 144) c. Content validity is defined as the amount that a particular measure represents all facets of the constructs it is supposed to measure (pg 144) d. Convergent validity is a property of measurement showing if a measure is correlated to other related measures (pg 145)

Answer 12

Answers: A Rationale: a. The MCID is a measure used to show what improvements are meaningful to patients b. If the therapist searches literature that is related to elbow ROM she will find a MCID value and will be able to know if the change she sees in her patient is clinically meaningful or not c. The MCID does not produce p-values and is not related to significance values and p-values are not related to clinically meaningful findings d. The MCID does not provide any information about statistical significance

Answer 13

Answers: A Rationale: a. Inability to play tennis with granddaughter is Ruby’s participation restriction because it prevents her from participating in her normal societal roles. b. Inability to swing the racket is an activity limitation. c. Limited ROM during the evaluation is a body structure and function impairment. d. Pain with movement on and off the court is also a body structure and function impairment.

Answer 14

Answers: C Rationale: a. If P > 0.05 then we don’t reject the null, but the P-Value in the question is <0.01 so we can reject the null. b. This interpretation would be correct if we were interpreting r values. c. Since the P < 0.05 the result is statistically significant. d. If P > 0.05 then the result would not be statistically significant.

Answer 15

Answers: A Rationale (1): a. Concurrent validity refers to how well one measure is correlated with the gold standard b. Content validity is the amount that a particular measure represents all constructs c. External validity relates to the generalizability of the results d. Internal validity refers to the actual study design and the control of variables

Answer 16

Answers: D a. Wrong because the MDC was calculated wrong, from the MDC equation, I multiplied (1.93 x SEM) x 2, instead of square root of 2. b. Wrong because the MDC was calculated wrong, from the MDC equation, I multiplied (1.93 x SEM) x 2, instead of square root of 2. Also if it were calculated correctly to be 9.02 the increase is less than the MDC. c. Wrong because the increase in score was 7 points and the MDC was 6.3 so the change is enough to be confident it’s not from measurement error. The MDC is calculated correctly here. d. Correct because the MDC is calculated correctly and the change in score is more than the MDC making us confident that the change is not due to error.

Answer 17

Answers: A Rationale: a. This is the correct answer because MCID is the minimal clinically detectable change and therefore tells us how much the score needs to change to see clinical significance. b. This answer is incorrect because this would be an example more so of cut-off scores. Cut-off scores would actually be more so that the patient hit a certain score and this has correlated and indicates higher risk of falling or lower extremity strength. c. This answer is incorrect because this would be an example of inter-rater reliability. In order to interpret this concept we would need to have an ICC value. d. This answer is incorrect because while it seems that the MCID would mean the minimal

Answer 18

Answers: D Rationale: All of these tests would be possible to administer on this patient. I created this question to test clinical and statistical reasoning of tests that we should know the protocol for. a. This answer is incorrect because while the statistically sound, the 5STS is not appropriate because gait is not being specifically tested. b. This answer is incorrect because while the statistically sound, the FSST is not appropriate because gait is not being specifically tested. c. This answer is incorrect because statistically it has the lowest specificity and sensitivity combination as well as it does not specifically test gait. d. This answer is correct because it specifically tests gait and balance and has moderate to good specificity and sensitivity. clinically detectable change would be from the norm values, it actually means the improvement or setback the patient has from their own, personal past scores.

Answer 19

Answers: D Rationale: a. MCID: 8 is less than 10 so there is no clinically important difference; MDC: 8 is greater than 5 so there is a detectable change that is not due to measurement error. Therefore, both parts of this answer are wrong. b. The first part is incorrect. c. The second part is incorrect. d. Both are correct.

Answer 20

ok 1) It is the thinking, working out problems, consulting patient/family, using judgement, consulting other health professionals, relying on experience, consulting literature, etc. ... and then processing all the info in order to make a decision that is best for the pt. 2) Both. It is the sum of thinking and decision-making processes associated with clinical practice. 3) False. It is important to know what the evidence says, but doesn’t mean that works for every person. You need to be creative, use your clinical reasoning skills, and individualize POC for each pt. 4) TRUE 5) - Critical thinking: the COGNITIVE piece of thinking - Clinical decision making: the ACTION or decision - Clinical reasoning: broad term that encompasses BOTH the thinking AND decision making. 6) True

Answer 21

``` 1) PT knowledge and eduction PT experience PT values, care, compassion Patient Values EBP Get patient to MOVE (movement system / anatomy) ``` Clinical reasoning is just one important component of the process. 2) Making a transfer is easy, but what if the pt has a tibial fracture, catheter, are bi-polar, NWB, lacking cognition, etc. Now you need to know what leg (so you know what way to transfer), are they WB or NWB, strength of the good leg (will you need to block), cognitive ability (follow directions). So now you can have all the knowledge in the world, but given the pt condition/situation, you need good clinical reasoning skills, care, compassion, and knowledge, and still get them to MOVE. Have to do ALL these. Most importantly, how do you take all the info and complexities and use your clinical reasoning. 3) False. There may not be just one correct way. There may be multiple ways, but take in all the info., and using clinical reasoning to create a plan. 4) True 5) False. It always develops, changes, is challenged, and needs improvement (and is different for every situation).

Answer 22

1) True. YOU HAVE TO REFLECT for clinical reasoning to go well. If you never reflect on what went well, or what you can improve, your clinical reasoning skills will never improve. 2) - Reflection-on-action: reflecting on experience AFTER event - Reflection-in-action: reflecting on experience DURING event - Reflection-for-action: Anticipating changes for FUTURE interactions 2A) Reflection-on-action is more deductive, and reflection-for-action is more inductive 3) - Novice = reflection-on-action - Expert = reflection-for-action

Answer 23

1) Hypothetico-deductive 2) Pattern recognition 3) NOVICE (new) clinicians ... the rookies 4) - Generate a hypothesis, then do tests/measures to test hypothesis - Lots of thinking it through - Lots of structure, processes, systems – and they need structure and to follow a process. 5) EXPERTS 6) - The expert recognizes patterns from experience - Pattern recognition, intuitive thinking, experience - It is quicker 7) False. Experts, do go back to ‘drawing board’ and use deductive reasoning if they don’t recognize a pattern. 8) Deductive (novices/new clinicians) 9) Deductive (novices/new clinicians) 10) - ICF model - Patient Management Model - Clinical Practice Guidelines - Clinical Prediction Rules/Guides 11) No, not really. You can’t really use inductive reasoning unless you have experience and can recognize patterns from seeing MANY many patients with the same issues. 12) - Reflection (on Experience) - Patterns - Open ended questions

Answer 24

- Cognitive - Behavior (action) - Affective (attitude) Learning is not only in the mind … you have to put it into action, and you have to CARE. If patients want to learn, they have to DO and they have to CARE.

Answer 25

- When you are not informed (lack of knowledge) - Bad data / information - Inability to interpret or comprehend data/info - Bad attitude - Don't believe - Biases - Not considering patients needs - Not consulting and factoring in the research - Not reflecting - Coming to an answer too early without enough information (not ruling in/out other issues).

Answer 26

1) - QuaNtitative is more objective, focuses on stats and numbers and statistical significance from a large sample size. - QuaLitative focuses less on the numbers and objective measures, but is more subjective research on real life patients 2) QuaNtitative is objective, QuaLitative is subjective 3) QuaNtitative 4) Quantitative 5) - Lab: QuaNtitative - Natural: QuaLitative QuaNtitative research is typically NOT done in a natural setting, it is in a lab in controlled environment. That is why a randomized controlled trials design is the highest level of quaNtitative research to try to mimic true patients and real settings. 6) - What: QuaNtitative - Why: QuaLitative 7) QuaNtitative 8) QuaNtitative 9) “interpretivism” 10) QuaLitative 11) - Numbers: QuaNtitative - Words: QuaLitative 12) Both 13) - QuaLitative uses more interview’s, focus group, questionnaire (open ended), participant observation - QuaNtitative uses more survey’s (closed-ended), collect data, numbers 14) - QuaLitative - QuaNtitative 15) - Validity = Confirmability (triangulation) - Internal Validity for quaLitative research = credibility - External validity in quantitative = transferability in qualitative - Reliability in quaLitative research = dependability 16) - QuaNtitative - QuaLitative 17) - QuaNtitative - QuaLitative 18) True 19) QuaNtitative has a control group typically, where quaLitative does not.

Answer 27

1) Triangulation is gathering info to generate VALIDITY in a QuaLitiative study. It is a powerful technique that facilitates validation of data through cross verification from two or more sources. In particular, it refers to the application and combination of several research methods in the study of the same phenomenon. 2) Interview, observation, artifact data – get it from all areas. You can get triangulation data from your research team, from an outside research team, from another research article. A research project where there are focus groups, individual interviews, observations, documents, etc. And they come from academic settings, clinical sites, and from all over the country. This is triangulation.

Answer 28

1) After data is collected (interview, document, focus group, observation) … you then need to categorize the data/info from research to make sense of it. It involves reading the data and giving labels or codes to the themes and ideas that you find. You create categories as you work through the data. You read it, interpret what you think it is saying, and then pull out key words and categorize / organize it into categories. Coding is an analytical process in which data, in both quantitative form (such as questionnaires results) or qualitative (such as interview transcripts) is categorized to facilitate analysis. Coding means the transformation of data for computer software. 2) False. In QuaLitative you CAN. But with QuaNtitative you can NOT. QuaNtitative is just collect all the data, then see results.

Answer 29

1) - Coding - Categorizing - Conceptualizing 2) Ok

Answer 30

Hand Heart Head

Answer 31

1) Coding 2) Words 3) - Open ended questions - Surveys - Interview - Questionnaires - Testimonials - Focus Groups - Journals - Observations - Stories - Case studies 4) - Just listing everything without categorizing it or analyzing it - Listing info that could identify the person - Taking comments and generalizing to the whole (quaLitative analysis and studies do NOT generalize to the whole). - Have a bias or interpretation of comments that benefit researcher or study 5) Called: Content Analysis - Get to know your data (spend lots of time ... read and re-read over and over, transcribe data, etc.) - Focus the analysis - Categorize the information (identify patterns/themes, organize into categories, give it labels). Also called CODING - Identify patterns within the various categories - Interpretation (bring it all together, what did you learn)

Answer 32

1) study of what befalls a population (related to health). Study of disease or conditions among a population. What their etiology and risk factors are, the impact on a population, the prognosis, preventative measures, etc.

Answer 33

1) - Prospective: The now and into the future. Who NOW has or will become injured / get the condition / get cured. - Retrospective: Looking into the past. Who already had the condition / injury. Prospective: study that watches for outcomes (development of a disease) during the study period and relates this to other factors such as suspected risk or protection factor(s). The study usually involves taking a cohort of subjects and watching them over a long period. Retrospective: study that looks BACKWARDS and examines exposures to suspected risk or protection factors in relation to an outcome that is established at the start of the study. Retrospective investigations are often criticized. 2) Prospective. Because when looking in the past (retrospective), there are so many why's that could contribute that you can't measure or account for. Can't determine cause and effect in retrospective studies. 3) Participants are all measured at the beginning - AT BASELINE - and then followed over time. Then it is recorded on who develops the condition and who doesn't, or who gets healed and who doesn't. It is then a comparison of individuals who develop the condition versus individuals who do not develop the condition. 3A) You have 2 groups at the start … those WITH the disease and those WITHOUT the disease/condition. It is a case-control study since some have the 'case' and some are the 'control' group. 4) - Prospective - Retrospective

Answer 34

1) A “cohort” is a group of individuals followed over time. A cohort could be people from same region, age, school, demographic aspect, condition, disease, injury, etc. 2) Framingham Heart Study (generations of people followed over time observing lifestyle conditions to determine cardiovascular disease development).

Answer 35

1) A study that compares patients who have a disease or outcome of interest (cases) with patients who do not have the disease or outcome (controls), and looks back RETROSPECTIVELY to compare how frequently the exposure to a risk factor is present in each group to determine the relationship between the risk factor and the disease. 2) - Have - Do NOT have 3) True - Case control studies are observational because NO INTERVENTION is implemented/attempted and no attempt is made to alter the course of the disease. The goal is to retrospectively determine (or observe) the exposure to the risk factor of interest from each of the two groups of individuals: cases and controls. 4) False 5) Retrospective studies 6) NO. An example ... if you are looking at pt's with OA retrospectively, you don't know if the OA was caused by obesity, injury, quad weakness, etc. Or ... if you are overweight you are more at risk for knee osteoarthritis. OR, did they get knee osteoarthritis that led to them being overweight. It is a chicken-egg thing and you don’t know what led to what.

Answer 36

**** IT's ALPHABETICAL - Endemic: presence of a disease within a specific geographic region - Epidemic: if the % of people with condition goes up in that region (basically if the diseases rises above the normal in that region) - Pandemic: it spreads world-wide

Answer 37

- Incidence: The number of NEW CASES of pathology in a given PERIOD OF TIME (expressed as a # / period of time). The injuries / exposures. 3.2 injuries per year (or per athlete exposures). - Prevalence: Proportion of population sample with pathology at given point in time (expressed as a % of the population). 2.7% of population has CHF

Answer 38

1) TRUE. It is not just 1 risk factor, it is usually many that play into getting condition. 2) - Intrinsic: within the person (internal) Ex: Sex, skeletal alignment, flexible or not, previous injuries, etc. - Extrinsic: outside of person or within the environment (external) Ex: Playing surface, protective equipment, aggression of other athletes, accidents, rules, etc. - Non-Modifiable (can’t change): Ex: Age, gender, genetics - Modifiable (CAN change) Ex: Occupation, obesity, joint injury, muscle strength 3) - Intrinsic: gender, age, skeletal alignment - Extrinsic: running surfaces, - Non-Modifiable: age, genetics - Modifiable: obesity, activities participating in, strengthening muscles, improving ROM, occupation

Answer 39

Sensitivity (Sn =): Ability of a test / intervention to CORRECTLY identify those WITH the condition Specificity (Sp =): Ability of the test / intervention to CORRECTLY identify those WITHOUT the condition SPin and SNout: - SPIN stands for SPecific tests rule IN the condition when the test is POSITIVE. - SNOUT stands for SeNsitive tests rule OUT the condition when they're NEGATIVE. Validity: How useful, accurate, truthful, and meaningful the study results are. Internal validity is how well the study was done (bias, randomized, blinding), and External validity is how applicable the results are to the general population (other patients). Correlation between IV & DV (Pearson’s r=): If Independent Variable (IV) impacts or creates change in Dependent Variable (DV) then there is a high correlation (validity). High correlation is closer to 1 (a r= 0.1 is low correlation between IV and DV). Reliability (ICC): When you do multiple tests / studies / measurements / interventions over time, you want them to be reliable and produce CONSISTENT repeated measures. Whether two tests over same day, or over multiple days, or through an intra-rater (same person doing multiple tests) or inter-rater (different testers) … Reliability is CONSISTENCY in test measurements over multiple tests. Effect Size (d=): Effect size is the magnitude, or SIZE OF AN EFFECT of an intervention, or size of difference between the two groups or interventions (experimental vs. the control group). P-value (p=): A small p-value (typically ≤ 0.05) indicates strong evidence AGAINST the null hypothesis, so you REJECT the null hypothesis (it means the IV is impacting DV, so there is correlation). A large p-value (> 0.05) indicates WEAK evidence against the null hypothesis, so you do NOT reject the null hypothesis (low correlation between IV and DV). Usually it is less than 0.05, but it tells us NOTHING about clinical significance. Type I and Type II Errors: - Type I errors: FALSE POSITIVE ('you are pregnant' to a man). You REJECT null hypothesis when it was true. (These are less common) - Type II errors: FALSE NEGATIVE ('you are not pregnant' to a pregnant woman). You do NOT reject null hypothesis when it was false. (These are more common) Sample Size: How large the group is being studied. Obviously the larger, the better (more statistical significance). Statistical Significance vs. Clinical Significance: Just cause you have statistical significance does NOT mean it is clinically relevant (and visa versa). Numbers Needed to Treat (NNT): Number of patients that must be treated in order to achieve one additional favorable outcome / prevent a bad outcome. It's the inverse of ARR (so NNT = 1/ARR) NNTB = Numbers needed to treat to get a Benefit. NNTH = Numbers needed to treat to cause Harm Agreement (kappa, k): K is the Kappa statistic which is INTER-RATER AGREEMENT (two PT's agree). It says two different PT's AGREE at 0.60 or 0.17 of this test/intervention. The higher to 1 the better or more agreement, closer to 0 is more chance and less agreement between testers. Bias: When researchers select participants in a biased way, or allocate / assign participants to a group (control or experimental) – this bias reduces the validity of the study. Blinding: Internal validity is improved when both the participants of the study, and the researchers / therapists are blinded to who is chosen for what group (control or experimental). Multiple Settings & Studies: Obviously the more the study is replicated, and then produces similar findings, the more valid and applicable it is. If the study was replicated by many different groups over time, in many different settings = more validity. Relative Risk (RR): The ratio of ... risk in the exposed group (cases) to the risk in the non-exposed group (controls). Exposed group risk / nonexposed group risk. A RR = 1 means risk is equal in both groups. If RR > 1, the risk in the exposed group is greater than the non-exposed group (positive association) If RR < 1, the risk more in the non-exposed (negative association) Ex: Smokers (exposed group) have a RR of 1.61 to developing CVD to non-smokers (non-exposed group) ... or smokers are 1.61 times more likely to get CVD than non-smokers. Relative Risk Reduction (RRR): Percentage that the treatment reduces risk compared to control. RRR = (1-RR) * 100 (goal is to get it to 100%). 75% RRR means 75% less likely to have an ACL tear if they do this program, or you’ve reduced the risk by 75%. Absolute Risk Ratio (ARR): The absolute arithmetic difference in event rates between control and experimental groups. Decrease in risk of treatment in relation to a control treatment. ARR= CER−EER. It is the inverse of NNT … so 1/NNT Odds Ratio (OR): A measure of association between an exposure and an outcome. The OR represents the odds that an outcome will occur given a particular exposure, compared to the odds of the outcome occurring in the absence of that exposure. OR = 1 implies that the event is equally likely in both groups OR > 1 implies that the event is more likely in the first group OR < 1 implies that the event is less likely in the first group Pre-test Probability: The probability of a patient having the target disorder BEFORE a diagnostic test result is known. Post-test Probability: The probability of a patient having the target disorder AFTER a diagnostic test result. (** To calculate post-test probability, use scale to set pre-test probability, then draw dot at the LR, then draw line through two dots to determine post-test probability). Likelihood Ratio (LR): +LR = sensitivity / (1-specificity) +LR > 10 is a test result with a LARGE effect on increasing the probability of disease/condition +LR between 5-10 is a test that has moderate effect on increasing the probability of the disease/condition +LR < 5 indicates a small effect on increasing the probability of the disease/condition -LR = (1-sensitivity) / specificity -LR < 0.1 indicates that the result has a large effect on decreasing the probability of the disease/condition -LR between 0.1-0.5 indicates that the test has a moderate effect on decreasing the probability of the disease/condition -LR > 0.5 indicates a small effect on decreasing the probability of the disease/condition

Answer 40

*** Most research is fabricated by researchers / professors / students / employees to try and get published, write a dissertation, prove their hypothesis, etc. But, if I find a study that has a HIGH sensitivity with a HIGH specificity, and the sample size in the study was statistically significantly large, there has to be a high correlation between independent and dependent variables, high reliability (ICC) between different tests and testers, effect size is high, agreement (k), etc. There has to be NO bias, random sampling and allocation done, participants and researchers / therapists were blinded, and the study was replicated in multiple times in multiple settings. IF ALL OF THIS IS TRUE ... then I have confidence that it is a valid study with enough data to implement in my clinical practice with patients. Otherwise … clinical experience > EBP.

Answer 41

1) - Systematic Reviews (and Meta-Analysis) - RCT's - Cohort Studies - Case Control Studies - Case Reports - Ideas, editorials, opinions - Animal research - In vetro research 2) - Systematic Reviews: are the best studies as they summarize multiple studies on a topic into one paper. Instead of having to read 50 articles on the topic, a systematic review will bring all that research, data, and conclusions from all 50 into one succinct paper to not only save the clinician time, but to also provide evidence from multiple RCT’s on outcomes and interventions (and clinical practices) that are best for the patient based on research / evidence. - Meta-Analysis: These will thoroughly examine a number of valid studies on a topic and mathematically combine the results (data) using accepted statistical methodology to report the results as if it were one large study. - Randomized Controlled Studies: **** Gold Standard for Clinical Trials. These are carefully planned experiments that introduce a treatment or exposure to study its effect on real patients. They include methodologies that reduce the potential for bias (randomization and blinding) and that allow for comparison between an experiment group (gets intervention) and a control group (who doesn’t get intervention) to see if IV will impact the DV being studied. A randomized controlled trial is a planned experiment and can provide sound evidence of cause and effect. - Secondary Analysis of a Cohort Study: Researchers just look at the data from a previously done Cohort Study and analyze that data. Typically researchers do this to manipulate data to whatever their hypothesis is. - Cohort Study: Identify a group of patients who are already taking a particular treatment or have an exposure, follow them forward over time (prospective), or looking back in time (retrospective), and then compare their outcomes with a similar group that has not been affected by the treatment or exposure being studied. Cohort studies are observational and not as reliable as randomized controlled studies, since the two groups may differ in ways other than in the variable under study. - Case Control Studies: Studies in which patients who already have a specific condition (the 'cases') are compared with people who do not have the condition (the 'controls'). The researcher looks back to identify factors or exposures that might be associated with the illness. They often rely on medical records and patient recall or surveys for data collection. These types of studies are often less reliable than randomized controlled trials and cohort studies because showing a statistical relationship does not mean than one factor necessarily caused the other. Researchers could gather certain data, or manipulate it, to prove hypothesis. - Case Report: Studies of a single patient. It follows the ICF model, but has no control group, no experimental factor, etc. Just studies that one person's specific case / intervention / outcomes. It doesn’t suggest cause and effect, but it does typically lead to further research studies.

Answer 42

1) NO. You cannot because you do not know the incidence of the exposed population. All individuals in the exposed group have the condition. 2) RR used for a PROSPECTIVE study. *** I can't determine the risk of you getting a condition if you already have it (retrospective). That is why RR can only be calculated in a prospective study, and case-control studies are retrospective. 3) OR can be used in case-control and prospective study

Answer 43

``` Mortality: Provides an insight of disease severity # of deaths / population ``` Morbidity: # of people in population who become ill (where mortality is about actual deaths)

Answer 44

1) - Clinician: Objective. DOE. (ROM, MMT) - Patient: Subjective. POE. Functional abilities (patient self report) verbally or through SF-36, DASH, LEFS 2) Randomizing should limit bias, but not necessarily mean there is blinding. Blinding limits experimenters from knowing, and randomization just picks people for control vs. experiment group at random. 3) A “Historical Control” is someone who has had a condition for a while now (and it’s not going away soon). They are a "control" participant in the study. 4) “Utilizers vs. Non-Utilizers” … some with LBP go to PT, and some do NOT go to PT (went somewhere else or didn’t go in). And compare them. 5) * ** Effectiveness relates to how well a treatment works in practice, as opposed to efficacy, which measures how well it works in clinical trials or laboratory studies. ***Sometimes the line between the two is gray. - Efficacy: Determined in a controlled experimental situation/enviornment with ideal conditions (very controlled). Very very controlled study, and a smaller controlled study. Effectiveness: Examines outcomes in real life situation. More real world and less standardized study, and bigger study and less controlled.

Answer 45

1) Decision making tools for clinicians including 3 or more variables. Quantifies individual results from various components of the history and physical exam to help the clinician make a diagnosis, prognosis, or likely response to treatment in an individual patient. They are the combination of clinical findings (cluster) that provide meaningful predictions about an outcome (diagnosis, treatment) of interest. 1A) Ottowa Ankle Rules 2) - Clinical prediction rule (but they are NOT rules, just guides) - Clinical decision rule 2A) - Helps improve clinician decision making - It improves patient outcomes - It improves, predicts and helps establish a diagnosis' better - It improves patient care / satisfaction - It reduces cost - Helps PT know when to refer pt 2B) - Who the guide is intended for (what type of pt or condition) - Performance characteristics - Conditions of when to apply it *** We need to know who the guideline is intended for (not everyone fits into the same treatment bucket). 2C) General industry wide statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options. *** Make recommendations for best practice 3) - Clinical prediction rules: derived from original research involving many patients and mathematical analysis. - Clinical Practice Guidelines: Consensus among many experts and much more broad comprehensive advice/guidelines. ** CLINICAL PREDICTION GUIDES are not clinical practice guidelines. The guide is a single investigation and focused. The guidelines are a systematic summary of findings and more comprehensive. 4) Position Statement 5) NO 6) NO 7) - Should be <5 years old or must be revised ever 5 years - Sponsoring organization should not be biased, but rather should be objective. 8) - Recommendations from industry experts (expert panel of clinician-scholars) to optimize patient care - Informed by MANY systematic reviews of evidence - Updated regularly to be up to date - Synthesize the best evidence / research to improve care for patients - Assist clinicians in making choices - Much more comprehensive than a single study - Not prescriptive 9) No. CPG's are broad recommendations for the practice of physical therapy. These guidelines do NOT tell you specifically what to do, they give broad general guidelines.

Answer 46

Regression or correlation So values close to one are more related or correlate to each other.

Answer 47

1) - These Clinical Prediction Guides are helpful tools and resources to new clinicians who need help to get started. - There are patterns, historical experience, proven methods, etc. that other clinicians have been through – and these guidelines are their experience and advice, and it is helpful. - They can enhance accuracy and efficiency of decision making. - They help to make a diagnosis - Give structure 2) The Goldman Algorithm: - Basically shows a flow chart for Dr's to use when people come into the ER having chest pain – a systematic way to know whether they were having a MI or not. It is just a guideline to help you have a plan or pattern on if they have a disease, and how to tell. - So if a person met the 4 criteria (ECG, pain, fluid, BP) it had a high sensitivity to predict who was having a MI. 3) True

Answer 48

1) 10 or higher (LR > 10 indicates that the test result has a large effect on increasing the probability of disease presence) 2) Less than 0.1 (a LR of <0.1 indicates that the result has a large effect on decreasing the probability of disease presence) 3) Shows this test is NOT good for having the test predict HAVING the injury (since it is a +LR of 1.77), but it is REALLY GOOD at having the test predict NOT having the condtion (since -LR is 0.02) 4) To calculate post-test probability, use scale to set pre-test probability, then draw dot at the LR, then draw line through two dots to determine post-test probability. 5) OAR's are NOT good at ruling IN an ankle injury since +LR is 1.57, and OAR is very good at ruling OUT an ankle injury since -LR is 0.08

Answer 49

1) - Systematic Reviews: are the best studies as they summarize multiple studies on a topic into one paper. They focus on a specific question, but instead of having to read 50 articles on the topic, a systematic review will bring all that research, data, and conclusions from all 50 into one succinct paper to not only save the clinician time, but to also provide evidence from multiple RCT’s on outcomes and interventions (and clinical practices) that are best for the patient based on research / evidence. - Meta-Analysis: These will thoroughly examine a number of valid studies on a topic and mathematically combine the results (data) using accepted statistical methodology to report the results as if it were one large study. It is a quaNtitative synthesis of the data of the systematic review of these multiple studies. 2) Obivoulsy systematic reviews are better than RCT's, and RCT's are better than case-control studies, etc. etc. But you also have sub grades within each category. So JOSPT and Modified CEBM scales are other ways to grade evidence. 3) False. Researchers can still pick and choose what studies to include. There can still be bias. 4) False. Just cause there is statistical significance, does NOT mean there is clinical significance. Plus, if the systematic review was done 20 years ago, it is out of date. Good systematic reviews are current within last few years (but those are hard to find).

Answer 50

1) Basically a systematic review starts with a question and follows a formal process. Traditional (Narrative or Literature) reviews typically do NOT have a clear methodological approach with subjective summaries (maybe from a biased author/expert). **** A literature review is often limited because it supports a position taken by the author, whereas a systematic review begins with an answerable question and works through a planned process. - Literature reviews: don't start with a ?, may be biased, are more broad, not evidence based, and offer a quaLitative or subjective position taken by the author. - Systematic reviews: starts with a focussed clinical ?, follows a formal process, provides results from multiple studies, is evidence based, etc. 2) It is a type of systematic review ... pools the data to give a quaNtitative estimation of the magnitude of the effect. Basically it is a type of systematic review where the DATA in multiple studies are pooled. 3) The “subjects” in these Meta-Analysis studies are NOT people, they are the actual STUDIES being reviewed. 4) Need to make sure all "subjects" (studies) are similar. Ideally each study is a RCT, had blinding, and use same methods and measures. 5) In order to do an Meta Analysis, the studies have to be similar enough. You can’t compare study with comparing knee OA and people did exercise for 3 weeks, and then a different study did exercise for 40 weeks. Those two studies are NOT similar in their methods, so it is comparing apples to oranges. You also can’t get several RCT’s and combine those with a bunch of case-reports and those all go into Meta-Analysis. Or comparing 18 yr olds in one study, to 65 yr olds in another study. Or one study does the TUG and another does the 10m walk test for balance … those two results can’t be combined and averaged. That won’t work since they aren’t similar studies. The studies have to be similar enough (there is a little bit of gray, but need to be similar enough). So "inclusion" criteria for each study used needs to be similar with: participants, demographics, interventions, measurements, timing, etc. 6) PRISMA‐ Preferred Reporting Items of Systematic Reviews and Meta‐Analyses MOOSE‐ Meta‐Analysis of Observational Studies in Epidemiology PRISMA and MOOSE are databases to find these studies. 7) True

Answer 51

1) incidence rate

Answer 52

- Case Reports: Most likely your CI will have you go look at the literature and come up with a plan on how to treat a patient. Or if you get experience with a difficult case, then publish it to help other clinicians in the future who see that case. Can be retrospective or prospective. - Grand Rounds = An important teaching tool and ritual of medical education (students) and inpatient care, consisting of presenting the medical problems and treatment of a particular patient to an audience consisting of doctors, residents and medical students. When a student presents a case to other clinicians and gets their input based on their experience. Where students / residents present a case and the more Sr. members of the group provide input. It is basically presenting a patient case, do a literature review, and get input from others. Grand rounds depends on: - Willing participants who can provide GOOD feedback - Respect for everyone involved - A review of the literature - Get the student to think (not just given answers)

Answer 53

Knowledge, clinical experience, clinician values (care, compassion), patient needs, and movement/exercise/treatment.

Answer 54

1) 1.5-2.0 2) Prevalence 3) Single Subject Design 4) Applicable to patient care

Exam 2 / Final Flashcards

(85 cards)