Week 2 Flashcards by Dakota Wilckens

Define EBM

“The conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of individual patients.”

involves:
best avaliable research evidence
clinical expertise
patient value and preferences

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What are the 5 steps of EBM

Ask a clear, answerable clinical question (PICO format)
Acquire the best available evidence
Appraise the evidence for quality and relevance
Apply the evidence to clinical practice
Assess the effectiveness and performance

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What are the models of EBM attitudes

Evidence Appropriatism: Emphasizes suitability over hierarchy. Best approach.

Evidence Agendaism: Cherry-picking data to support a pre-set agenda.

Evidence Nihilism: Rejecting action unless there is definitive evidence.

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How to form a scientific question?

Use the PICO Model

P- population
I - intervention
C - Comparison
O - Outcome

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Understand the EBM landscape:

Types of studies!

Experimental: researches introduce interventions

Observational: No intervention, just observations

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Pyramid hierarchy (From highest to lowest)

Systematic Reviews/Meta-analyses
Randomized Controlled Trials (RCTs)
Cohort studies
Case-control studies
Case series/reports
Expert opinion

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Explain the EBM outcome measures

Pain Scales: VAS (Visual Analog Scale), 0–10 ratings

Neck Disability Index (NDI): Assesses impact of neck pain

Oswestry Disability Index (ODI): Gold standard for low back pain function

SF-36: 8 health domains (physical, mental, pain, vitality, etc.)

Beck Depression Inventory: Depression severity

Well-being Index: General subjective well-being

Likert Scale: Measures attitudes/perceptions (commonly used in surveys)

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Apply EBM search stratergies

Use MeSH terms (Medical Subject Headings) on PubMed, Medline, Cochrane

Reference tracking is essential to confirm claims

Combine keyword + subject heading searching

Be critical of search engine results—always verify journal, author, and context

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Explain BIAS

Bias (systematic error):

Confirmation Bias: Favoring info that supports beliefs

Anchoring Bias: Relying too much on first info

Availability Heuristic: Overemphasizing recent or memorable events

Observer Bias: Researcher’s expectations affect outcomes

Selection Bias: Non-representative participant sample

Funding/Publication Bias: Favorable outcomes get published more

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Explain Triangulation

Using multiple sources, methods, or observers to cross-verify data and improve validity.

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Explain Reflexivity

Ongoing self-reflection by researchers on how their personal background, experiences, and biases influence their research.

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Explain Push Survey

A manipulative survey designed to elicit a biased response. E.g. “DJ’s lecture was the best ever! Rank: Good, Great, Excellent.”

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Explain Placebo effect

Improvement due to the belief in treatment, not the treatment itself.

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Explain Nocebo Effect

Worsening symptoms due to negative expectations or belief in harm

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Qualitative studies are?

Explore lived experiences, perceptions, and social meanings

Allow for context-rich understanding of behavior and beliefs

Complement quantitative research and are crucial for EBP

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Differentiate between black and white literature vs grey literature

Peer-reviewed

Indexed in databases (e.g., PubMed, Scopus)

Includes journals with impact factors

Considered higher scientific credibility

Grey Literature:

Not indexed/peer-reviewed

Includes policy documents, reports, conference abstracts, textbooks

Quality is variable, needs critical appraisal

Sometimes contains valuable early or alternative insights

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Explain why ethics is so important

Any study involving humans or animals must go through an Ethics Review Board (ERB).

Key ethical concerns:

Informed consent

Participant anonymity

No coercion or undue harm

Fair treatment and benefit sharing

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Difference between Retrospective, Prospective, and Longitudinal Studies

Retrospective: Looks back (e.g., chart reviews)

Prospective: Follows subjects forward

Longitudinal: Follows same subjects over a long time

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What are the difference signs of Pseudoscience vs. Science?

SCIENCE:
- Based on empirical, testable evidence
- Transparent methods and peer review
- Willing to change based on new evidence
- Seeks to falsify and test theories
- Uses structured methodology
- Clearly defined terms

PSEUDOSCIENCE:
- Relies on anecdotal or untestable claims
- Lacks peer review, often secretive
- Resistant to change or criticism
- Confirms biases; cherry-picks supportive info
- Often vague, lacks controls or replication
- Ambiguous or exaggerated terminology

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What are the various aspects of the EBM Triad?

The Evidence-Based Medicine Triad:

Best available research evidence

Data from peer-reviewed clinical studies, meta-analyses, etc.

Clinical expertise

The practitioner’s own experience, judgment, and skillset

Patient values and preferences

Respecting the patient’s personal choices, goals, and cultural beliefs

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Name and Describe Some of the Various Causes of Cognitive Bias

Confirmation Bias: Favoring info that supports existing beliefs; ignoring contradiction.

Anchoring Bias: Over-reliance on the first piece of information received.

Availability Heuristic: Giving more weight to information that is easily recalled or more dramatic.

Bandwagon Effect: Adopting ideas because they’re popular, not necessarily valid.

Dunning-Kruger Effect: People with low ability overestimate their competence; experts underestimate theirs.

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Name and Describe Some of the Various Causes of Bias in Research

Selection Bias: Sample doesn’t represent the population (e.g., recruiting only gym-goers for fitness study)

Measurement Bias: Use of faulty tools or leading questions skews data

Observer Bias: Researcher expectations influence interpretation

Publication Bias: Journals prefer to publish positive results

Funding Bias: Results influenced by who pays for the research (e.g., pharma-sponsored trials)

Reporting Bias: Selective disclosure of results

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What is the Difference Between Placebo and Nocebo?

PLACEBO:
Beneficial outcome from an inert treatment due to expectation of benefit

Improves symptoms despite no active ingredient

NOCEBO
Harmful outcome from a neutral intervention due to expectation of harm

Patient feels worse because they expect to

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What Does the SF-36 Measure? And the Other Measures Discussed?

SF-36

8 domains of health: pain, physical functioning, vitality, mental health, emotional/social role, general health

Gold standard for comprehensive health-related QoL

NECK DISABILITY INDEX

Disability due to neck pain

Used for both acute and chronic neck pain

OSWESTRY DISABILITY INDEX

Functional status in low back pain

Gold standard for LBP assessment

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What is Knowledge Translation?

Knowledge Translation (KT) refers to the process of effectively disseminating research findings and integrating them into clinical practice.

Key points of knowledge translation

It’s one of the biggest challenges in healthcare. Clinicians may resist adopting new evidence-based practices if: They already see patient satisfaction They have large volumes of anecdotal clinical success KT ensures that valuable evidence isn’t wasted and reaches front-line healthcare.

Current Limitations of Chiropractic Research in Australia

1. Limited Financial Resources - Chiropractic receives less research funding than professions like pharmacy or medicine. 2. Small Research Workforce - Estimated 200–300 researchers worldwide in chiropractic. Few researchers are full-time or producing consistent evidence-based work. 3. Weak Research Infrastructure - Many chiropractic programs lack dedicated research departments. 4. Fragmented Funding and Goals - Different funding bodies (ACA, ASRF, CA Research Foundation) work independently with little collaboration. 5. Need for Workforce Planning - There's a push to develop research capacity, improve communication, and host research conferences to unite stakeholders. 6. Barriers to Publication and Uptake - Chiropractors often lack access to or training in academic publishing.

Summary of Findings – Lyndon-Woods et al.

Study purpose: Compare the research priorities and perspectives of Australian chiropractic practitioners vs academics. Method: - Mixed-methods survey - Sample: Practitioners: 340 respondents Academics: 33 respondents KEY FINDINGS: Acedemics: - Prioritized musculoskeletal (MSK) conditions research - Want to build on current MSK evidence Practitioners: - Preferred research into pediatrics, non-MSK conditions, and basic sciences - Want to expand chiropractic’s scope and explore under-researched areas

What is the primary goal of critical thinking in healthcare? A) Defending your opinions B) Memorizing treatment guidelines C) Analyzing and evaluating arguments for soundness D) Following tradition

Which type of reasoning starts with a theory and tests it through observation? A) Inductive B) Deductive C) Abductive D) Circular

Abductive reasoning involves: A) Broad generalizations B) Drawing a probable conclusion based on limited information C) Testing a universal law D) Challenging a hypothesis with a control group

What is a logical fallacy? A) An irrelevant opinion B) A scientific bias C) An error in reasoning D) A type of hypothesis

Which fallacy attacks the person rather than their argument? A) Straw man B) Ad hominem C) Red herring D) False dichotomy

What does EBM stand for? A) Ethical-Based Medicine B) Evidence-Based Medicine C) Expert-Based Method D) Empirical Biomedical Model

Which of the following is not a synonym for EBM? A) Evidence-Informed Practice B) Evidence-Based Healthcare C) Evidence-Based Judgement D) Evidence-Based Chiropractic

What decade did EBM emerge as a formal approach in healthcare? A) 1950s B) 1970s C) 1990s D) 2000s

The EBM Triad includes all EXCEPT: A) Best available research B) Clinical expertise C) Legal policies D) Patient values/preferences

Who is known for a classic definition of EBM? A) BJ Palmer B) Sackett C) Still D) Logan

The EBM process requires that evidence is always combined with: A) Legal consent B) Peer review C) Professional judgment and patient input D) Statistical review only

Which of the following is the ideal attitude toward evidence according to the lecture? A) Evidence Nihilism B) Evidence Agendaism C) Evidence Appropriatism D) Evidence Resistance

What is the first step of the EBM process? A) Assess B) Acquire C) Appraise D) Ask

What is the final step in the EBM process? A) Apply B) Assess C) Ask D) Appraise

What does the “O” in PICO stand for? A) Outcome B) Observation C) Objective D) Output

Which of the following best describes the “C” in PICO? A) Case study B) Comparison C) Condition D) Cause

Example of a PICO question: In adults with knee osteoarthritis (P), does exercise (I) compared to NSAIDs (C) reduce pain (O)? This is an example of: A) An observational summary B) A qualitative report C) A structured clinical question D) A theoretical assumption

What is at the top of the traditional evidence hierarchy? A) Expert opinion B) Case reports C) Systematic reviews and meta-analyses D) Cohort studies

Observational studies differ from experimental studies because they: A) Introduce an intervention B) Observe without manipulating variables C) Always use blinding D) Use control groups only

An RCT is an example of which type of study? A) Observational B) Descriptive C) Experimental D) Cross-sectional

A retrospective study looks: A) Into future events B) At current beliefs C) Backward at previous data D) At alternative models

What is a longitudinal study? A) Study conducted over a short time B) Follows subjects over an extended period C) Involves only one observation D) Is always experimental

What is a key feature of a validated outcome measure? A) Peer-reviewed author B) Emotional response C) Scientific accuracy and repeatability D) Intuition

Which tool measures disability due to neck pain? A) Oswestry B) Beck C) NDI D) SF-12

The Oswestry Index assesses: A) Depression B) Low back pain-related disability C) General well-being D) Social functioning

The SF-36 includes all of the following EXCEPT: A) Vitality B) Physical function C) Adjustment accuracy D) Pain

Which tool measures mental health by scoring depression symptoms? A) Likert B) SF-36 C) Beck Depression Inventory D) Visual Analog Scale

What is a Likert scale commonly used for? A) Diagnosing back pain B) Measuring opinion or agreement C) Analyzing nutrition D) Measuring spinal angles Answer: B

Bias is best defined as: A) Peer-reviewed research B) Accurate data C) Systematic error in thinking or research D) A variable

Which bias involves favoring information that supports your belief? A) Confirmation bias B) Measurement bias C) Observer bias D) Reflexivity

What is observer bias? A) Sampling error B) Researcher's expectations influence interpretation C) Participant dishonesty D) Faulty tools

Triangulation refers to: A) Using multiple perspectives or methods in research B) A chiropractic diagnostic test C) Reflecting on one’s own values D) Repeating a study

Reflexivity is the act of: A) Repeating a method B) Applying consistent force C) Critically reflecting on how your own views affect your research D) Interpreting graphs

The placebo effect refers to: A) Negative side effects B) No reaction at all C) Improvement due to belief in treatment D) Proper application of medicine

What is the nocebo effect? A) Side effects caused by a real drug B) Adverse effect due to negative expectations C) Lack of placebo D) Toxicity

A push poll is designed to: A) Collect accurate feedback B) Measure physical force C) Manipulate survey responses D) Test for range of motion

Black-and-white literature refers to: A) Grey zone data B) Peer-reviewed, indexed journal articles C) Government propaganda D) Marketing brochures

Grey literature includes all EXCEPT: A) Textbooks B) Peer-reviewed journals C) Policy reports D) Conference proceedings

Which source is considered most credible in EBM? A) Blog posts B) Indexed peer-reviewed journals C) Grey literature D) Social media posts

Which search engine is specific to chiropractic literature? A) Google B) Index to Chiropractic Literature C) Medscape D) Yahoo

Which of the following is NOT a trusted health research engine? A) PubMed B) Cochrane C) Google Scholar D) TikTok

What is the largest chiropractic research funder in Australia? A) WHO B) ACA C) ASRF D) CA Research Foundation

A major barrier to chiropractic research in Australia is: A) Oversupply of researchers B) Too much funding C) Weak infrastructure and limited full-time researchers D) No interest in patient care

According to Lyndon-Woods et al., what research area did academics prioritize? A) Pediatrics B) Nutrition C) MSK (musculoskeletal) conditions D) Neurology

What area did practitioners want more research in (per Lyndon-Woods et al.)? A) Spinal surgery B) MSK only C) Non-MSK, pediatrics, and basic sciences D) Radiology

Define Evidence-Based Medicine and name its three core components.

Evidence-Based Medicine (EBM) is the conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of individual patients. The three core components are: Best available research evidence Clinical expertise Patient values and preferences

List the 5 steps in the EBM process in order.

Ask a focused clinical question (e.g. using PICO) Acquire the best available evidence Appraise the evidence for quality and relevance Apply the evidence in clinical practice Assess the outcomes and reflect on performance

What is the purpose of using a PICO format in research? Provide an example.

PICO is used to structure clinical questions for research, making them clear and answerable. Example: P: Adults with chronic low back pain I: Chiropractic spinal manipulation C: Pain medication O: Reduction in pain and improved function

Differentiate between a prospective and retrospective study.

Prospective study: Follows subjects into the future to observe outcomes after an intervention or exposure (e.g. RCTs). Retrospective study: Looks backward at existing data or past events to find correlations (e.g. case-control studies).

What is the SF-36 tool used for? List three domains it measures.

The SF-36 is used to assess overall health-related quality of life. Three domains it measures: Physical functioning Mental health Pain

Describe the difference between a placebo and a nocebo effect.

Placebo effect: Positive health outcome from an inert treatment due to the patient’s expectation of benefit. Nocebo effect: Negative outcome due to the patient’s expectation of harm, even if the treatment is inactive.

Explain what a push poll is and why it is considered biased.

A push poll is a type of survey designed to influence the respondent’s opinion through leading or manipulative questions rather than gather unbiased data. It introduces systematic bias and undermines data validity.

What is reflexivity in qualitative research and why is it important?

Reflexivity is the process where researchers reflect on how their own background, experiences, or biases influence the research process and interpretation. It’s important to maintain transparency and credibility in qualitative studies.

What did the Lyndon-Woods et al. study reveal about academic vs practitioner research interests?

Academics prioritized research into musculoskeletal (MSK) conditions to build on existing evidence. Practitioners preferred focus on pediatrics, basic sciences, and non-MSK conditions, indicating a divergence in research priorities.

List three current limitations of chiropractic research in Australia.

Limited funding and resources compared to other health professions Few full-time researchers, and low academic publication rates Lack of collaboration between funding bodies and research organisations

Week 2 Flashcards

(85 cards)