Week 2

Question 1

Define EBM

Answer 1

“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

Question 2

What are the 5 steps of EBM

Answer 2

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

Question 3

What are the models of EBM attitudes

Answer 3

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.

Question 4

How to form a scientific question?

Answer 4

Use the PICO Model

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

Question 5

Understand the EBM landscape:

Types of studies!

Answer 5

Experimental: researches introduce interventions

Observational: No intervention, just observations

Question 6

Pyramid hierarchy (From highest to lowest)

Answer 6

1. Systematic Reviews/Meta-analyses
2. Randomized Controlled Trials (RCTs)
3. Cohort studies
4. Case-control studies
5. Case series/reports
6. Expert opinion

Question 7

Explain the EBM outcome measures

Answer 7

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)

Question 8

Apply EBM search stratergies

Answer 8

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

Question 9

Explain BIAS

Answer 9

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

Question 10

Explain Triangulation

Answer 10

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

Question 11

Explain Reflexivity

Answer 11

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

Question 12

Explain Push Survey

Answer 12

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

Question 13

Explain Placebo effect

Answer 13

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

Question 14

Explain Nocebo Effect

Answer 14

Worsening symptoms due to negative expectations or belief in harm

Question 15

Qualitative studies are?

Answer 15

Explore lived experiences, perceptions, and social meanings

Allow for context-rich understanding of behavior and beliefs

Complement quantitative research and are crucial for EBP

Question 16

Differentiate between black and white literature vs grey literature

Answer 16

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

Question 17

Explain why ethics is so important

Answer 17

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

Question 18

Difference between Retrospective, Prospective, and Longitudinal Studies

Answer 18

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

Prospective: Follows subjects forward

Longitudinal: Follows same subjects over a long time

Question 19

What are the difference signs of Pseudoscience vs. Science?

Answer 19

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

Question 20

What are the various aspects of the EBM Triad?

Answer 20

The Evidence-Based Medicine Triad:

1. Best available research evidence

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

2. Clinical expertise

• The practitioner’s own experience, judgment, and skillset

3. Patient values and preferences

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

Question 21

Name and Describe Some of the Various Causes of Cognitive Bias

Answer 21

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.

Question 22

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

Answer 22

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

Question 23

What is the Difference Between Placebo and Nocebo?

Answer 23

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

Question 24

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

Answer 24

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

Question 25

What is Knowledge Translation?

Answer 25

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

Question 26

Key points of knowledge translation

Answer 26

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.

Question 27

Current Limitations of Chiropractic Research in Australia

Answer 27

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.

Question 29

Summary of Findings – Lyndon-Woods et al.

Answer 29

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

Question 30

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

Answer 30

C

Question 31

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

Answer 31

B

Question 32

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

Answer 32

B

Question 33

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

Answer 33

C

Question 34

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

Answer 34

B

Question 35

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

Answer 35

B

Question 36

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

Answer 36

C

Question 37

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

Answer 37

C

Question 38

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

Answer 38

C

Question 39

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

Answer 39

B

Question 40

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

Answer 40

C

Question 41

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

Answer 41

C

Question 42

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

Answer 42

D

Question 43

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

Answer 43

B

Question 44

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

Answer 44

A

Question 45

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

Answer 45

B

Question 46

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

Answer 46

C

Question 47

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

Answer 47

C

Question 48

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

Answer 48

B

Question 49

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

Answer 49

C

Question 50

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

Answer 50

C

Question 51

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

Answer 51

B

Question 52

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

Answer 52

C

Question 53

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

Answer 53

C

Question 54

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

Answer 54

B

Question 55

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

Answer 55

C

Question 56

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

Answer 56

C

Question 57

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

Answer 57

B

Question 58

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

Answer 58

C

Question 59

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

Answer 59

A

Question 60

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

Answer 60

B

Question 61

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

Answer 61

A

Question 62

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

Answer 62

C

Question 63

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

Answer 63

C

Question 64

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

Answer 64

B

Question 65

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

Answer 65

C

Question 66

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

Answer 66

B

Question 67

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

Answer 67

B

Question 68

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

Answer 68

B

Question 69

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

Answer 69

B

Question 70

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

Answer 70

D

Question 71

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

Answer 71

B

Question 72

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

Answer 72

C

Question 73

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

Answer 73

C

Question 74

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

Answer 74

C

Question 75

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

Answer 75

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

Question 76

List the 5 steps in the EBM process in order.

Answer 76

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

Question 77

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

Answer 77

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

Question 78

Differentiate between a prospective and retrospective study.

Answer 78

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).

Question 79

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

Answer 79

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

Question 80

Describe the difference between a placebo and a nocebo effect.

Answer 80

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.

Question 81

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

Answer 81

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.

Question 82

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

Answer 82

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.

Question 83

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

Answer 83

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.

Question 84

List three current limitations of chiropractic research in Australia.

Answer 84

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