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48 Cards in this Set
- Front
- Back
- 3rd side (hint)
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What is biologic plausibility?
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Something makes practical sense based on knowledge of anatomy, biomechanics, physiology and provides a logical pathway from basic science to clinical application
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Clinical pathway to support Evidence based medicine
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1. Ask question
2. Find evidence (lit review) 3. Critical appraisal (understand it) 4. Translate and integrate 5. Apply and assess 6. Contribute (do your own research) |
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What is qualitative research?
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Examines beliefs, understanding and attitudes through a skillful interview and specific content analysis
Sports DSP Not as common as Quantitative in the PT literature |
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In vitro vs. in vivo
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In Vitro: Evidence from a cellular level, difficult to translate in the real world. ie. animal studies or biomechanical studies on cadavers
In Vivo: real life, ie strain gauges on ACL |
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Three types of research designs that provide evidence
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1. Analytical: Systematic reviews and meta-analyses
2. Descriptive: Surveys, correlations, epidemiological studies, EMG studies 3. Experimental: Efficacy of interventions |
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Three sub-categories of experimental research designs
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1. Pre-experimental: pre-post testing of one of more groups
2. True experimental: Randomized with control group 3. Quasi-experimental: desgiend to fit real world applications while controlling threats to internal validity by using a pseudo control group |
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Describe the Levels of Evidence from the Center for Evidence-based Medicine in Oxford, England
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I: highly controlled RCT, systematic reviews
II: Lesser quality RCT, retrospective study, cohort, systematic reviews with no controls III: case-controlled IV: case series V: expert opinion |
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Describe the Grades of Evidence, adapted from the Center for Evidence-based Medicine in Oxford, England
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A: Consistent level I studies
B: Consistent Level II or III C: Level IV D: level V |
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Where to begin Lit Review
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Physiotherapy Evidence Database (Pedro) b/c contains over 19,000 RCTS, systematic reviews and CPGs
PubMed (but doesn't index all journals) CINAHL, CENTRAL, EMBASE *Use 4 with Boolean operations (and, or) |
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Two most important questions to ask when critically appraising an article
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1. Was the study design appropriate to answer the question and provide the correct evidence?
2. Was the statistical analysis appropriate to answer the research question through the design -Essentially, was the design and statistical analysis correct? |
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Problems with RCTs?
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They may have very narrow clinical relevanace
Experimenatal conditions established in RCTs to determine cause and effect don't always represent the heterogeneity of a patient population |
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What is a meta-analysis?
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-Systematic review of evidence along with POOLED ANALYSIS of data
-Quantifies the results of various studies to a standard metric that allows for statistical analysis to calculate EFFECT SIZES -Uses a forest plot to visually show results of individual studies and showing CONFIDENC INTERVAL |
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What is a quasi experimental
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RCT with 2 groups, but no true control
Both groups get some sort of intervention Often more practical that true experimental design |
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Types of cohorts
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1. Pre-post (one training group, follow them)
2. Correlation: Relationship between 2 variables: evaluation and injury 3. Epidemiological: occurrence rates 4. Descriptive; EMG 5. Preventive: ID risk factors, intervene, and follow 6. Diagnostic: clinical exam to gold standard |
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Three types of case studies
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1. Case control (retrospective comparison of one group to a control)
2. Case series 3. Case study (one) |
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Are cohort studies randomized?
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No, they are observational studies with no experimental design
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Two basic types of statistics
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1. Descriptive: identify central tendency (mean, median, mode), variability, and confidence intervals. ie. regression analyses
2. Experimental: inferential (can be applied to a broader population). ie. T-tests and ANOVA |
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Can a study have both descriptive and experimental statistics?
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Yes, think of EMG studies, they may show the mean EMG, but then also you an ANOVA for differences between subjects
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Three types of T-Test
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1. Simple t-test: compare mean of group with a standard
2. Two-sample t-test: compare mean of two independent groups 3. Paired t-test: compare mean within same group (pre-post) |
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What should a sample size be based off of?
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Power analysis (how many subjects are needed to detect meaningful difference)
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Can a study have external validity without having internal validity?
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No, if it is to be clinically applicable (external validity), then it must be performed and analyzed correctly (internal validity)
A study can have internal validity without having external validity (ie. nobody cares about your research) |
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When does internal validity exist?
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When changes in the DV are due to the IV
-Measurements to detect change must be valid! |
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What happens if an extraneous variable is not well controlled?
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It may contaminate a study and creat an outcome enot representing true change, thus threatning internal validity
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what is observational bias?
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Examiners potentially rating variables more or less favorably with knowledge of the subject's grouping
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Three questions to consider when examining external validity?
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1. Are pts described in enough detail to decide if they are comparable to those I see in practice?
2. Are treatments or assessments described well enough so one can provide the same to pts? 3. Was clinical outcome relevant and clinically significant? |
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Type I and II errors
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Type I: reject the null hypothesis, but you shouldn't have (you think you're the man, but you're not)
Type II: accept the null hypothesis, but there really was a difference (You idiot!) |
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Why do type I and II error occur?
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Type 1: alpha level wasn't right
Type II: statistical power not there (power anlaysis left you short of your dreams) |
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Normal power level
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0.8
Needed to determine if sample size is adequate to avoid committing a type II error and needs to be done a priori |
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What is effect size
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Cohen's d value
Standardzied value of the relationship between two variables, and provides the magnitude and direction of a treatment effect >0.8 is large effect |
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ICF components
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Health coniditon (origin)
Body structure and function (organ level) Activity (person level) Participation (Societal level) |
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Statistical significant vs. clinical significance
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100 meter sprint: tenth of a second may be statistically insignificant, but this is very clinically signifincant
*Need to use confidence level (p-value) in addition to the effect size (Cohen's D) |
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What is confidence interval?
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CI is a range of values with upper and lower limits that includes the true parameter if the experiment is repeated
Essentially, an indicator of the reliability of the study |
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What does a meta anlaysis provide?
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a more powerful estimate of the effect size of an intervention by combinine results
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more powerful estimate by...
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Odds ratio
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give sthe probability of an event happening
used in case-control and epidemiological studies ie. odds of spraining ankle while playing soccer |
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Relative risk
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used in RCTs and cohort to compare an intervention group to control group
Relative risk of spraining ankle if you did prevention program |
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Absoulte risk reduction (ARR)
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the decrease in risk following treatment in relation to a control
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Number needed to treat (NTT)
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the average number of patients in a clinical trial who need to be treated for a patient to benefit compared to a control (1/ARR)
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Prevalence vs. incidence
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Prevalence: number of cases that exist within a population whetehr diagnosed or not
Incidence: the number of NEWLY diagnosed cases during a time period (reported per year) |
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Pearson's Correlation
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"r"
Relationship between 2 variables 0 = no relationship +1 = one variable is directly dependent on another -1: directly inverse |
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How do we assess the iplemenation of EBP?
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RE-AIM (Reach, adoption, implementation and maintenance)
R: how many pts were helped by applying evidence E: was it effective for pts? A: how many clinicians are using it? I: was it consistently implemented? M: was is sustainable? long-term? |
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Factors affecting power
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1. Sample size (too small?_
2. Difference in group means (want this small) 3. Variation within groups you are studying (want this small) 4. Alpha level (don't set too low or you might commit a type II error) |
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How to determine confidence interval?
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alpha level = .01
CI = 99% |
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T-Test. When?
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Inferential
Difference between 2 groups only. The IV can only have 2 groups |
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ANOVA. When?
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Difference among many means, may have many IVs
Tests significance of group differences between two or more groups IV can have 2 or more categories. ie. Do SAT scores differ for low, middle, and high income students? |
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Chi-Square Test. When?
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Differences in frequencies, or rleationships between nominal (categorical) variables
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What 3 things are used to minimize bias?
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blinding
randomization matching |
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3 things for external validity
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patients, treatment, clinical outcomes described in detail
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4 things for effect size
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1. odds ratio (epidemiological)
2.relative risk (<1 to >1) 3. Abdoulte risk (%) 4. NNT |
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