EBP Notes PDF

~ etters Ch 1 "Highlights". 1 5 Step Model of Evidence-Based Practice (Have insight into process....

~ etters Ch 1 "Highlights". 1 5 Step Model of Evidence-Based Practice (Have insight into process. general focused Searchable Clinical ↳Identify need for Info. Develop a Question Conduct a search to find best Possible Research evidence to answer your Q. 3 Critically Appraise the Research Evidence for Applicability & Quality 4 Integrate wichnical expertise the the critically appraised Research evidence Patients VEC Evaluate the Efficacy & Effectiveness of Steps 1-4 & Identify ways to Improve them in Future 2. 3 Pillars of evidence (Fig. 1. 1) Optimize Patients outcomes # entific Clinical Patients values circumstances expertise Research 3 3 sources. of evidence (Fig : 1. 2) 1 Clinical expertise.. Scientific 2 Research. 3 Patients values& circumstances 4. The evidence Pyramid (Fig. 1. 8) Most likely High-Quality - I. systemata Randomized Clinical Trala Case - control Studies Narrative Reviews , Expert Opinions Textbooks , Least likely High-Quality meters Ch 2 Highlights. Section 1 1. Identify the le components of Pt Management need for 1 Examination : Obtaining history Perform review & do tests & measures to gather data about pt Also , could dentify referral. a , a systems the. a 2 Evaluation Clinical. : judgements based on data gathered. Diagnosis : 3 data into organizes the clusters , syndromes or categories to help the prognosis intervention strategies 4 Prognosis (optimal improvement interventions) : Determine Plan of care & Time required to reach that level Intervention : shared decision making , Reassess &adjust when needed U. Outcomes Measurement : Results of patient management which includes the impact of PT interventions. Differentiate 2 between background Qs vs. ForegroundAs · Background Q's : Ask about general information & are not specific to an individual, Typically used when we don't know too much about the patient, Typically answered by general sources such as textbooks & reliable web page · Foreground Q'S : Are specific to a particular patient , condition , Clinical outcome of interest Typically answered through research studies 3 PICO. !!! Atlas like 10 exclamation Pts ! - PICO Are the components of a Searchable Clinical Question about interventions p : Patient (or population) & clinical characteristics I : Intervention C Comparison : 0 : Outcomes 4. Explain ICF model & Relate it to patientOutcomes Fetters Ch. 2 Highlights. cont Section 2 1 Do. the Self-tests 2. 182. 2 lanswers Send of chapter 2 Describe. the Clinical Practice Guidelines (CDGs) How to best incorporate them into practice - CPGs are systematically constructed statements that give recommendations based off the best available research evidence. - By using CPGs that relate to your question published whin Syrs , Scores , well on the Specific criteria you'll avoid reading multiple individual studies - CPGs also provide experts wlbeing able to fill in research gaps. Familiarize 3 w/fve search Engines 4 Familiarize. yourself wI"Combining Terms" section of how to use Boolean Operators (Fg. 2. 9) "AND"-Articles will only come /those up I words you want "OR" - Articles will show any article wlany of the I words you want Fetters Ch. 3 Highlights What are the 12 Questions ? - I through 5 are for the Applicability Of Research 1 Is the study's purpose relevant to clinical question? my. ↳ Start Abstract by reading the to determine relevance 2 Is the Study population to clinical question ?. applicable my patient or my ↳ characteristics of your patients lage background) , 3 Are the intervention & Comparison/control intervention ?. groups receiving a clinically realistic ↳ Method section , Is it feasible ?, Is it described in enough detail ? 4 Are the outcome clinical I conducted in matter ?. measures relevant to the question , were they a clinically realistic ↳ Do they provide the info. needed to apply the results ? Likely to demonstrate a benefit your patients goals ? Do they Span FCF the model ? 5 Was. follow-up sufficiently long to determine the impact of the intervention on the subjects lives ? ↳ for Depends on cost. But needs to be long enough the patient to return to work or daily life Le through 10 for Quality - are 6 Were participants intervention ?. randomly assigned to groups ↳ Randomized Controlled Trial/Randomized Clinical Trials standard considered of the most valid : the gold , one designs ↳ Reduces Bias. Is the 7 sampling Procedure (recruitment strategy) likely to minimize bias ? ↳consecutive volthe sample : Includes all patients referred to this clinic problem ↳ selective sample Patients are : recruited , less ideal & vigorous but is common Practical ↳ Can be sampled from 1 or 2 sites 8. Are for ? all participants who entered the study accounted ↳ Details about who dropped out of a study & reasons are important considerations for appraisal 9 Was between. a comparison made groups wlpreservation of original group assignments? ↳ Found in the analysis/results section , ITT = Intention - to -Threat Analysis 10 Was. blinding masking optimized in the study design (evaluators , participants therapists)? , ↳ The therapist giving treatment in a research study should not measure outcomes in the study 11 Aside from the allocated treatment , were treated ?. groups equally ↳ Treatments compared win should equivalent in all aspects of intervention protocol a study be 12 Are study. sources of funding & Author conflicts identified ? ↳ Transparency of potential conflicts it possible for the reader to then decide how to it makes apply Applicability Refers · : to the process of evaluating a study determining what specific people might benefit from the intervention Research Notation R subjects randomized or Not ! 1 Intervention observation (time of measurement) Kamper Reading WK 3 : Fundamentals of measurement Terminology to know ! 1. Construct : What you're interested in measuring. Measure 2 : How the construct is measured 3 Score : Based. on the measures 4 Screening measures : Designed to how it that healthy person future. estimate likely is a will have a certain condition in the ↳ Cardiovascular Risk 5. Diagnostic measures : Designed to determine whether someone does or does not have a certain condition ↳ Lachman test for ACL rupture 6. Prognostic Tools : Designed to help predict Whether or when a patient will recover ↳ Jrebo Musculoskeletal Pain Questionnaire 7. Treatment-Based Classification tools : Designed direct to a patient toward a certain type of treatment ↳ STarT Back Tool. Outcome 8 measures : Designed to track the level or presence of Symptom a , function, or disease marker ↳ Patient Specific Functional - Scale 9. Subjective measures : Refers to the extent of personal judgement involved in taking a measure 10. Objective measures : Refers to what can be measured /seen * Research has do not shown that reliability Validity depend on how objective or subjective a measure is * Important to recognize that some constructs are inherently subjective , such as a persons pain experience in such cases a more subjective measure will be the most valid  Fetters Ch 4. Highlights 1 Distribution of. data - Normal distributions : Based on repeated measures in a large sample of people (Bell-shaped curve) skewed distributions : Common volclinical populations bic people vidisease - distribution of values or injury may not have the typical seen in a healthy population. 2 Descriptive Statistics : Provides an overall impression of the typical values for a group the variability whin between groups - Mean : The Average , sum of a set of observations divided by the # of observations , Estimates -one representation of the variability in the sample - standard deviation : Most commonly used measure , Average amount that each individual scores varies from the mean of the set scores - Median (50th percentile) Refers :. to the point below which half of the observations fall - Confidence Intervals Range : of values that includes the real true mean for a population of people Range Difference the highest& - : between lowest scores in distribution 3. Types of data - Nominal : Categories , ala categorical , There is norder of the categories. If only I categories = Dichotomous scale uniform - Ordinal Categories : that are ordered, The ranking whin the scale typically indicates most to least but the distance between is not ↳ Likert ↳ Rankin Both - Continuous (ratio) : Ordered Precisely & continuously the measured intervals are equal termed L , - Interval : Measured precisely & Share the properties of equal intervals as viratio scales 4. Reliability Types of Reliability - A Intra Individual. - (Intrn-subject) : Measures from the same person should remain stable over repeated measures in a short period time B Intra-Rater : Repeatability. of a measure by the same therapist on the same pt & 2 or more time points C Iter-Rater :. Repeatability between 2 or more therapists measuring the same patient - How Reliability is quantified A Intraclass. correlation coefficient (ICC) : Takes into account both the nature of the change the absolute values Which makes it the preferred statistic to evaluate reliability of continuous data (ratio/interval) 5. Hypothesis Testing (NAST) Type 1 Error Results of study may falsely statistically significant difference - : a conclude that there is a when there is actually no difference Type 2 Error : Results of also falsely that there is statistically significant difference - a study may conclude between groupsWhen there is actually a difference. Inferential Statistics 6 Effect Size Cohen's - : d is most common d provides a measure of just how distinct the samples are how far apart the two means are - , , d Meangroups Mean control group 1 If - large = d big difference between the _ a = 2 SD control group groups - P-values Expresses : the probability that chance contributed - Number needed to treat (NNT) : ratio of the rate of the desired outcome in the experimental group & the rate of the desired outcome in the control/comparison group. Expressed in terms of persons - Relative Reduction Risk (RRR) (CER-EER)/ (CER)) : - A negative of Both of these would indicate thatthe intervention had - Absolute Reduction Risk (ARR) : (CER-EER) the opposite - result : The control coud , being more successful than the experimental Lond. Kamper Readings Highlights Week 5 : Interpreting outcomes & Sampling FO 1 : & w/in individuals 1. Change : Score on an outcome measure (ffollow up) minus the score on the same measure at an earlier time point lebaseline) · Change whin - a person or mean change a group of people 2 Difference. : Requires data from 2 groups of people. The between-group difference is the mean score on - an outcome measure in Treatment group A minus the mean score in Group B. The difference can be called ↑ Treatment Effect" or "Treatment Response" wen groups Why do these get confusing 3 Treatment Effect : A comparative effect What be if patient got Treatment A compared to. , can expected a What can be expected of a patient Treatment got. The B difference in outcome scores between groups quantifies the treatment effect 4 Treatment Response. : So , the "effectiveness" of low response to) Treatment A , as reported in a Particular study interpreted in the of treatment B involved , is light what. Responders 5 A person wha large : change in outcome ↳ This is blc confusing this person can respond Treatment to A but that person could also respond Treatment B to * Any improvement made whin a Clinical trial is the culmination of MULTIPLE Factors , not just the treatment : - The actual treatment having biologic/physiologic effects - Patient expectations - Natural progression of the condition - Measurement Error - Learning or familiarization effects FO 2 : 1 Statistical Significance. : The probability under a specified statistical model that a statistical summary of the data would be equal to or more extreme than its observed value 2. Clinical Significance : A mean difference between groups thats large enough for patients to consider the difference important. P-value 3 : Represents the probability that the true difference between the mean of 2 groups is as big or bigger than the difference reported in the study if , the groups came from the same population & Assuming that the data meet various statistical assumptions ↳ Canvas P-value all of win NOT description : is about probability finding the result the study - but its a probability of the "results being due to chance" or a value to reflect our confidence that the difference is "real" 4. Size of Effect : With a large enough sample Size , you may very well see statistical differences between groups, But the question is are those differences clinically meaningful ? sampling : 1 Representative A sample that Sample is the way except rolfewer :. same as the population in every , individuals  5A. 1-Samples vs. Populations · Cronbach's Alpha measure the correlation between multiple different outcome variables. Consistency between these measurements - The Primary difference between a sample & the Population is : Sample includes only those individuals enrolled in the research study Population includes all patients wha given disease/condition 5C-InferentialStatistics · Inferential statistics : Meant to make some sort of inference about the broader population using the sample of research participants that we had to study · Null Hypothesis Significance Testing - : Intentional comparison. By default all groups are going to have the same clinical outcome Fetters Ch 10. Notes Figures 10. 1 $10 2. Psychometric Properties - Reliability ↳ Internal Consistency establishes the extent which multiple items within an outcome measure reflect the same construct (Berg Balance Scale) Cronbach. The ↳ Alpha statistical test used to assess internal consistency scores from range 0 to 1. Scores close to 1 indicate the individual items have high , positive correlation, indicating High Scores close to 0 indicate that the individual Internal Consistency a · items do not correlate wleach other Indicating Low Internal consistency , Scores should be greater than 0 70 & less than 0 90 -.. ↳ Test-Retest establishes the extent to which an outcome measure produces the same result when repeatedly applied to a patient who has not experienced change in the characteristic being measured - Can be Within a session or Between Sessions - Within session example : Measuring joint ROM 3 times in a now on a given patient & determining if those measurements are consistent - Between session example : Measuring joint ROM on a patient today & then again next week on that same patient (wassumption the Rom won't change in that time) - Validity Outcome measures ability to measure the characteristic feature that its intended to measure Clinical Meaningfullness outcome pt volconsequential - measures ability to provide the Clinician the info. 3 Major Types of Validity & their subtypes ** know these A 1. Content Expert Validity Establishes that an outcome measure includes all the characteristics that it purports to measure , panel ↳Does the measure include all important of the construct? components SubType : - Face Validity Based on informal evaluation by experts that a measure ears to measure what its intended to measure , Informal Expert Input ↳ Does the to measure ? measure appear to measure what its intended. Criterion Validity 2 Compare measure to an established measure of the same characteristic or construct - Gold Standard : Virtually irrefutable measure - ReferenceStandard : Best available comparison when a gold standard is not available ↳ How does the other , more established measures ? measure compare to Subtypes : - Concurrent Compare to a gold or reference standard the same point in time ↳ Does the measure being tested correlate whthe gold or reference standard when the 2 are administered concurrentyo - Predictive Compare measure to a gold or reference standard after time has passed ↳ Does the measure being tested correlate wha gold or reference standard administered after time has passed ?. Construct Validity Test 3 the measure under conditions that establish that it measures the theoretical Construct that is designed to measure ↳ Does the demonstrate that it the theoretical that its measure represents construct designed to measure ?  Subtypes : - Known Groups Compare performance on the measure from groups wlknown differences in the characteristic of interest ↳ Does different the outcome measure distinguish between the known groups ? Convergent Assess Similarity the in scores between the measure of interest &another - measure or variable that should correlate voltue construct of interest ↳ Does clother measures performance on the measure converge , characteristics , or variables that represent the same construct ? - Discriminant Assess the similarity in scores between the measure of interest If another measure or variable that should not correlate withe construct of interest ↳ Does performance on the measure diverge from measures , characteristics , or variables that do not represent the same construct ? What does the MCFD represent ? Minimal Clinically Important Difference : Smallest difference in outcome measures that is considered meaningful between 2 groups · MCID can help w/2 components : - Study designs : in calculating the required sample size for studies to ensure they're adequately powered to defect meaningful differences Comparative Effectiveness : Enables the comparison of different treatment modalities to identify which - offers the greatest potential benefit to patients