9/19a CDM (Integrated Care and Practice)

Question 1

Intervention effects - how much they changed

Answer 1

• within group effects (change measured within a group, pre-intervention measures, how did the groups change)
• between group effects (comparing the changes measured in each group, look at different exercises and nothing to compare)

Question 2

Effect Size

Answer 2

Magnitude of the difference between groups

• absolute = with units
• -within group: take mean value after intervention -mean value before interventon
• -between group: mean change in group 1 - mean change in group 2
• standard = no units
• -standardized so you can compare different outcome measures with each other.
• -Absolute mean difference/”pooled” standard deviation
• -Interpretting SMD: 02=minimal, 0.5=moderate, 0.8=large
• -does not directly relate to clinically meaningful change
• -if we replicate study, we will be 95% confident that the mean value/standardized value will land between expected limits

Question 3

T/F: the more variable the confidence interval, the less likely someone is to buy into a study

Answer 3

TRUE

Question 4

Effect size vs statistical approach

Answer 4

• statistical approach = useful for reasearch

- effect size = useful in USING research *** what we want to use, more of a clinical meaning

Question 5

What does reporting a p-value tell us?

Answer 5

the lower end of the confidence interval and how far away it is from 0. AKA, it tells us how confident we are that the change is not 0

Question 6

statistically significant means

Answer 6

that p<0.05

Question 7

what do you use when:

1. you want to know the effect the patient should expect?
2. you want to know if the intervention is more effective than another?
3. you want to know how confident we should be in the effects?
4. you want to compare the effects across studies using different outcomes?

Answer 7

1. you want to know the effect the patient should expect?
   - absolute; within
2. you want to know if the intervention is more effective than another?
   - standardized OR absolute; between
3. you want to know how confident we should be in the effects?
   - standardized;between OR absolute;within
4. you want to compare the effects across studies using different outcomes?
   - standardized;between OR within

Question 8

How do you use intervention articles for CDM with a patient?

Answer 8

• The average within group affect in a RCT
• determining the within group effect is clinically important
  - -x(post) - x(baseline) = x(intervention)
• Apply absolute effects in a study
• standardized effect forest plot and absolute effect forest plots will only be one side of the chart if it’s between group!

Question 9

how is the confidence interval determined?*****

Answer 9

CI = effect +/- Z(alpha) x SE(mean)

• Standard Error of the Effect is calculated by (std dev)/(square root of sample size). if the SD stays the same, but the sample size increases the SE gets smaller and confidence interval gets smaller
• Z sore = how confident we want to be, the higher the z-score, the more confident we want to get and the larger the confidence interval
• Intervention effect is found when creating a forest plot

Question 10

Weighted mean difference

Answer 10

• when you have thicker bars, studies are weighted
• it means that one study is weight more heavily in the overall summation because there may have been more people in that study
• the resultant at the base tells us how we should feel about the whole analysis and what it favors
• Meta-analysis on the systematic review

Question 11

what do you want to look out for when reading articles?

Answer 11

1. purpose
2. population
3. groups (what was done)
4. effects - not statistical significance, rather clinical effects
5. intervention (dose)