Chapter 1 Flashcards
What role does research have in this class and as a future clinician/researcher?
Critical readers are critical thinkers and critical thinking is the foundation of effective professional practice
What is a critic?
One who forms and expressed judgements of the merits, faults, value or truth of a matter–characterized by careful, exact evaluation and judgement (Page 1-slide 3)
How does a critical review help us as clinicians?
- of the research literature helps inform clinical decision making
- Clinical practice should be based on relevant basic and applied research
Clinical practice should not be based on what?
pronouncements by authorities, intuition, or dogma
page 1
What is research?
-
- organized way to seek answers to questions
- the cornerstone of an experimental science
- research either results in a
(1) rediscovery or already known facts and principles
(2) attempts to answer a formerly unanswered questions in an objective and repeatable fashion - attempts to confirm or deny what is already believed to be true
(Page 1)
Professionals perform assessments ________ and assessments __________
for intervention
of intervention
You wear two hats: As students we can be _______ and _____ of research
consumer (as a clinician picking assessment/therapy we want to use)
and producer of research (when we create a study, collect data, and analyze)
What are the two branches of research?
(1) Quantitative: more highly valued in our profession
(2) Qualitative: open-ended & use interview questions
- uses input from people
- Group, semi-structured interviews
- Responses are recorded, analyzed, and coded
* (3)Mixed: more quantitative with a little more descriptive
What is epistemology?
The study of the nature and foundation of knowledge
Why do we have research?
it’s a way of knowing, and obtaining information/data
What are Charles Sanders Pierce’s notion of “four general ways of knowing” (hint methods of tenacity)
- Method of tenacity
- Method of Authority
- Method of Intuition
- Method of Science
What is method of tenacity?
beliefs–always known something to be true even though there is evidence that contradicts it.
People hold firmly to certain beliefs because they have always known them to be true and frequent repetition of the belief enhances ostensible validity
-ex. Saying the world is flat even though there’s a ton of contradictory evidence
What is method of authority?
people accept knowledge from an individual or group of individuals who have been in some way designated as authoritative producers of knowledge
- “accept knowledge from institutions”
ex. belief that the sun revolves around the earth because government/religion says so
What is method of intuition?
Also known as: “method of pure rationalism” or “a priori method”
- use of pure reason based on prior assumptions that are considered to be self-evident with little or no consideration given to the role of exp
limitation: exp may show that a self-evident truth is not a valid assumption in a logical system
What is method of science?
the most powerful and objective method available to gain new knowledge via scientific research (empiricism and rationalism)
Scire means what?
to know
Define scientific research
systematic, controlled, empirical, amoral, public, and critical investigation of natural phenomena. It is guided by theory and hypotheses about the presumed relations among such phenomena
T/F research findings are good or bad
False, are considered in terms of their reliability and validity
Scientific research depends on a complex interplay of 2 distinct lines of inquiry. What are they?
Empiricism and Rationalism
What is empiricism?
philosophical doctrine that knowledge is gained through experience and evidence
- Rely on inductive reasoning - in order to accepted it must be based on evidence gained from observations of phenomena and critically eval the accuracy
Core of scientific endeavor
What is rationalism?
Referred to as: schematic, formal, or analytic
a philosophy that assumes knowledge must be gained through the exercise of logical thought.
rely on deductive reasoning (use of general principles to make inferences about specific cases)
deals with abstract models
What is schemapiric?
proper and judicious joining of the schematic with the empirical
why? because both of these are essential in a scientific study
Empiricism vs. Rationalism
Rational ex: dev. of a theory of language
Empiricism ex: functional analysis of behavior & eschewed the exclusively rational approach
T/F research is a process of testing rather than proving, and it implies an objectivity that lets the data lead where they will
True
Define scientific method
- recognition of a problem that can be studied objectively!!!
- you must collect data through observation or experiment and draw conclusions based on analysis
Scientific research can be broken down to ______ and ______.
- Basic research
2. Applied research
What is basic research?
(Under scientific method)
Directed towards the development of knowledge
Provides broad base of knowledge
The foundation for development of practical solutions.
Theoretical support
What is applied research?
(Under scientific method)
solve a problem of immediate consequence
Clinical research
what are two major types of empirical approaches in Scientific Method?
- Descriptive
2. Experimental
Descriptive research vs. experimental research
Descriptive: examines differences, developmental trends, or relationships among factors through objective measures (test, surveys, naturalistic observ.)
Experimental: examines causation through observation of the consequent effects of manipulating certain events or characteristics (variables) under controlled conditions (variables)
Define Scientific Theory
Theories are statements formulated to explain phenomena
established through empirical and rational inquiry
empirical facts are meaningless without theoretical framework
What is a theory?
a FORMAL representation of data in minimal number of terms to identify and outline cause and effect relationships. Theories are the ultimate aim of science.
they a establish a framework from which meaningful generalizations can be made
Another purpose of scientific theory is to facilitate the modeling of phenomena or various processes. What are possible models?
Physical: cadavers, plastic models, animals
Conceptual: psycholinguistic models of language
Computational: mathematic models
they can be tested to see whether it is consistent with what is observed or fits empirical data
What is Scientific Paradigm?
A group of prominent theories and a collective way of identifying problems & investigation.
Theories are refined or replaced
construction is dependent on the dynamic nature of scientific inquiry
Paradigm shift (e.g. germ perspective changed medicine, genetic perspective)
Define determinism in relationship to scientific theory
the assumption that the universe is lawful
What are the 5 essential factors that can figure centrally in the life of a theory? (Aka strength of theory)
- Accountability (data within it’s domain)
- Explanatory Relevance (theory explains occurrences under certain conditions)
- Testability (must be verifiable and falsifiable)
- Ability novel or new phenomena
- Be parsimonious (fewest set of assumptions to explain the data)
Outline the general framework that underlies empirical research
- Statement of a problem to be investigated
- Delineation of a method for investigation of the problem
- Presentation of the results derived from the method of investigation
- Drawing of conclusions from the results about the problem
In the scientific method what is included in “Statement of the problem”
Clear and concise statement of what is being investigated
Hypothesis of research question, or purpose.
Rationale for the study through review
Development of an argument–the need for and significance of the particular study (Like a legal case)
In the Scientific Method describe “methods”
Subjects, materials, procedures
Closely linked to problem
Statement of problem needs to be clear to develop methods
address how the study is to be conducted and on whom
In the Scientific Method explain “results of investigation”
addresses what was specifically found
often supplemented by tables and figures
Minimal explanation–
specific breakdown of the results as they relate to the problem
In Scientific method describe “conclusions”
Interpretation of results
Theoretical and practical implications
discussion: So what, now what?
How conclusions are reached and the way in which they point the direction for future research highlights the way in which scientific method works to build knowledge
T/F the flow of research process is best understood in a linear progression of steps
False! it is more appropriately viewed as a circular spring board (pg 8)
- There are always new lines of inquiry
- We test by observing and observe by testing
What is the nature of research?
Evidence based practices
Define evidence based practices?
clinical decision making that integrates the application of clinical experience and expertise, recognition of the needs and perspectives of the person receiving services, and identification of the best supporting scientific research evidence
T/F EPB is a prescribed process that can be dictated by a handbook or manual
FALSE it is a systematic process that cannot be dictated in a handbook or manual
How many individual are involved in full-time research?
1%
T/F EBP is not prescribed
True!
It is highly contextual and specifically addresses the individuals needs of services
EBP can be described as what shape?
Three-legged stool or triangle
- clinical experience and expertise
- Identification of the best supporting scientific research evidence
- Recognition of the needs and perspectives of the person receiving services
What does PICO stand for?
Population, intervention, comparison, outcome
What are three issues that confront clinicians when referencing external evidence in clinical decision making ?
- No clinician has time to perform comprehensive search of journals and textbooks for clinical evidence
- Clinician’s do not often have the ability to evaluate research critically via the levels of evidence used in treatment efficacy
- Relatively little ‘empirical’ research has been conducted
T/F there seems to be a disconnect between research and clinical practice?
True, which is why research-practice relationships need to improve!
Why is there a disconnect between research and clinical practice?
Due to the pervasive notion that research does little to inform clinical routine and a benighted model that segregates producers from consumers of research
Ingram 1998 proposed 3 distinct relationships/lines of communication that may exist between research and practice
- research-driven communication
- practice-driven communication
- shared-interest communication
T/F research in communicative disorders is extremely diverse?
True. BUT
-numerous other fields contribute to the body of research, but we need to create out own knowledge base and clinical methods to remain distinguished as a health profession rather than a technical field
Research driven vs. practice driven vs. shared interest relationships
Research Practice Shared-Interest
Centers on the report the manner in reasonable ass that
-ing of research which clinicians a continuum of int.
findings and the manner express their exists b2ween
in which they are imple interests to rese researchers &
mented in practice archers regarding practitioners
their info needs & (most effective comm)
input they provide
to promote research
What is a myth in the editorial process
Myth that if an article appears in print, it must be worthwhile
Explain the peer-review process
- members of the profession review article submissions
- Discern differences in excellence through critical evaluation
- A stance of healthy skepticism is good for the reader and in the long run, for the researcher and the profession
What are challenges of cyber space?
the abundance of choice has raised some serious challenges:
Professional responsibility to judge the authenticity, validity, and reliability of the many sources of information
the problem is not too much information
What is information literacy?
addresses those skills that allow individuals to “recognize when information is needed and have the ability to locate, evaluate, and use it effectively”
What is a good cyber reference?
American Library Association: concept of information literacy
Skills that allow individuals to: recognize when information is needed and have the ability to locate, evaluate, and use it effectively
What are the three types of information sources?
- primary source
- secondary source
- tertiary
What are primary sources?
first appearance of research results in the literature–information in it’s original form
what are secondary sources?
in describe, explain, or interpret information contained in the primary source
What is a tertiary source?
Information collated from various sources to present a broad or rudimentary overview of a topic
ex. Wikipedia
Which side of the triangle: an 85 year old client with aphasia refuses to work on crossword puzzles for his home exercise program
Client perspective
which side of the triangle: a study that includes a control group and random assignment with an n=50 demonstrates the efficacy of a fluency program
External Scientific evidence
What side of the triangle: a aphasiologis with 25 years of experience modifies a therapy approach for a specific client on his caseload
Clinical expertise/experience
EBP is highly ______ and addresses the _______ in need of services
contextual; individual
variables to consider: age, gender, how long they’ve had the disorder
T/F EBP is endorsed by any authority, institution, or organization?
False, it is not! what is evidence based cannot be endorsed because there could be bias or conflict of interest
-this is a good safeguard!
What do PJs stand for?
Professional Judgement
Who determines the quality of our field’s evidence?
Speech Pathologists and Audiologist, so we need to wear our PJs!
When you want to determine if something is EBP you will use ______?
PICO
Create a clinical question (using PICO) for the following clinical case: a patient who presents with a new onset CVA (Cerebral vascular accident or stroke)
P: stroke patient
I: early initiation of aphasia treatment
C: aphasia treatment after initial spontaneous recover time
O: Functional communication abilities
Create a clinical questions (using PICO) for kindergartner with articulation disorder
P: kindergarteners with artic disorders
I: individual pull-out treatment
C: group pull-out treatment
O: ability to consistently produce /s/
create a clinical question (using PICO) for a minor who suffered a TBI
P: 17 year old male with a severe TBI
I: cognitive rehab
C: no cognitive rehab
O: return to work/school
How do we critically evaluate reviews?
- where to find systematic reviews
2. Individual studies
What is a systematic review?
a comprehensive overview of the research literature that addresses a specific clinical question and describe the extent to which various diagnostic or treatment approaches are supported by the evidence
BUT stops short of making specific recommendations for clinical practice
forms the basis for evidence-based clinical practice guidelines
“pre-filtered evidence”
regardless of topic, all systematic reviews approach the literature systematically using a formal set of explicitly stated selection criteria to limit bias
Does publication in a peer reviewed journal guarantee scientific quality? why or why not?
No, unfortunately publication in a peer reviewed journal is not a guarantee of scientific quality
When using a systematic reviews what two questions do you ask yourself to guide your evaluation?
- Is the evidence relevant to your client?
questions: population, age, environment, bilingual/monoling - Who wrote, funded, and published the review?
questions: the writers background and the time the articles were published/conducted
What can assist us in determining the type of quality of individual studies? should we use the good vs. bad paradigm?
no, don’t use a binary scale of good or bad; think of it as a spectrum
Very formal——->very informal Very dissatisfied—–>very satisfied
What are the holy words when rating an study?
randomization and control
Reproduce the rating scale for rating the weight/quality of the outcome of a study
IA Well-designed meta analysis of >1 randomized controlled trial
IB Well-designed randomized controlled study
IIA Well-designed controlled study w/o randomization
IIB Well-designed quasi-experimental
III Well-designed non experimental studies, i.e. correlational & case studies
IV. Expert committee report, consensus conference, clinical experience of respect authorities
What is the highest level on the rating scale?
IA and IB
What is a meta analysis?
1st they have to do a systematic search to find quantitative studies, that have randomization and control groups in the design
2nd they use a specific statistical analysis on those numbers collectively to see if there is a strong significance of the data collected
What is the lowest level on the rating scale?
Level IV
What is a quasi-experiment?
use a control group of subjects with which an experimental group may be compared
-pre and post treatment vs. no treatment pre and post
Practice grading this study: a convenience sample of 4 participants with aphasia and four research assistants with seven days of intervention and pre/post assessments
IIB or III
Practice grading this study: community-based program for individuals with aphasia with a comparison group. Participants self-selected treatment group versus comparison group
IIA or IIB
Practice grading this study: sample size was 250 (consecutive enrollment of stroke survivors in a large medical center) with random assignment into Treatment A, Treatment B, or a control group
IB
What is treatment efficiency and is it cost effective?
It is tied to many factors and assessed via a cost-benefit analysis
Yes, it is the best outcome for the least amount of money
T/F treatment outcomes research shows a positive correlation but you can’t prove causation.
True
It identifies treatment benefits with the intent of establishing a relationship between treatment and functional improvement.
Treatment efficacy–the improvement of client performance can be shown to be what?
- derived from the treatment rather than other extraneous factors
- real and reproducible
- Clinically important (internal validity, statistical sig, practical sig)
To improve the external validity and support the generalization of findings you need what?
Randomization and sample size
Randomization includes samples of ______, _______, and ______ to be included in the study
people, settings, & times
this is a key procedure researchers use to enhance the external validity results
what is an ex. simple random sampling?
“Call everyone that lives in city x”
it is often discussed only with respect to subjects in a study but can also be considered for settings,values of ind variables, times of measurements, stimulus materials, measurement procedures
What is a stratified random sampling?
an accessible population for a study is first divided into categorized subgroups or strata, from which subjects are drawn randomly
What are the 5 types of research samples?
random, simple random, stratified random, cluster sampling, multistage sampling
What is cluster sampling?
all subjects are members of a group that was selected
ex. students in a classroom, school, or district
What is multistage sampling?
selection may continue to random identification of a grade or classroom and so on
define sample size
Generalization can also be improved by increasing sample
increasing the number of subjects in the simple leads to higher probability of detecting an effect of a given size in the population–you want a LARGE sample size
What are some advantages and disadvantages of group design?
Nontreatment group provides independent reference vs.
not as flexible as a single-subject design
Subjects can be randomly assigned to treatment groups vs.
intrasubject variation not measured or controlled
Can generalize from rep sample by inductive reasoning vs.
random sampling or close matching of subj needed for inference
can calculate effect size with meta-analysis vs. does not reveal extended temporal measures of dependent variable
what are some advantages of single subject design?
Smaller # of subjects who act as their own controls vs.
less gernalizable than group designs
Avoids subject-matching problems vs. greater need for direct or systematic replications
Examines behavior at level of ind subject over time vs.
intersubject variability not well accounted for
flexible design can be modified vs. needs for more time & effort per subject
variation can be controlled
What are 4 key steps in EBP
- Framing the clinical question (PICO)
- Finding the evidence (using PICO)
- Assessing the evidence (using the scale)
- Making the decision
