CI Test 1 Flashcards
Evidence Based Practice
includes standardized outcomes, standardized terminology, personalized care, and constantly evolving practice
International Classification of Function
A model of health and disability; labels health conditions based on its effects on body sxs/fxns, activities, participation, environmental factors, and personal factors
Body Structures/Functions (ICF)
Addresses where the impairment is; includes things such as pain, limited ROM, weakness,
Activities (ICF level)
Actual activity effected by the impairment; could include walking, climbing stairs, bed mobility, balance
Participation (ICF level)
How the limited activity actually effects daily life; things such as cannot deliver mail because they can’t walk, cannot be an usher at church, cannot wash the dishes; could include mobility activities, community activities
Environmental Factors (ICF)
things that could effect the individual’s function/limitations that are in the environment; weather, climate, roads, disability access
Personal Factors (ICF)
Factors within the individual that could effect an individual’s outcome in recovery; depression, motivation
Evidence Based Practic
the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients; requires clinical expertise, research evidence (valid/relevant), and patient values
Steps of Evidence Based Medicine
- Determine need
- Create Question
- Search Database
- Triage
- Critical Appraisal
- Integration
- Application
(DCST CIA)
Determine Need (EBM)
Step 1
The patient creates need for clinically important information
Create Question (EBM)
Second step
Information needs to be converted into an answerable question
Search Database (EBM)
3rd step in EBM
Search for answer to clinical question using relevant sources
Triage (EBM)
Fourth step in EBM
Determine best evidence source for the solution to the problem
Critical Appraisal (EBM)
Step five
Evidence is appraised for validities and applicability
Integration (EBM)
Step 6
Integrate the evidence, experience and patient values to develop a plan of care
Application (EBM)
Step 7
Evidence is applied and clinical outcomes are evaluated
How do we prevent PTs from not maintaining EBP after they graduate?
Encourage use of standardized outcome tools, keep track of outcomes, and assess performances
Autonomy
The ability to make one’s own decisions and to act on them; “self-determination”
Beneficence
The obligation to attend to the well-being of participants;
The need to maximize benefits and minimize harm
The need to critically evaluate the risk/benefit relationship
Justice
Fairness in a study; equitable distribution of benefits and burdens
There is an equal chance of being assigned to intervention groups
Control Groups in Clinical Research (maintaining ethical action)
The best way to determine the effect of an intervention is to compare to a control group;
To make it ethical, offer a treatment option to the control group
There might not be any treatments that have been shown to be effective, so in this case it may be justified in comparing no treatment to a new treatment
Nuremberg Code
First formalized guidelines for research; evolved from Nazi war crimes trials;
Every individual must give informed consent for participation
Declaration of Helsinki
Independent review of research protocols by an impartial committee; research findings obtained without this review should NOT be published
Institutional Review Board
Reviews research protocols to ensure rights of participants are protected; must consist of at least 5 members of a diverse make up from different social, cultural, and occupational backgrounds
IRB Reviews Research Proposals Based on:
Scientific merit Competence of investigators Risk to participants Feasibility based on resources available Risk-benefit ratio
Full IRB Review
For experimental procedures that have never been performed; with more than minimal risk; also for vulnerable populations;
Expedited Review
for very minimal risk experiments that uses standardized protocols frequently used in the past; reliability studies of the common clinical examination tools fall under this
Only a partial board convenes
Exempt REview
Surveys, interviews, as long as the information remains anonymous/ cannot be identified;
Studies of existing records
Elements of Informed Consent
Invitation to participate; Information, consent, and authorization Elements
Information Elements of Informed Consent
Disclosure of information; what is going to happen during the study to the subject;
What risks are there? What steps minimize these risks? What would happen in the case of harm? What are the benefits? How are they ensuring confidentiality? How long are they keeping info? Where can a participant go if they have questions?
Form written in lay language
Consent Elements
The assurance that participation is voluntary and the subject must be able to provide consent for themselves, otherwise they need a responsible party to sign
Is there compensation?
The subject is free to withdraw at any time
Authorization Elements
Consent to use data and other materials for publication and dissemination
Who gets authorship in a research study?
Made Substantial contributions to conception and design OR acquisition of data OR analysis and interpretation of data
AND
Drafted the article or revised it critically for important intellectual content
AND
Contributed to final approval of the version to be published
Population (N)
The larger group to which you want to generalize your findings
Sample (n)
A smaller, hopefully representative, subgroup from the population used to determine truths about the population
Process of Sampling
Define target population (clearly define the criteria for the group), identify accessible population (identify the portion of the target pop that has an equal chance of being selected), obtain sample
Inclusion Criteria
Characteristics that you decide must be present; primary trains of your target population that should be relevant to the research question; more of these strengthens INTERNAL validity but creates more restrictions so there is a lower EXTERNAL validity
Homogenous Sample
Makes generalization difficult; could be easier to study, however may be difficult to apply to a large group
Exclusion Criteria
Factors that would disqualify individuals from participating in your study; confounding factors that may interfere with interpretation should be considered; closely related to inclusion criteria
Probabilistic Sampling
Ideal scenario; uses a randomly selected sample from the accessible population
Non-Probabilistic Sampling
Used when it is not possible to obtain a true random sample; non-probabilistic
Random Selectin
Probabilistic; every individual in the accessible population has an equal chance of being included in the study;
Every individual has an equal chance of having some of the characteristics in the target population
Should help prevent “sampling bias”
Sampling Bias
Individuals either over-represent or under-represent characteristics of the population;
Sampling Error
Difference between sample statistics and population parameters is due to chance;
Probabilistic: can estimate this error
Non-probabilistic: cannot estimate sampling error
Simple Random Sampling
Accessible population often defined by membership, directories, or lists
Each member has an equal chance of being selected
Random number generator, throw dice, names in hat, etc.
Systematic Sampling
Systematically select individuals on an interval basis (every other, every third, etc.)
Sample Interval= number in the accessible population divided by the desired number for the sample (N/n)
Stratified Random Sampling
Identify relevant population characteristics; partition the population into homogenous, non-overlapping strata based on characteristics; draw random or systematic samples from each strata
Disproportional Sampling
When stratified sampling is being used, but the strata have very different representation in the population; results in insufficient sample sizes in some groups
Select random samples of adequate size from each category; must weight the scores for data analysis to correctly represent the sub strata
Weighting Data
Score is multiplied by the weighting factor in the analysis; makes the scores from the more highly represented individuals count for more in the analysis
Cluster/Multistage Sampling
Strategy to link members of the accessible population to an already established grouping; successive random sampling of a series of groups in the population
Ex: if we already have geographical groupings; in large multi enter trials; during every step of reducing groups we randomly select; (regions of the US)
Convenience Sampling
Recruiting individuals as they become available (consecutive sampling) or ask for volunteers and wait for the phone to ring
Quota Sampling
Uses stratification (attempts to represent each strata in the same proportion as in the target population); recruiting stops once quota has filled
Purposive Sampling
Individuals are hand picked for inclusion by the research based on certain criteria; large potential for bias
Snowball Sampling
Stage 1: a few participants who meet criteria are tested
Stage2: these participants then identify others who qualify
Step 3: it continues
Often used for hidden or hard to reach populations
Recruitment
Must not coerce (caution when using own patients), must be able to withdraw from study at any time;
Statistical Power
Ability to find differences between groups if they exist; small sample size generally indicates a lower power
Reliability
Reproducibility, consistency
Validity
Accuracy, correctness; are you on the mark?
Systematic Error
Consistent, however it always overestimates/underestimates; errors from measurement to measurement are predictable; (reliable not valid)
Random Error
Error due to chance; errors from measurement to measurement are unpredictable;
Observed score = true ability +/- random error
Reliability Coefficients
Reliability is a measure of how much total variance is attributed to true differences between scores; as error increases, reliability coefficient approaches zero; as error decreases, reliability coefficient approaches 1.0
T/(T+E)
T= true score variance E= error variance
Test-Retest Reliability
Used to establish that an instrument/tool is capable of measuring variable consistently; used for self-report questionnaires or mechanical/digital read outs;
Has limitations from one session to the next
Test-Retest Intervals: far enough apart to avoid learning/carryover (testing)/memory effects; impact of fatigue; close enough to avoid genuine growth
Intrarater Reliability
Stability of one person’s measurement across 2 or more trials; blind the tester to control for bias
Inter rather Reliability
Variation between two or more raters who measure the same group of people; best assessed in a single trial
Discrete Data
Described by whole units; (could be dichotomous- a discrete variable with only two values)
Nominal Measurements
Classify/label; mutually exclusive categories (male/female); numbers ONLY represent a category; have no relationship with each other (names of states, names of plants)
Ordinal Measurements
Designates a ranking/order, but the intervals are NOT assumed to be equal; numbers represent a rank-order;
Freshman, sophomore, junior, senior
Professor, affiliate, guest
Continuous Data
A number that theoretically can take on any value along a continuum; an indefinitely large number of fractional values
Interval Measurements
Designates equal intervals, order, but no true zero; intervals are equal; numbers represent a value, but not absolute quantity;
Temperature, 0-10, 11-20, etc.
Ratio Measurements
Designates equal intervals, order, and a true 0; numbers represent a value, absolute quantity from 0
Height, weight, time, goniometry
Direct Variables
Concrete characteristics gathered by the Rater; focus on precision and calibration;
ROM (angles), height, HgB
Indirect Variable
Indicators of an attribute used to represent an abstract concept; use some form of direct observation to then infer a value for the variable
Force, temperature
Operational Definitions
Helps us define variables; should inform the reader of:
What, how, who, how often (frequency), how long (duration)
Confounding Variables
We need to identify and control extraneous variables so they don’t become confounding variables; age, gender, socioeconomic status
Randomized Control Trial in PEDro
compares at least 2 interventions that are related to PT; must involve human subjects; must be randomized and published in a peer review journal
Systematic Review
a systematic analysis of available research (RCTs); rates each trial based on specific criteria; second highest level of evidence
Clinical Practice Guideline
a guideline for the best course of treatment based on research; highest level of evidence
Trends in Studies in PT
increased # of RCTs (last 30 years), systematic reviews (last 15 years), and clinical practice guidelines (last 10 years)
International Classification of Function
a model of labeling health and disability
