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Clinical Outcome Measures Flashcards

1
Q

4 Pyschometric properties of reliability

A

Internal consistency
Test-retest
Intra-rater
Inter-rater

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2
Q

Internal Consistency

Definition

A

Consistency of construct across individual items of outcome measure

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3
Q

Internal Consistency

Study Design

A

Conduct outcome measure on group of people-> analyze intra-subject correlation between them

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4
Q

Internal Consistency

Statistical Results

A

Chronbach alpha
measures correlation

Ideal: 0.7-0.9

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5
Q

Internal Consistency

Appraisal Considerations

A

Sample size

Participants wide diversity in outcome measure

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6
Q

Test-retest

Definition

A

Consistency of test when given to a person (unchanged in outcome) on two different occasions

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7
Q

Test-retest

Study Design

A

One person gives test to same people on different days

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8
Q

Test-retest

Statistical Results

A

ICC or Kappa

Closer to 1 better

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9
Q

Test-retest

Appraisal considerations

A

Sample size

Wide diversity in outcome measure

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10
Q

Intra-rater

Definition

A

Consistency of raters when compared to themselves on two different occasions

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11
Q

Intra-rater

Study Designs

A

Several therapists give test to same people at different times

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12
Q

Intra-rater

Statistical Results

A

ICC or Kappy

Closer to 1 better

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13
Q

Intra-rater

Appraisal considerations

A 
Sample size
Diversity in outcome measure
Stable in characterstic of interest
Same circumstances for assesment each time
Time appropriate between assessments
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14
Q

Inter-rater

Definition

A

Consistency of raters compared to each other

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15
Q

Inter-rater

Study Design

A

Therapists measure same participants and their scores are compared

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16
Q

Inter-rater

Statistical Results

A

ICC or Kappa

Closer to 1 better

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17
Q

Inter-rater Appraisal considerations

A 
Sample size
Diversity in outcome measure
Stable in characteristic of interest
Same circumstances each assesment
Time appropriate between assesments
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18
Q

3 Main groups of Validity and their subcategories

A
  1. Content
    - face
  2. Criterion
    - concurrent
    - predictive
  3. Construct
    - convergent
    - discriminative
    - known groups
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19
Q

Content Validity Characteristics

A

Def: includes all the content required

Design: expert panel conducts extensive assesment

Statistics: none

Considerations: diversity of experts, several rounds of giving opinions, transparent process

20
Q

Face Validity Characteristics

A

Def: makes sense to me

Design: read it, think, done

Stats: none

Consider: diversity of experts, transparent process

21
Q

Criterion Validity Characteristics

A

Def: compare to established measure

Design: measure OM of interest to established OM

Stats: Spearman rho or Pearson Correlation Coeff
-1 to 1

22
Q

Criterion (concurent and predictive) Validity Appraisal Considerations

A

Gold standard credible?
Blinding?
Everyone does both assessments?
Time appropriate between assessments?

23
Q

Concurrent Validity Characteristics

A

Def: two measures correlate at same time point

Design: comparison at same time

Stats: spearman rho
-1 to 1

24
Q

Predictive Validity

Charactersitics

A

Def: OM of interest is correlated with another OM at later point

Design: OM of interest is compared to later OM

Stats: Spearman Rho
-1 to 1

25
Construct Validity | Characteristics
Def: Does OM measure what intended to? Desgin: Measure OM to established gold standard Stats: Spearman Rho -1 to 1
26
Construct, Convergent, and Discriminitive Validity Appraisal Considerations
Argument for gold standard? Blinding of raters? All participants complete both measures? Time appropriate?
27
Convergent Validity | Characteristics
Def: does OM of interest correlate with another measure Design: measure Om to established gold standard Stats: Spearman Rho -1 to 1
28
Discriminitve Validity | Characterstics
Def: does Om interest NOT correlate with measure known to measure different construct Design: Measure OM to established OM Stats: Spearman Rho -1 to 1
29
Known Groups Validity | Characteristics
Def: Does OM produce different results for groups of people known to be diff. on construct the OM is supposed to measure? Design: measure three distinct diff. groups and look for score differences Stats: Analysis of variance for linear trends p value Considerations: differences between groups sufficiently established?
30
Ceiling/Floor Characteristics
Definite: common for individuals to get highest/lowest score Study Design: measure diverse sample and look at proportion that get high/lowest Stats: % Considerations: sufficient diversity in sample? full range of population?
31
Minimal Detectible Change Characteristics
Def: min amount of change required on OM to exceed anticipated measurement error/variability Design: test-restest reliability and then calculate MDC Stats: points on outcome measure scale Considerations: all tet-retest reliabil plus calculations
32
Responsiveness Characteristics
Def: OM ability to detect change over time Design: measure population at two points over time when expect change Stats: effect size Considerations: reasonable to expect change in time between assessments?
33
Minimal Clinically Important Difference Definition
Minimal amount of change on OM patients are likely to percieve as beneficial
34
MCID Study Design
Measure group likely to experience change and gold standatd representing meaningful change. Find cutoff score that detects meaningful change
35
MCID Validity Considerations
1. Diverse sample 2. Participants likely to experience change! 3. Sufficient time for change! 4. Reliabile/valid measures 5. Sample size 6. Rater blinding! 7. Sufficient follow-up! 8. Gold standard actually measures meaningful change!
36
MCID Statistics
Cutoff scores and expected sensitivity, specificity, and LR ratios
37
ICC/Kappa Number Interpretation
>0.8 excellent ageement >0.6 substantial >0.4 moderate
38
Spearman Rho Number Interpretation
+1: positive correlation - 1: negative correlation 0: no correlation >0.85 strong >0.6 moderate
39
Effect Size Number Interpretation
>0.8 large 0. 5-0.8 moderate 0. 2-0.5 small
40
Positive LR Number Interpretation
>10 large 5-10 moderate 2-5 small
41
Negative LR Number Interpretation
0-.1 large .1-.2 mod .2-.5 small .5-1 negligible
42
8 Questions of Appraising Diagnostic Research
1. Entire SPECTRUM of pts represented in study? My patient? 2. COMPARISON with reference GOLD standard of diagnosis? 3. Were diagnostic tests performed by 1 or more RELIABLE EXAMINERS who were MASKED to results of referance material? 4. Did all subjects recieve BOTH tests regardless of test outcomes? 5. Was diagnostic test INDEPENTANTLY interpreted of all other clinical info? 6. Were CLINICALLY USEFUL STATS included in analysis/interpretation for clinical application? 7. Is test ACCURATE and clinically RELEVANT to PT? 8. Will resulting POST-TEST PROBABILITIES affect management and help the patient?
43
Factors affecting Appraisal Question: entire spectrum represented?
What were authors trying to achieve? Are their goals different from yours? --look in abstract or beginning of methods
44
Factors affecting Appraisal Question: comparison to gold standard?
Was there a reference test or gold standard? | Did they compare the two?
45
Factors affecting Appraisal Question: reliable examiners masked?
Were there reliable examiners? | Were they blinded to other test results?
46
Factors affecting Appraisal Question: were clinically useful stats used to interpret clinical application?
Likelihood rations/ sensitivity and specificity | Overall accuracy of the test
47
Factors affecting Appraisal Question: will post-test prob affect patient management?
Look at negative and positive LR

EBP (3 decks)

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