Critical Inquiry and EBP Flashcards
A level evidence
strong
lots of evidence from RCTs, at least one high quality
B level evidence
moderate evidence
single high quality RCT
or
multiple lower quality RCT
C level evidence
weak
based on single weak RCT
or
preponderance of evidence from: case control, case series, retrospective
D level evidence
conflicting evidence
E level evidence
theoretical or foundational
F level evidence
expert opinion
P value
probability differences between groups (results) is due to chance. assuming null hypothesis is true.
Type 1 error
detecting a difference when there isn’t one “backing a loser”
Type 2 error
no difference between groups but there actually is one “missing a winner”
-could be too few subjects to detect a difference
Effect sizes
0.8+ = LARGE
0.5-0.79 = moderate
0.2-0.49 = small
lower than 0.2 = trivial
Interrater reliability
multiple clinicians performing the same test
Intrarater reliability
same clinician performing the test
Cohen’s Kappa
Interrater reliability 0 = no better than chance <0.4 = poor 0.4-0.6 = fair 0.6-0.75 = good >0.75 = excellent 1 = perfect
Positive likelihood ratio
how much to increase suspicion of certain condition based on positive test result. Larger than 1. >10 = large shift toward 5-10 = mod <5 = small 1 = no change
Negative Likelihood ratio
how much to decrease suspicion based on a negative test result, smaller than 1. <0.1 = large shift away 0.1-0.2 = mod 0.2 = small 1 = no change
Sensitivity
probability that a person will test positive when they have the disease. Ability to detect disease.
Higher sensitivity = rule OUT
SNOUT
Risk of false positives
Specificity
probability that a person will test negative when they don’t have the disease.
Higher specificity = rule IN
SPIN
Selection Bias
study population not representative of target population
defense: completely blind randomization
Information Bias
misclassification, diagnostic, or calibration bias. Faulty instruments or methods.
Misclassification
participant coded wrong - smoker coded as non smoker, etc
Diagnostic or detection bias
differential assessment of outcome between exposed and unexposed groups
decrease: blinding study staff.
Calibration bias
inaccuracies in measurements inherent in device or due to operator error
publication bias
failure to publish solely on basis of direction or magnitude of difference in study results
Placebo effect
individual believes tx will work, that belief has therapeutic value.
Placebo needs to look like real tx. Biggest effect on outcomes mediated by the brain: pain, fear, perceived functional ability.
Nocebo Effect
negative beliefs can result in worse outcomes. exaggerated if its implied or suggested there will be negative side effects, or if subject had side effects from treatments in the past.
Control for placebo and nocebo effects
exclusion criteria to remove individuals with past positive or negative tx results.
Randomization.
Hawthorne Effect
subjects that know they are in a research study tent to work harder
Observer effect
people work harder when being watched. Healthcare: more improvements with more attention, give both groups same attention/time.
John Henry Effect
control group perceives they are disadvantaged vs experimental group and work harder. control group may seek other tx in addition or perform more self tx.
Blind subjects to decrease
Pygmalion/Rosenthal Effect
expectations of those in authority effect outcomes, may be researchers expectations cause them to treat different groups differently, effecting outcomes.
Blind clinicians to decrease.
ICF Model: Body functions
physiological functions of body systems - including psychological
ICF Model: Body Structures
anatomical parts of body such as organs, limbs, and their components
ICF Model: Impairments
Problems in body function or structure such as significant deviation or loss
ICF Model: Activity
execution of a task or action by an individual
ICF Model: Participation
involvement in life situation
ICF Model: Participation restrictions
problems an individual may experience in involvement in life situations
ICF Model: Environmental factors
physical, social, and attitudinal environment in which people live and conduct their lives.
