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PHYSIOTHERAPY > Developing Criticality Exam > Flashcards

Developing Criticality Exam Flashcards

1
Q

What is the BPS model?

A

First established by Engel in 1977 due to a need for a broader approach to healthcare. His articles The Application of the BPS Model (1980) discusses the need to ask about residence, occupation, relationships etc.

Holistic view: biology, thoughts, motivations, cultures, behaviours

Criticises reductionists view and the biomedical model

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2
Q

What is PSCEBSM?

A

Can be used when applying the BPS model to a patients
Type of pain
Somatic and medical factors
Emotional factors
Behavioural
Social factors
Motivation

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3
Q

What is the ICF model?

A

The International Classification of Functioning, Disability and Health
Health condition
Human function - Activities - Participation
Environmental factors - Personal Factors

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4
Q

What is the difference between the Hollistic and Reductionist view of healthcare?

A

Reductionist:
Focus on parts, associated with the biomedical model, linear cause and effect framework

Precise and clarity
But narrow, fragmented view, can offer an incomplete understanding of

Hollistic: Focus on the whole person, BPS model, MDT, patient centred care

Comprehensive, patient care, comprehensive

Complex, resource intensive and variability

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5
Q

What is Ontology?

A

The nature of reality. What society consists of. It tries to explain and categorise everything that exists.

Eg in Physiotherpay the bones, muscles, tendons, ligaments and anatomical structures
In Physiotherapy, ontology would look like a structured framework eg
Conditions - mask, neuro, cardio
Treatments
Therapy
Body functions
Assessment tools

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6
Q

What is Epistemology?

A

The nature and value of knowledge. How we come to know things.
Eg in Physiotherapy following empirical methods, such as goniometry ROM assessments, to gain clear scientific results.

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7
Q

What are some different ontologies some people may have?

A

Materialism: only physical mater exists
Dualism: mind and matter
Idealism: Mental or spiritual
Existentialism: Individual existence, freedom and choice.
Realism: universal truths/facts
Empiricism: facts become true by observation
Positivism: rejects that clear facts can be found
Post modernism: facts shift depending on interpretation and perception, Change with time.

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8
Q

What are some different ways we might find things out?

A

Empiricism: knowledge through sensory experience and observation
Rationalism: knowledge through reasoning and logical deduction eg mathematics
Intuition: knowledge through immediate understanding
Authority: accepting information from credible sources
Pragmatism: evaluating the truth of beliefs based on their practical applications.

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9
Q

What is the difference between between science and pseudoscience?

A

Science: scientific method relying on empirical and measurable evidence. Undergoes peer review. Builds upon established theories. Open to scrutiny.

Pseudoscience: often relies on anecdotal evidence or untestable claims eg homeopathy.

Science DISPROVES whilst Pseudoscience PROVES

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10
Q

What are some of the most common clinical guidelines?

A

NICE guidelines on Anxiety: identifications and assessments, low intensity psychological intervention, individual self help, psycho educational groups, high intensity psychological intervention eg CBT or drug treatment. Finally, highly specialist treatment.

WHO guidelines on heart disease: cessation of tobacco use, reduced salt intake, regular physical activity, avoiding harmful use of alcohol.

Other influential criteria: centres for disease control and prevention. American Heart Association.

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11
Q

What are the differences between Policies, Procedures, Protocols and Guidelines?

A

Policies: must follow, mandatory
Procedure: step by step instructions on how to perform, specific tasks and activities
Protocol: Detailed plan for specific clinical care. Often based on evidence. Prescriptive, minimal room for interpretation.
Guidelines: suggestions based on evidence based practice. Usually none-mandatory. General direction and support more flexibility.

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12
Q

What is Evidence Based Healthcare and what are the three components?

A

Use of updated guidelines to inform best practice
Ensures effective healthcare for the patient and the system

Patient Values - preferences, expectations and concerns
Best of Clinical Expertise
Best of Research Evidence

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13
Q

What is the alternative to evidence based healthcare?

A

Intuition based decision making
Based on personal experiences and instinct, not on systematic evidence.

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14
Q

What areas can evidence be categorised into?

A

Epidemiology - commonality
Diagnosis - what is the condition
Intervention - what is the best treatment eg observational and interventional studies
Prognosis - how long before I am better

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15
Q

What are the 4 principles of bioethics?

A

Autonomy
Beneficence
Non-maleficence
Justice

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16
Q

What is autonomy?

A

The right of individuals to make informed and voluntary decisions about their own lives and bodies eg informed consent

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17
Q

What is beneficence?

A

Obligation to act in the best interest of others, promoting good and preventing bad

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18
Q

What is non-maleficence?

A

Obligation to avoid causing harm eg deciding against risky procedures and the risks outweigh the benefits

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19
Q

What is justice?

A

Fairness and distribution of resources and access
Eg public health policies promoting accessibility

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20
Q

What are the key HCPC ethical guidelines?

A

Promote and protect interest of service users
Communicate appropriately
Work within the limited of your knowledge
Delegate appropriately
Respect confidentiality
Manage risk
Honest and trustworthy

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21
Q

What are the main theories of ethics?

A

Consequentialism: judges the rightness of actions based on their consequences

Virtue ethics: Emphasises the role of character eg an honest person tells the truth as it represents their virtuous character

Deontology: emphasises the importance of rules, duties and obligations. Eg telling the truth is always right.

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22
Q

What would you do if a patient refused treatment?
What would you do if a patient insisted on having a treatment that you knew wasn’t beneficial?

A

THINK:
Autonomy
Beneficence
Non-maleficence
Justice

23
Q

What is logic?

A

Reasoning conducted according to strict principles of validity, laws of thought, correct reasoning, valid inferences and logical truth.
Provides a framework for constructing arguments

Key components:
Proposition, arguments, validity, soundness

24
Q

What is inductive logic/reasoning?

A

Observational studies
Specific Observation - Pattern Recognition - General Conclusion

Example: Observing what exercises work well for non specific lower back pain.

Arguments are probabilistic.
Example: the sun has risen everyday in history, so the sun will rise tomorrow.

25
Q

What is deductive logic?

A

Randomised Control Trials:
Theory - formulate hypothesis - collect data - analyse data - reject/accept hypothesis

Example: all patients with sciatica have radiating lower limb pain, a patient has these symptoms, conduct tests, analyse results and accept or reject hypothesis.

If the premises are true, the conclusion cannot be false
Example: all humans are mortal, Socrates is a human. So, Socrates is mortal.

26
Q

What is an argument?

A

A proposition from which another is inferred or followed.
Can have a number of premises but only one conclusion.
Consider: validity, soundness

27
Q

What is a fallacy?

A

A failure of reasoning that renders an argument invalid
Example: people have been trying for years to find a cure for cancer. No one has found a cure. Therefore a cure doesn’t exist.

28
Q

What is base rate fallacy?

A

People neglect the base rate in favour of the individuating information.

Example: Shy Steve, librarian or salesman?

29
Q

What are formal fallacies?

A

An issue with the logical form or structure of an argument
The conclusion does not logically follow the premises ]
Example: If it is raining, the ground will be wet, the ground is wet, therefore it is raining.

30
Q

What is an informal fallacy?

A

Errors in reasoning that occur due to the context or language. Faulty assumptions or ambiguity, irrelevance or emotional appeal.

Example: We shouldn’t trust … because they have been arrested. Attacks character rather than the validity of what they are saying.

  • Attack on the person
  • Oversimplifying someone’s argument
  • Appeal to ignorance eg cancer cure example
  • Presenting 2 options where more than 2 are available
  • Conclusions based on small samples
  • Appeal to authority or popularity.
31
Q

What is abductive logic?

A

Forming a hypothesis to explain a set of observations. Seeks the most likely explanation for observations.
Example: patient with lower back pain and sedentary lifestyle. Possible explanations: herniated disc, muscle strain, sciatica. Best explanation: hypothesises muscular imbalance due to sedentary lifestyle.

32
Q

What is probability?

A

The idea or the chance of something happening
The higher the probability the more likely it is to occur

Example: flipping a coin.

33
Q

What is Frequentist probability?

A

Likelihood of an occurrence based on repeat trials.
The frequency of an event over a large number of trials predicts its future likelihood.

Example: study to look at exercise and lower back pain. 70/100 people saw decreased pain with increased exercise.

34
Q

What is Bayesian Probability?

A

Conditional probability - the likelihood of an outcome occurring based on a previous outcome in similar circumstances.

Example: probability of a patient having a lumbar disc herniation. Use the prior probability (the likelihood of back pain being a disc herniation) and the sensitivity and specificity of the MRI test. Can then calculate the probability of a positive MRI result. Can combine these probabilities to update our beliefs (posterior probability).

35
Q

What are some risks in healthcare?

A

Risk of sepsis from acupuncture
Risk of falls
Cross-contamination
Infection
Muscle atrophy
DVT post operation

36
Q

What is the point of the Monty Hall Problem?

A

3 doors (2 goats and 1 car)
Important for decision making under uncertainty
Counter-intuitive strategies can sometimes be the most effective eg switching to a new treatment plan as new information becomes available

Re-evaluation of surgery risk assessments as new methods become available

The values of updated information.

37
Q

Briefly explain the concept of statistics?

A

Deals with collection, analysis, interpretation, presentation and organisation of data.

Mean, median, mode, standard deviation, range

Inferential statistics: predictions based on a sample of data (hypothesis testing)

Probability
Sampling
Data collection
Data analysis

Example: studies to see whether certain exercises are effective in reducing lower back pain. Sample, data collection, descriptive statistics. Results. Interpretation.

38
Q

What are dependant and independent variables?

A

Dependant - measure
Independent - change

Example: A study looking at effectiveness of a specific exercise on LBP. Dependant = lbp levels. Independant = exercise programme

39
Q

What is the difference between a null hypothesis and an experimental?

A

In a null hypothesis you state that there is no link/correlation between how often you smoke and your risk of developing. Eg the new drug has no effect on blood pressure.

Experimental hypothesis: predicts what changes (indicates the presence of an effect) will take place in the dependant variable when the independant variable is manipulated. Eg the new drug lowers blood pressure.

40
Q

What is a P-value?

A

The probability of something happening. P-value of 0.05 or lower means the results are significant and you reject the null hypothesis.
Often use a T-test to get to this point. A t-test compares 2 means and determines whether they are significantly different or not.

41
Q

What are confidence intervals?

A

A range of values derived from the sample data that is likely to contain the true population parameter within a certain level of confidence.
Normally want a CI of 95% plus.

42
Q

What are standard deviations?

A

A measure of how spread out the values in a data set are around the mean. Low SD = values are close to the mean
Example: measuring ROM in knees mean improvement 15 degrees. SD = 2 degrees. This means that most improvement is within 2 degrees of the mean. A lower SD indicates that improvements are fairly consistent among patients.

43
Q

Briefly explain the concept of clinical reasoning?

A

Understand the clients occupational needs, make decisions about intervention and think what to do. Allows evaluation, diagnosis and treatment of patients. Analysing patient information, integrating evidence based practices and making informed decisions.

Example:
Patient assessment, problem identification, diagnosis, treatment planning, intervention, evaluation, reflection and learning.

Cognitive process that incorporates thinking skills and knowledge used to make clinical decisions and judgements through the evaluation, diagnosis and management of patient problems.

44
Q

Explain hypothetical-deductive reasoning

A

Accounts for results obtained through direct observation and experimentation. Through inference this will predict further effects that can be verified or disproved by empirical evidence.

Linked to deductive logic - theory, hypothesis, data, hypothesis RCTs.

45
Q

What does metacognition mean?

A

Awareness and understanding ones own thought process.
Higher order thinking skills that can include planning, monitoring and evaluating ones cognitive activities.

Self-awareness
Self-regulation

Essential in problem solving and learning

46
Q

What are some types of metacognition?

A

Metacognitive experiences: thinking and thinking in the moment

Metacognitive knowledge: how a persons beliefs can affect their own cognition

Tasks and goals: the outcome you want to achieve when thinking about your own thinking

Metacognitive strategies: strategies used to achieve your own goals.

47
Q

Explain what Pattern Recognition is?

A

A data analysis method to recognise patterns and regularities in data
- expert knowledge
- non-complex problem
- problem familiarity

Based on INDUCTIVE logic: making generalisations from specific observations. Patterns can be generalised to make predictions or classifications about new data.

48
Q

Briefly explain the difference between qualitative and quantitative research?

A
49
Q

What research method sits at the very top of the evidence/research hierarchy? Why?

A

Systematic Reviews and meta analysis of RCTs
RCTs
Cohort studies
Case control studies
Cross-sectional studies
Case reports
Expert opinion

50
Q

What do observational studies do?

A

Cohort studies - investigate the causes of disease, risk factors and health outcomes. Disease eitiology, history of disease, public health. Follow participants who share common characteristics - longitudinal. Can be prospective or retrospective.

Case control studies - Investigate associations between exposures and outcomes. Compare individuals with a specific conditions to those without. Case vs Control Determining risk factors for injuries.

Cross-sectional studies - Analyse data from a population at a single point in time. Assess prevalence of outcomes or characteristics at a single point in time. Snaoshot in time, population based, descriptive and analytical. Eg estimating prevalence of a disease at a given time - health surveys. Determine associations between two variables.

51
Q

What is an ethnography and what is its importance in Physiotherapy?

A

A qualitative research method that involves in depth studies and systematic recording of human cultures, practices and interactions.
Typically immerse themselves in the daily life.
Participant observation, interviews, field notes, cultural context

Valuable insight in Physiotherapy:
Understanding patient perspectives
Improving patient centred care
Enhancing communication and trust
Identification of barriers
Informing programme development
Advancing professional practice.

52
Q

What does PICO mean?

A

A framework used in evidence based practice to formulate research questions and guide the search for relevant evidence.
1. Patient or problem
2. Intervention
3. Comparison - the alternative to the intervention eg placebo
4. Outcome

Example:
P - elderly patients with knee osteoarthritis
I - new Physiotherapy exercise programme
C - standard care
O - improvement in mobility

Helps to provide clarity and focus, structured literature search, improved study design, evidence based practice.

53
Q

What is the best method for investigating the effectiveness of a treatment?

A

Randomised control trial

Causality, bias reduction, reproduceability

Cost, ethical concerns, generaliseability, complexity

54
Q

What is risk?

A

Modifiable and Non modifiable
Absolute - eg how many people affected by a disease
Relative - how many people affected after a drug eg 1/2 or double.

PHYSIOTHERAPY (14 decks)

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