EBP

Question 1

Level I

Levels of Evidence

Answer 1

1. systematic reviews, meta-analyses and randomized controlled trails
2. High-quality, prospective study
3. Group 1: controlled; group 2: treatment
4. Values obtained from many studies with multiway sensitivity analyses

Question 2

Level II

Level of Evidence

Answer 2

1. Less quality RCT; prospective comparative study; retrospective study
2. Two-group, nonrandomized studies; pretest-posttest design
3. Untreated controls from an RCT
4. Values obtained from limited studies with multiway sensitivity analyses
5. Systematic review of Level II studies or Level I studies with inconsistent results

Question 3

Level III

Level of Evidence

Answer 3

1. Case control study; retrospective comparative (Cohort) study
2. One-group, nonrandomized studies; pretest-posttest designs
3. Study of nonconsective patients without consistenly applied ref. “gold standard”
4. Analyses based on limited alternatives and cost and poor estimation
5. Systematic review of Level III studies

Question 4

Level IV

Level of Evidence

Answer 4

1. Case series; case control study
2. Descriptive studies that analyze outcomes (single-subject and case designs)
3. Poor reference standard
4. Analyses with no sensitivity analyses

Question 5

Level V

Level of Evidence

Answer 5

1. Case report
2. Expert opinion
3. Personal observation

Question 6

T/F: Level I or II evidence within a literature review are the only level of evidence that address and justify the efficacy of the intervention.

Answer 6

True

Question 7

Nagelkerke R Square

Effect Sizes

Answer 7

1. Explains how the variance in the dependent variable can be explained by the independent variables
2. how well the regression model explains the observed data

Example: an R-squared of 60% reveals that 60% of the variability observed in the target variable is explained by the regression model

Closer to 1 means the data perfectly fits the linear model.

Question 8

Numbers Needed to Treat

Effect Sizes

Answer 8

1. The number of patients who would need to receive treatment to produce a positive outcome in one patient who otherwise would have had a negative outcome
2. Focuses on intervention

Assesses 2 things:
1. potential utility of a particupar diagnosis test
2. how likely it is that a patient has a disease or condition

A ratio of the probability that a test result is correct to the probability that the test result is incorrect

LR=1 means test has very little influence on the fact that the patient does or does not have the disease
Test is useless.
Pre-test vs Post-test
Or comparing two competing point hypotheses (null and alternate hypotheses)

Question 9

Likelihood Ratio

Effect Sizes

Answer 9

1. The likelihood that a specific test result would be seen in a person with the target disorder
2. Focuses on diagnosis

Question 10

Cohen’s d

Effect Sizes

Answer 10

1. Measures the magnitude of the difference between two means (comparing two groups) in standard deviation units
2. Focuses on intervention
3. 0.2=small effect; 0.5=moderate effect; 0.8=large effect
4. Difference between two Sample SD is used to estimate the population SD results interpret the effect
5. Small effect size are too small to differentiate by the naked eye (ex. difference in height in 15 and 16 y.o girls)
6. Medium effect size are just large enough to be seen by the naked eye (ex. diff height between 14 and 18 y.o. girls)
7. Large effect size are obvious; difference between groups. (observed height between 13 and 18 y.o girls)

https://www.youtube.com/watch?v=IetVSlrndpI

Question 11

An OTR is reading a research study to determine the benefits of a new device that claims to improve task performance by delivering electrical stimulation to a hemiparetic hand. The OTR uses a different device at the clinc and wants to determin if the new device will be worth the investment. The OTR would like to know how many clients should use the new device for one of them to benefit from the device. Which statistic reported in the result section is the BEST indicator of this information?

A] Negelkerke R Square
B] Number needed to treat
C] Likelihood ratio
D] Cohen’s d

Answer 11

B] Numbers needed to treat
1. NNT is a form of affect size in intervention studies
2. Indicates number of pt. that would need to rec. treatment for 1 patient to have a postive outcome
3. Effect size indicates magnitude of the difference btwn two methods

Nagelkerk R Square
1. Explains how the variance in the dependent variable can be explained by the independent variables

Likelihood Ratio [diagnosis]
1. A specific test result would be seen in a person with the target disorder

Cohen’s d [intervention]
1. Measures magnitude of difference btwn two means in standard deviation units

Question 12

Criterion-Referenced

Standardized Assessment

Answer 12

1. Standardized assessment
2. Client is graded in terms of some behavioral standard
3. Identify performance on a specific task

Question 13

Norm-Referenced

Standardized Assessment

Answer 13

1. Standardized assessment
2. Client is compared to a group of other people who have taken the same measure
3. Utilized as an outcome measure

Question 14

Descriptive Research

Types of evidence

Answer 14

1. observing and measuring without manipulating variables.
2. It can identify characteristics, trends and correlations.

Question 15

Qualitative Research

Answer 15

1. a process of naturalistic inquiry that seeks an in-depth understanding of social phenomena within their natural setting.
2. It focuses on the “why” rather than the “what” of social phenomena and relies on the direct experiences of human beings as meaning-making agents in their every day lives.

Question 16

Descriptive and qualitative research

Answer 16

Descriptive and qualitative research gives the practitioner an idea of typical occupational experiences and needs that clients with particular conditions may have:
1. Qualitative designs
2. Case studies
3. Case series
4. Cohort studies
5. Cross-sectional studies

Question 17

Exporatory research

Answer 17

1. Investigates research questions that have not been studied in depth.
2. The preliminary results often lay the groundwork for future analysis.
3. Questions tend to start with “why” or “how”, and the goal is to explain why or how a previously studied phenomenon takes place.

Evaluates assessment and can help practitioners make decisions about types of interventions they use with their clients as well as the probable outcomes
1. Cross-sectional studies
2. Case-control studies

Question 18

Experimental research

Answer 18

1. a kind of study that rigidly follows a scientific research design.
2. It involves testing or attempting to prove a hypothesis by way of experimentation.
3. As such, it uses one or more independent variables, manipulating them and then using them on one or more dependent variables.

Question 19

Experimental and exploratory research

Answer 19

Can help practitioners make decisions about the types of interventions they use with their clients as well as the propbable outcomes

1. Randomized clinical trials
2. Quasi-experimental studies
3. N-of-1 studies (single-subect design)
4. Cohort studies
5. Case series design

Question 20

An OTR® reads a scientific study that compares treatment effectiveness after an activity-based intervention versus rote exercise to increase upper extremity function in two groups. The mean score on the activity-based group increased by 14 points, and the mean score of the rote control group increased by 12 points. Results from the t test that compared the group outcomes were statistically significant (p < .05). Which type of design BEST describes this scientific study?

Case-control
Correlational
Descriptive
Experimental

Answer 20

Solution: The correct answer is D.

The experimental study design addresses intervention effectiveness because participants are assigned to different groups to determine the effects of the intervention.

A, B: Case-control and correlational designs are used to identify relationships between variables to identify risk factors or causes of a situation. The use of two groups with different interventions requires effectiveness measures over time.

C: Descriptive study design is used to describe and analyze a phenomenon, not determine the effectiveness of an intervention.

Item Source. NBCOT®. (2013). Retired item inventory. Adapted to fit the purpose of the online exam prep tool.
Baker, N., & Tickle-Degnen, L. (2019). Evidence-based practice: Integrating evidence to inform practice.

Question 21

An occupational therapy clinic has purchased a new standardized assessment tool. The occupational therapy practitioners are checking the interrater agreement for routinely using the tool. The point-by-point agreement for all raters at the clinic was found to be 70%. What information does this calculation provide?

Additional practice for administering and scoring the tool is needed.
Minimum acceptable standards for interrater reliability have been met.
Service competency for raters using the assessment tool has been attained.
The majority of raters administered the assessment tool correctly.

Answer 21

Solution: The correct answer is A.

The suggested interrater reliability of a standardized test is 80%; a point-by-point agreement of 70% is generally too low for good interrater reliability and suggests that there are differences in the way practitioners are administering the assessment.

B, C, D: The suggested interrater reliability of a standardized test is 80%; a point-by-point agreement of 70% is generally too low for good interrater reliability and would not suggest a psychometrically sound assessment.

Question 22

An OTR® has had many observations of the adjustment that clients go through following spinal cord injury. The OTR® would like to put together focus groups to explore the experiences of individuals who are adjusting to spinal cord injury. What study design methodology would be best for this type of research project?

Randomized controlled trial
Single-case design
Phenomenology
Participant observation

Answer 22

Solution: The correct answer is C.

Phenomenological study design would allow for the collection of participant’s experiences through focus groups that contain open-ended interview questions.

A: Randomized controlled trial (RCT) study design is appropriate for studying the effects of different treatment by assigning participants to different intervention groups. RCT involves quantitative data collection based on outcome measures, whereas the scenario described suggests gathering of client experiences through qualitative data.

B: Single-case designs include only one participant and would not be useful in gathering the experiences of multiple individuals with spinal cord injury through focus groups.

D: Participant observation study design involves the researcher becoming part of the participant’s experience and gathering qualitative data in the process through experiencing the same contexts the participant does. The researcher would not be able to join as a participant with individuals with a spinal cord injury to share a like experience.