EBP EXAM 2:3

Question 1

What is efficacy?

Answer 1

· The effect/how it works under ideal conditions
· Inclusion/exclusion criteria
· The study is internally valid (it measures what it says it measured)
· Can it work? (Ideal)

Question 2

What is effectiveness?

Answer 2

• The effect/how it works under “real life” conditions
• Can it work clinically
• Efficacy + Adherence = Effectiveness

Question 3

Why is there a difference between efficacy and effectiveness?

Answer 3

• Cant have the exact same layout in real-life
• Complex problems
• Variations in motivation
• Variations between therapists knowledge and experience
• Efficacy (can it work?) + adherence (what happens in real life?) = effectiveness (does it work?)
• Adherence includes complex problems, more heterogeneous sample, variations in therapist’s knowledge and experience, variations in motivation, and cost
• Efficacy (does it work in research studies?)
• Effectiveness (does it work in practice?)
• Efficiency (does it contribute to more efficient use of resources?)

Question 4

Define efficiency.

Answer 4

• Does it contribute to more efficient use of resources?

* Will it work in your setting?

Question 5

What is an evidence synthesis?

Answer 5

• The integration of information from multiple studies
• Study 1 + study 2 + study 3 = clinical bottom line
• Clinical bottom lines (results, strength/quality of evidence, common themes among studies)
• Short summary of the best answer
• Conclusions supported by more than one study
• Boundaries around the answer (limits of application, cautions, strength of the research support, limitations of research studies)

Question 6

Why should we synthesize evidence rather than relying on evidence from one study?

Answer 6

• It’s very unlikely that only one study will give you the answer to your questions
• Summaries and compare (makes it easier if you have it organized to look across studies and determine what they mean as a group.)
• Help capture underlying similarities or differences (how findings might relate to differences or similarities
• Helps illustrate data trends (same studies showing same things, gives you stronger answer to your question)
• Supports next steps

Question 7

When what is included in evidence tables that are used to synthesize evidence?

Answer 7

· Level of evidence
· Sample size (larger studies usually stronger, have more power than smaller studies)
· Participant characteristics (ages, ethnicities, diagnoses)
· Methodological quality (well done or poorly done)
· Type of intervention used (slightly different in one study vs. another; can account for differences in results)
· Summary of results
· Limitations (was the study good enough for me to rely on it?)
· *Makes it a lot easier to look at studies and see what was found when they are put into tables

Question 8

Describe the outcomes or “clinical bottom lines” that might be included in a synthesis.

Answer 8

• Statements about the levels of evidence
• Similarities and differences in methods used
• Overall findings (not only in each individual study, but as a whole as well)
• Domains targeted (did you get answers that related to occupations?)
• Client characteristics? (is my client similar to the participants in the studies?)
• Contraindications (any risk/negative/harm you should be aware of?)

Question 9

What could you do if your synthesis reveals contradictory evidence or partial answers to your PICO question?

Answer 9

• Use BEST available evidence (one study will not totally answer question)
• Advise clients of biases or limitations (there is research out there, but this is what it says)
• Explain advantages and disadvantages of interventions
• Greater use of expert clinical opinion, clinical reasoning (can help your client make a good decision)