EIP

Question 1

Strategies for finding RCTs

Answer 1

1) look for limiters/filters targeting RCTs
2) field searching (targets publication type/RCTs)
3) RCT-related keywords
4) determine if database has special focus on RCTs

Question 2

Finding RCTs in PubMed

Answer 2

1) Randomized Controlled Trial filter (under “customize”)
2) Advanced search -publication type = RCT
3) Clinical Queries- Therapy (category) & Narrow (scope)

Question 3

finding RCTs in medline & CINAHL

Answer 3

RCT limiter under publication type on the limit your results page

Question 4

finding RCTs in TRIP database

Answer 4

controlled trials filter in the refine results by evidence type menu on right

Question 5

finding RCTs in SportDiscus & AMED

Answer 5

these databases do not have a specific limiter/filter for RTCs.
-need to add RTC-related keywords
(try randomized OR randomised OR random*)

Question 6

finding RCTs in PEDro

Answer 6

PEDro has a special focus on RCTs and groups RCTs together in your search results automatically.

• look for results labeled clinical trial in method column.
• PEDro pre-appraises RCTs for quality; the quality score shows up in score column

Question 7

5 Steps to EBP

Answer 7

1) Ask
2) Access
3) Appraise (quality)
4) Apply
5) Assess (effect & self assessment)

Question 8

background Q’s

Answer 8

• general questions

- multiple tangents depending on different patient & dr perspectives

Question 9

foreground Q’s

Answer 9

• clinical Q’s that will give you a better chance at finding the best available evidence
  1) Therapy -will modality help?
  2) Harm -will there be adverse effects?
  3) Prognosis -what’s the observed outcome?
  4) Diagnosis - will a particular test help?

Question 10

creating foreground Q’s

Answer 10

P: population/problem
I: intervention
C: comparison (not always necessary)
O: outcome of interest

Question 11

useful sources of pre-appraised literature

Answer 11

1) Dynamed
2) Turning research into practice (TRIP)
3) Physiotherapy evidence database (PeDro)

Question 12

levels of evidence

Answer 12

1) systemic review –> meta-analysis** OR qualitative
2) randomized control trial
3) cohort
4) case study/ report

Question 13

best answer for a therapy Q is found?

Answer 13

RCTs

Question 14

best answer for a risk factor of rare condition is found?

Answer 14

case-control studies

Question 15

best answer for a diagnostic Q is found

Answer 15

cross-sectional studies

Question 16

best answer for a prognosis Q is found

Answer 16

cohort studies

Question 17

anecdots

Answer 17

he said, she said stories

• pure observation
• unpublished

Question 18

case reports/series

Answer 18

• published studies of what happened to a single person or group of people
• based on observation only

Question 19

cross-sectional studies

Answer 19

exposure & outcome are measured at the same time & once like a snapshot in time
-DIAGNOSIS-related Q’s

Question 20

Case-Control Studies

Answer 20

people w. disease & people w/o obtained info about past exposure that can be considered a risk for the disease
-HARM-related Q’s

Question 21

cohort studies

Answer 21

data is obtained via exposure of 2 groups (tx & control) over time.
–PROspectice = both groups followed forward in time NOT in the past

-RETROspective = both groups followed forward in time but starting at time in the past

Question 22

randomized control trial (RCT)

Answer 22

considered the primary study for foreground Q’s about therapy.
-meta-analysis & systematic reviews

Question 23

key components of a RCT =

Answer 23

• subjects = treatment OR control group
• allocation is done using ransom mechanism
• baseline measurements are taken
• intervention is applied in blinded fashion to treatment & control group
• outcome measured by blind assessors in both groups over a pre-determined follow-up

Question 24

ABCDFIX =

Answer 24

A= allocation / administered
B= blinding
C= comparisons
D= drop outs/ lost data
F= follow up
I= intention to treat (only when there is lost data)
X= everything else

Question 25

Look for ABCDFIX in...

Answer 25

``` A = methods section B= methods C= Table 1/figure 1 D= figure 1 F= figure 1 I= results X= everywhere! ```

Question 26

are allocation and randomization the same thing?

Answer 26

NO

Question 27

is blinding the same as concealed allocation?

Answer 27

NO

Question 28

blinding most important players =

Answer 28

1) Dr. 2) Patient 3) Outcome assessor ** - look to see if they asked patient if they thought they knew which group they were in = if blinding actually worked or not

Question 29

Subjective (-) Vs. Objective (*) measures

Answer 29

- pain rating * motion palpation - dizziness - length of time you can sit w/o pain * orthopedic tests * low back endurance timed - questionnaire regarding things you can no longer do at home * deep tendon reflexes - number of days missing work

Question 30

Comparison

Answer 30

after randomization is one group at an advantage - comparable start - comparable extra help - comparable attention - comparable compliance

Question 31

Drop Outs why should we care?

Answer 31

- subjects who dropout might be different than those that stay - loss of randomization - loss of statistical power

Question 32

what we want to know about drop outs

Answer 32

- how many (5-20% rule) - how was loss distributed (evenly btw groups) - why was data lost? (adverse effects, got well?) - was it corrected for?

Question 33

Follow up

Answer 33

was it complete/ long enough for the clinical outcome? SHORT TERM = 4-6 weeks? LONG TERM= heart 2-10years OR low back pain (6-12m)

Question 34

intention to treat...

Answer 34

once randomized always analyzed | **must in RCT = addresses known & unknown prognosis factors

Question 35

5 reasons to like intention to treat

Answer 35

1) preserves randomization 2) maintain prognosis balance 3) preserves sample size balance 4) helps prevent an overestimation of how good a treatment really is 5) intention-to-treat better reflects