Ethics & EBP Flashcards
Veracity
An ethical obligation to be honest and truthful
Justice
An ethical obligation to provide equal and fair treatment to all
Autonomy
An ethical obligation to respect the wishes of the client
Nonmaleficence
An ethical obligation to do no harm to each other
Beneficence
The moral and ethical obligation to do good for each other
Fidelity
An ethical obligation to be fair and respectful
Response to Intervention (RTI) framework: Tier 3 services
A tier in the Response to Intervention (RTI) framework in which:
- intense 1:1 interventions are provided at the individual level
- may include further evaluation to determine need for additional services
Response to Intervention (RTI) framework: Tier 1 services
A tier in the Response to Intervention (RTI) framework in which:
- interventions are focused at the systemic level for all students in general education
- includes universal screenings and interventions
Response to Intervention (RTI)
An evidence-based model used to identify and reduce the impact of academic or behavioral concerns on students’ learning needs within the general education system
It contains the following key features:
- based on a multi-tiered framework
- outlines the delivery of client-centered education and interventions for all students
- response to interventions is analyzed and used to determine if more intensive services are required
Response to Intervention (RTI) framework: Tier 2 services
A tier in the Response to Intervention (RTI) framework that focuses interventions on students who are underperforming academically or who have behavioral concerns
Case study research design
Research study design that includes a qualitative analysis of group or individual by collecting data without manipulation of an independent variable, commonly used to analyze the effects of new interventions, may include:
- observation
- interview
- record
Observational research study design
Research study design used to analyze behaviors or outcomes of subjects, conducted:
- without influence from the researcher
- in natural or controlled environment
Quasi-experimental research design
Non-randomized research study design used to determine whether an intervention or program has a causal impact on participants
Systematic review
Method for analyzing research studies in the literature with a focus on:
- a specific topic or question
- collecting data based on specific search criteria
- coding and evaluation of data
- interpretation of results
- summarizing findings
Hierarchy of evidence: Level V
Level of evidence that:
- does not have a research component
- offers information about a particular topic
- includes qualitative research and expert opinions
Hierarchy of evidence: Level IV
Level of evidence that includes:
- studies conducted with a nonexperimental design
- single-subject case studies
- cohort studies
Hierarchy of evidence: Level III
Level of evidence where validity of results are threatened
Includes:
- results from a non-randomized research study that has a control group and an intervention group but research subjects have not been randomized to each group
Hierarchy of evidence: Level II
Level of evidence that includes:
- results from a single randomized controlled trial (RCT) that have an effective research design and appropriate sample size
Hierarchy of evidence: Level I
The strongest level of evidence that includes:
- meta-analysis of multiple randomized controlled trials (RCT)
- systematic reviews with homogeneity of evidence
Meta analysis
Method for combining and contrasting quantitative results from various studies without statistical synthesis of the results, used to find patterns and relationships
Qualitative research
Formalized method of inquiry for gaining an in-depth understanding of attitudes, concerns, and behaviors, may include:
- interviews
- observations
- focus groups
Quantitative research
Systematic method of inquiry that attempts to answer a hypothesis using statistical analyses, may include:
- experimental studies
- customer surveys
- goal audits
Directional hypothesis
Research question in which the researcher is able to predict if outcomes related to variable manipulation will be positive or negative (i.e., single-tailed)
Continuous quality improvement
Structured managerial method used to evaluate efficiency and effectiveness of processes and procedures to foster an ongoing commitment to:
- problem resolution
- customer satisfaction
- organizational learning
- data driven decisions
- training for all levels of the organization
- data driven decisions and measurable outcomes
Nondirectional hypothesis
Research question in which the researcher cannot predict if outcomes related to variable manipulation will be positive or negative (i.e., two-tailed)
Null hypothesis
Research statement in which the researcher predicts outcomes related to manipulation of variables
PICO method
Acronym that describes the method used to formulate a clinical or research question
P - patient/population
I - intervention/indicator
C - comparison/control
O - outcome
Scaled Score
Test scoring procedure involving a mathematical conversion of the number of items that a test-taker correctly answers on a test transformed so that there is a consistent scale used across all forms of a test
Similar to converting from pounds to kilograms or centigrade to Fahrenheit (e.g., the weight or temperature has not changed, only the format used to report the units)
Primary literature
Category of scientific literature that includes original research studies or sources of information
Secondary literature
Category of scientific literature that summarizes, references, or analyzes original sources of information
Occupational alienation
A disconnect between an individual and participation in meaningful activity (e.g., an older resident of a nursing home who is immersed in nonperferred activities), or a disconnect between an individual and a fulfilling environment (e.g., a refugee living in a new culture)
May result in:
- loss of self-identity
- loss of self-determination
Occupational dysfunction
An interruption, often caused by prolonged occupational deprivation, in the ability to perform and participate in typical occupations
Occupational deprivation
A condition in which an individual is unable to participate in meaningful life activities due to external factors (e.g., poverty, local regulations, refugeeism)
Occupational risk factors
Internal and external conditions that impact health and wellness outcomes and/or influence an individual’s ability to fully engage or participate in meaningful life activities and occupations
Occupational imbalance
Ineffective balance between productivity, leisure, and rest that negatively impacts health and wellness
Health promotion
Process of increasing the individual’s awareness of risk factors and behavioral changes that influence health, encourage self-management, and facilitate well-being
Occupational marginalization
Ineffective ability to make personal choices or decisions regarding participation in meaningful occupations
Social determinants of health
Environmental factors that impact a person’s quality of life, health, and functioning
Derived from the conditions of a person’s environment, such as where a person lives, works, worships, or plays
Tertiary prevention strategy
Methods or actions intended to decrease long-term effects of a disease or disability
May include:
- social support
- rehab services
Secondary prevention strategy
Methods or actions intended to reduce the progression of a disease
May include:
- early detection of a disease
- medical intervention for illness or conditions
- preventing the development of secondary conditions
Primary prevention strategy
Methods or actions intended to inhibit the development of a disease
May include:
- good eating habits
- quality sleep/rest
- regular exercise and daily activity
- routine physical exam by a physician
Confidentiality
Process of restricting communication of protected health information to within proper limits
In health care provision it is a legal and ethical expectation
Altruism
Unselfish concern for the welfare of others
Equality
Treating all individuals equally with attitude of fairness and impartiality; respecting beliefs, values, and lifestyles in day-to-day interactions
Freedom
Right to exercise choice and to demonstrate independence, initiative, and self-direction
Justice
Abide by laws that govern practice and to respect the legal right of each individual
Levels of supervision
Direct supervision: required for students and aides; supervising therapist is nearby and always observing
Close supervision: direct observation and contact daily at the work site on a regular basis
Routine supervision: face-to-face contact every 2 weeks at the sire of work; can include regular supervision though telecommunication
General supervision - initial direction and F2F contact with supervising therapist at least once a month, with interim supervision as needed by telecommunication
What is the hierarchy of evidence?
Level I: Systematic reviews and well-designed meta-analyses of several Randomized Controlled Trials (RCTs)
Level II: Well-designed RCTs
Level III: Well-designed nonrandomized quasi-experimental studies
Level IV: Controlled non-interventional descriptive studies, including correlational and case control studies
Level V: Uncontrolled non-interventional studies, including case reports, and qualitative studies
Level VI: Expert opinion of respected authorities
What is test-retest reliability?
A metric indicating whether an assessment provides consistent results when it is administered on two different occasions
When an instrument or assessment consistently provides the researcher with same results, we can say that there is test-retest reliability.
Test—retest reliability is calculated based on the two administrations of the assessment; the “Time 1 score” is the first variable, and the “Time 2 score” is the second variable
What is split half reliability?
This is a technique used to assess the reliability of questionnaires:
Assessment items are divided into two smaller sections (usually by dividing them into odd and even items, or first half and last half)
Scores are then correlated from the two halves of the assessment.
What are parallel forms of reliability?
When there are multiple versions of the same test, it is important to determine if each version of the test will provide consistent results.
In this measure of reliability, an assessment’s alternative forms are administered to subjects at the same time and then scores are correlated from the two forms of the assessment
A counterbalanced design might be utilized for testing
What is internal consistency?
This is the extent to which the items that make up an assessment covary or correlate with each other. This may be referred to as the homogeneity of the assessment.
Do all items in the assessment accurately measure a construct
Internal consistency and construct validity are closely related.
If an assessment has a high internal consistency, we can assume that there is construct validity as well.
What are rater/observer effects on reliability?
There are two sources of observer/rater error that are typically examined:
- Observer presence and characteristics – The presence of the rater may impact the behavior of the subjects (The Hawthorne effect)
- Rater bias – Bias may be introduced when one rater takes two or more measurements of the same item. The rater may be biased by remembering the score on the subject’s previous attempt/performance.
What is inter-rater reliability?
When you have two or more raters who are assigning scores based on subject observation, there may be variations in the scores.
All raters should observe a single trial, either simultaneously or via video recordings of the subject’s performance.
Raters should not compare or collaborate on scores.
We would like to see agreement in the scores from all raters.
What is face validity?
The assumption of validity of a measuring instrument based on its appearance as a reasonable measure of a given variable
An assessment has the appearance of measuring an underlying construct
The weakest evidence of validity; used alone, it is insufficient to demonstrate the
validity of an assessment
Face validity can be helpful in deciding whether or not to use an assessment. It may help to determine if an assessment is relevant to what we want to measure.
What is content validity?
A type of measurement validity – the degree to which the items in an instrument adequately reflect the content domain being measured
Content validity is the adequacy with which an assessment is able to capture the construct it aims to measure
It is concerned with whether the items that make up the assessment adequately are relevant to the variables that are being measured.
Content validity is also concerned that irrelevant content be excluded from the assessment
What is criterion validity?
The ability of an assessment to produce results that are in agreement with or predict a known criterion assessment or known variable.
It is important to select a criterion assessment for comparison that is recognized and demonstrated to have good reliability and validity. You compare your results to a test that is considered to be the “gold standard” assessment for that criterion
Criterion validity includes what 2 types of evidence?
Concurrent validity- the degree to which the outcomes of one test correlate with
outcomes on a criterion test, when both are given at the same time
Predictive validity- an instrument is used to predict some future performance
What is construct validity?
Does the assessment measure the construct that it is intended to measure?
This is the ultimate objective of all forms of empirically assessing validity
A type of measurement validity in which the degree of a theoretical construct is measured
What is efficacy?
Efficacy is generally defined as the benefit of an intervention as compared to a control or standard program.
It provides information about the behavior of clinical variables under controlled, randomized conditions
This allows researchers to examine theory and draw generalizations to large populations
What is a type I error?
When the researcher reports a relationship between the intervention and the outcome (or progress) when no relationship (or progress) really exists
What is a type II error?
When the researcher reports that no relationship (or improvement/progress) exists between the intervention and the outcome, when there really was a relationship or improvement
What is sensitivity?
One who has the condition will be classified as having the condition
Test sensitivity – refers to how well a test detects a condition that is actually present
What is specificity?
One who does not have the condition will be classified as not having the condition
Test specificity - refers to how well a test detects that a condition is not present when it is actually not present
What is the best level of evidence to use when reviewing treatment and/or prevention?
RCT
What is the best level of evidence to use when reviewing prognosis?
Cohort study
Dignity
Demonstrates and attitude of empathy and respect for self and others; treating the client with respect in all interactions
Truth
Faithful to facts and reality; in all situations, occupational therapy personnel must provide accurate information in oral, written, and electronic forms
Prudence
Exercises judiciousness, discretion, vigilance, moderation, care, and circumspection in the management of one’s affairs; use of clinical and ethical reasoning skills, sound judgment and reflection to make decisions in professional and volunteer roles
Procedural reasoning
Addressing client’s functional limitations through the specific assessment and intervention techniques appropriate for that area of disability in order to remediate, adapt, or compensate for lost occupational abilities.
Interactive reasoning
Collaborating with the client to encourage, coach, problem solve, and promote active engagement in occupation.
Focuses on the therapist-client communication, emotions, and motivational issues of occupational performance.
Conditional reasoning
Connecting with the client in their own culture and world in order to create meaningful occupational experiences.
This may not always be conscious but involves OT therapeutic use of self in order to convey empathy with a nonjudgmental, culturally sensitive approach in order to visualize how clients see themselves both now and in the future.
primary prevention
directed towards relatively health individuals (e.g. - wearing a seat belt)
secondary prevention
provided when a person is already in a state of ill health and is demonstrating active signs and symptoms
e.g. - home exercise program as a part of cardiac rehab program
occupational deprivation
dispossession, divestment, confiscation, or taking from that keeps a person from acquiring, using or enjoying something
occupational alienation
underutilization or undermining of health by capitalism and technological advancements. The quest for success and technology itself is not dangerous but it can create an alienating effect when human occupations are minimized and/or eliminated in the name of progress
