Evidence Based Practice; Foundational Models Flashcards
1
Q
Foundational Models: Nagi
A
- cascade from disease to impairments to functional limitations to disability
- disease –> impairment –> functional limitations –> disability
- only linear, unidirectional arrows, ICF more like web with bidirectional arrows
- nagi: one leads to another
2
Q
Foundational Model: ICF
A
- multidisciplinary and international
- describes how people live with their health condition
- relationships between health conditions, body functions and structures, activities and participations
- references how environmental and personal factors affect function
- participation refers to societally expected roles
3
Q
Process of Patient Client Managment
A
- Examination –> Evaluation –> Diagnosis –> Prognosis (Including Plan of Care) –> Intervention –> Outcomes
- examination: look at contextual factors and impairment and participation to piece it together called PT Diagnosis
4
Q
Evidence-Based PT Practice
A
- clinical decisions made in the practice of physical therapy are made based on best evidence currently available with consideration of patient preferences
- mix of evidence you have and info from patient brought into play
- “open and thoughtful clinical decision making” about the physical therapy management of a patient/client: 1. articulate steps taken to make a conclusion 2. rationale for your conclusion 3. potential impact of taking or not taking action 4. appraisal of risks and benefits of various options
- integrates the “best available evidence with clinical judgement” and the patient/client’s preferences and values: 1. studies that are relevant to the clinical question, consideration of the level of evidence, weighing in of patient preferences/values, collaborative decision making
- considers the larger social context in which PT services are provided, to optimize patient/client outcomes and quality of life
- financial constraint timeline
5
Q
EBPT Definitions
A
- evidence: potentially-any empirical observation about patients/clients; preferably-systematic research, sometimes from the basic sciences of medicine, but especially from patient-centered clinical studies
- clinical expertise does not equal habits: what is the best way to treat the patient, and what clinical evidence is there
- clinical expertise: more effective and efficient patient/client management based on experience, learning and reflection about practice; includes ability to identify and evaluate the: patient’s unique health status, diagnosis and prognosis, benefits and risks of potential interventions, patient’s resources and limitations
6
Q
The 5 Steps of EBP
A
- ask question
- find evidence
- appraise evidence
- apply clinical references
- evaluate results
7
Q
DPT 781
A
- ask: question formation-recognize what is unknown about patient’s condition; convert needed information into an answerable question; clinical question
- Find: search for relevant information; access the evidence, conduct a literature search
- appraise: review and appraise the evidence
8
Q
Questions
A
- clinical: focus on management of a particular patient
- research: identify and define variables that will be studied using a specific research design and involving predetermined populations
- questions about: 1. examination 2. diagnosis 3. prognosis 4. intervention 5. outcome
9
Q
EBPT Focus Areas-Examination and Diagnosis
A
- usefulness of diagnostic tests and clinical measures
- diagnostic tests: “special tests”, imaging studies
- measures: ROM, strength, vital signs, wound dimensions, sensation
- diagnosis: process that “includes integrating and evaluating the data that are obtained during the [PT] examination to describe the patient/client condition in terms that will guide the PT in determining the prognosis, plan of care and intervention strategies”
10
Q
Prognosis
A
- prediction of the natural course of a condition, or its risk of development
- “predicted optimal level of improvement through intervention and the amount of time required to achieve that level
11
Q
Prognostic Factor
A
- a characteristic that increases or decreases the likelihood of an individual’s eventual outcome:
- demographic: e.g. age, gender, ethnicity, education, socioeconomic status
- disease-specific: e.g. severity of disease or injury acuity or chronicity
- co-morbidities: other conditions present that influence outcome
- other: e.g. insurance coverage, access to health care
12
Q
Types of Prognostic Factors
A
- favorable (protective)
- increase the likelihood of a positive event (hypothetical example: family support increases likelihood of discharge to home)
- decrease the likelihood of an adverse event (hypothetical example: pressure relief maneuvers decrease the risk of ischial tuberosity skin breakdown)
13
Q
EBPT Focus Areas
A
- usefulness of diagnostic tests and clinical measures
- usefulness of prognostic factors
- efficacy, effectiveness and safety of interventions
14
Q
Intervention
A
- the purposeful use of various PT procedures and techniques in collaboration with the patient/client and, when appropriate, other healthcare providers, in order to effect change in the patient/client’s condition
- PICO model: how effective is the intervention that you apply?
15
Q
Focus: Performance
A
- interventions intended to enhance skill-based activities
- PT examples: coordination exercises to support athletic performance; flexibility exercise to enhance dancing ability
16
Q
Focus: Rehabilitation
A
- interventions intended to optimize function
- PT examples: gait training with assistive devices following stroke, joint mobilization techniques removal of a lower extremity cast
17
Q
Outcome
A
- measures stemmed around reliability and validity
- end result of patient/client management
- observed measures (e.g. return-to-work, discharge home)
- self-report measures: surveys completed by patients/clients–generic health status/quality of life, body part/region specific, disease/condition specific
18
Q
EBPT The Steps
A
- form clinically meaningful, answerable questions pertinent to the individual patient/client
- track down the info from credible sources
- evaluate the validity of the evidence
- determine its usefulness for the management of the individual patient/client
- use the evidence in practice
- evaluate the outcome
- determine the impact on future practice–will it change?
19
Q
Barriers to EBPT
A
- therapist: lack of knowledge and skills, lack of confidence
- profession: lack of evidence, respect for authority and tradition
- system: lack of time, lack of access, not reimbursable, lack of administrative support, political challenges (anyone being paid to do these studies-by whom)
20
Q
Overcoming EBPT Obstacles
A
- establish a routine (calendar, number of articles reviewed, method for obtaining evidence)
- collaborate (multi-disciplinary journal clubs, student assignments)
- highlight successes (inservices, patient testimonials)
21
Q
Clinical Question: PICO
A
- P: patient-target population, characteristics of the patient or problem
- I: intervention-what is the intervention being considered, prognostic factor, diagnostic test
- C: comparison-what comparison or control is being considered? not relevant for a question of prognosis
- O: outcome-what measurements will be used to understand the effectiveness of an intervention? the importance of a prognostic factor? the accuracy of a diagnostic test?
22
Q
LEAP
A
-linking evidence and practice
23
Q
Types of Questions
A
- background: normal physiology or behavior, pathophysiology, ex: normal aging of tissues in age progression?
- foreground: selection and interpretation of diagnostic tests or clinical measures, prediction of specific patient prognoses, comparative risks and benefits of various treatment strategies, potential outcomes and their measurement
24
Q
Elements of a Good Question
A
- patient
- diagnostic test or measure, prognostic indicator, intervention, clinical prediction rule, outcome, or self-report outcome measure
- comparison if available
- consequence (what you want to achieve by using the test, measure, prognostic factor, intervention, clinical prediction rule, outcome or self-report outcome measure)
