Exam 1

Question 1

What are the oxford centre for evidence based medicine levels of evidence?

Answer 1

• Level 1: systematic review of RCTs
• Level 2: Randomized trial or observational study with dramatic effect
• Level 3: Non-randomized controleed cohort/follow-up study
• Level 4: Case-series, case-control studies, or historically controlled studies
• Level 5: Mechanism-based reasoning (formerly known as expert opinion)

Question 2

What do critical analysis of research reports do?

Answer 2

• Determines validity of the report

* Applicability for clinical decisions

Question 3

What do the guidelines for reporting of studies do?

Answer 3

• CONSORT statement
• Enables reader to better assess validity of the results
• Many others (Ex. STROBE)

Question 4

Describe evaluating research reports

Answer 4

• Critical analysis of research report
• Guidelines for reporting of studies
• Success of evidence-based practice dependent on incorporating research findings into clinical decision making

Question 5

How do you distinguish the quality of the journal?

Answer 5

• When evaluating scientific merit of an article, consider journal’s reputation
• Peer-reviewed/refereed journals
  
  • Content experts
  • Accepted based on recommendation of reviewers
  • Processes ensure that articles meet standards (importance of study, originality, methods, interpretations/conclusions)

Question 6

What questions should be asked when evaluating components of a study?

Answer 6

• What is the study’s intent?
• Is the study sound in it’s methodology?
• Are results meaningful?
• Can the results be applied to my patient?

Question 7

What is the question ‘what is the study’s intent’ looking at?

Answer 7

The problem under investigation

Question 8

What should be considered when asking ‘is the study sound in it’s methodology’?

Answer 8

• If not, results may not be valid
• Details of subjects (how selected/inclusion/exclusion criteria)
• Random assignment? Blinding?
• Reliable and valid measures?
• Equal treatment of groups (apart from intervention)?

Question 9

What should be considered when asking ‘are results meaningful’?

Answer 9

• Was there an effect of the intervention?

* Clinically significant and statistically significant

Question 10

What should be considered when asking ‘can the results be applied to my patient’?

Answer 10

• Depends if your patient is similar to the patients studied
• Is treatment feasible in my clinic?
• Is treatment feasible for my patients based on their preferences?

Question 11

What are the characteristics of clinical research?

Answer 11

• Structured and systematic
• Objective process
• Examines clinical conditions and outcomes
• Establishes relationships among clinical phenomena (ex. how strength affects balance)
• Provides evidence for clinical decision making
• Provides impetus for improving practice

Question 12

What are examples of clinical phenomena?

Answer 12

Manual muscle testing, ROM, propensity for falls/balance, balance confidence
*Things we can document and keep track of over time

Question 13

How does clinical research shift in the 20th century and what influenced the shift?

Answer 13

• the shift was after influenced research priorities
• Focus on outcomes research to document effectiveness
• application of models of health and disability
• attention to evidence based practice (EBP)

Question 14

What did rehabilitation outcomes used to be related to?

Answer 14

*were related to improvements in pathologies or impairments

Question 15

What do outcomes include now?

Answer 15

• WHO definition of health to include physical, social, and psychological well-being
  
  • consider patient satisfaction, self-assessment of functional capacity, quality of life (QOL)
  • Now clinicians must document outcomes to substantiate effectiveness of treatment

Question 16

What do outcomes research do?

Answer 16

• How successful are our interventions in clinical practice specifically in terms of disability and survival
• Studies use large databases including info not only on functional outcomes, but also on utilization of services, insurance coverage etc.
• Measure the effectiveness of treatment in terms of patient satisfaction and outcomes as well as in terms of revenue/costs; staff productivity
• Questionnaires are often used to measure outcomes in terms of function and health status
• Health status scales (ex. instruments such as the Medical outcomes study short-form 36 reflects physical function, mental function, social function, and other

Question 17

What are the models in research and what do they focus on?

Answer 17

• Biomedical Model
  
  • Focuses on relationship b/w pathology and impairments
  • Physical aspects of health
  • No consideration for how patient is affected by illness
• Disablement Model
  
  • Pathology, impairment, functional limitation, disability

Question 18

In a disablement model: Nagi, describe pathology, impairment, functional limitation, and disability

Answer 18

• Pathology- interference with normal bodily processes or structures
• Impairment- anatomical, physiological, or psychological abnormalities
• Functional limitation- inability to perform an activity in a normal manner
• Disability- limitation in performance of activities within socially defined roles

Question 19

What does the ICF model do?

Answer 19

• Describes how people live with their health condition
• Includes references to environmental and personal factors affecting function
  - Contextual factors
• Has parallels to Nagi model

Question 20

What are the parallel between the ICF and Nagi model?

Answer 20

• Health condition: pathology
• Body function/structure: impairments
• Activity: functional limitation
• Participation: disability

Question 21

Describe ICF outcomes

Answer 21

• Outcomes may be related to (targeted to) the impairment level
  
  • BUT must also establish functional outcomes that influence performance at the activity or at the participation levels
    - Ex. increasing strength and balance will allow the person to ambulate in the community and socialize with friends (activity level and participation level)

Question 22

What does evidence based practice (EBP) do?

Answer 22

*Provision of quality care depends on ability to make choices that have been confirmed by sound scientific data, and that decisions are based on best evidence currently available

Question 23

How does EBP begin?

Answer 23

*It begins by asking a relevant clinical question related to Patient diagnosis, prognosis, intervention, validity of clinical guidelines, safety or cost effectiveness of care

Question 24

PICO is a good clinical question, what does it stand for?

Answer 24

P = patients/population
I = Intervention
C = comparison/control
O = outcome of interest

Question 25

In a patient 2-weeks post hip replacement, is active exercise more effective than passive ROM exercise for improving hip ROM; what represents PICO in this inquiry?

Answer 25

``` P = patient 2 wks post hip replacement I = active exercise C = more effective than passive ROM exercise O = improving hip ROM ```

Question 26

Describe what PICO does

Answer 26

* Question is a precursor to searching for the best evidence to facilitate optimal decision making about a patient's care * Terms in PICO can be used as search terms in a literature search for best evidence * Clinicians search and access literature * Critically appraise studies for validity * Determine if research applies to their patient

Question 27

What are the components of EBP for clinical decision making?

Answer 27

* Clinical expertise * Best research evidence * Clinical circumstances and setting * Patient values and preferences

Question 28

What are some sources of knowledge for clinical decisions and to guide clinical research?

Answer 28

* Tradition (always done this way) * Authority (expert opinion) * Trial and error (Try something and if it fails try something else) * Logical reasoning * Scientific method

Question 29

What is logical reasoning?

Answer 29

* A method of knowing which combines - Experience - Intellect - Thought * Systematic process to answer questions and acquire new knowledge * 2 types of reasoning - Deductive - Inductive

Question 30

Describe Deductive reasoning

Answer 30

* Acceptance of a general proposition and the inferences that can be drawn in specific cases * General observation- specific conclusion * Ex.= poor balance results in falls, exercise improves balance, therefore exercise will reduce risk of falls

Question 31

Describe Inductive reasoning

Answer 31

* Specific observation- general conclusion * Ex.= Patients who exercise don't fall, Patients who don't exercise fall more often, Therefore exercise is associated with improved balance (and fewer falls)

Question 32

What kind of reasoning is used in the introduction section of a research manuscript?

Answer 32

*Deductive logic is used when developing research hypotheses from existing general knowledge

Question 33

What kind of reasoning is used in the discussion section of a research manuscript?

Answer 33

*Inductive reasoning is used when researchers propose generalizations and conclusions from data in a study

Question 34

What is the scientific method?

Answer 34

* Rigorous process used to acquire new knowledge * Based on 2 assumptions - Nature is orderly/regular and events are consistent and predictable - Events/conditions are not random and have causes that can be discovered

Question 35

What is the scientific approach defined as?

Answer 35

*Systematic, empirical, controlled and critical examination of hypothetical propositions about the associations among natural phenomena

Question 36

What does the systematic nature of research imply?

Answer 36

* Implies a sense of order to ensure reliability | - Logical sequence to identify a problem, collect and analyze data, interpret findings

Question 37

In the scientific method, what are the empirical, control, and critical examination?

Answer 37

Empirical: in research refers to direct observation to document data objectively Control: control of extraneous factors Critical examination: scrutiny of your findings by other researchers

Question 38

How do you classify research?

Answer 38

*Can classify research based on a number of schema according to purposes and objectives

Question 39

What are qualitative and quantitative research?

Answer 39

* Quantitative: measurement under standardized conditions- can conduct statistical analysis * Qualitative: understanding through narrative description; less structured- interviews

Question 40

What are basic and applied research?

Answer 40

* Basic: 'bench research'- not practical immediately, may be useful later in developing treatments * Applied: solving immediate practical problems- most clinical research

Question 41

What is translational research?

Answer 41

* Translational: - Scientific findings are applied to clinical issues - Also the generating scientific questions based on clinical issues - 'bedside to bench and back to bedside' * Collaboration among basic scientists and clinicians

Question 42

What is experimental research?

Answer 42

* Experimental: researcher manipulates one or more variables and observes - major purpose is to compare conditions or intervention groups to suggest cause and effect relationships - RCT is the gold standard of experimental designs - Quasi-experimental: limited control but can get interpretable results

Question 43

What is non-experimental research?

Answer 43

*Non-experimental: investigations that are descriptive or exploratory in nature

Question 44

What is exploratory research?

Answer 44

* Exploratory: examine a phenomenon of interest including its relationship to other factors - In epidemiology researchers examine associations to predict risk for disease by conducting cohort and case-control studies - Methodological studies use correlational methods to examine reliability and validity of measuring instruments - Historical studies reconstruct the past on the basis of archives and other records to suggest relationships of historical interest to a discipline

Question 45

What is descriptive research?

Answer 45

* Descriptive: describe individuals to document their characteristics, behaviors and conditions * Several designs

Question 46

What are the several designs in descriptive research?

Answer 46

* Descriptive surveys: use questionnaires, interviews * Developmental research: patterns of growth and change over time in a segment of the population, natural history of a disease * Normative studies: to establish normal values for diagnosis and treatment * Qualitative research: Interview and observation to characterize human experiences * Case study or case series

Question 47

How do you collect data?

Answer 47

* Collect data based on subject's performance on defined protoccol * Surveys * Questionnaires * Secondary analysis of large databases: use data collected for another purpose to explore relationships

Question 48

What is a research process and what are the 5 major steps?

Answer 48

* Logical framework for a study's design * 5 major steps: - Identify the research question - Design the study - Methods - Data analysis - Communication

Question 49

Why were Theories created?

Answer 49

*Created because we need to organize and give meaning to complex facts and observations

Question 50

What do theories entail?

Answer 50

*Interrelated concepts, definitions or propositions that specifies relationships among variables and represents a systematic view of specific phenomena

Question 51

What does scientific theory deal with?

Answer 51

*Scientific theory deals with empirical observation and requires constant verification

Question 52

Why do we use theory?

Answer 52

* Use theory to generalize beyond specific situations and to make predictions about what we expect to happen - Provide framework for interpretation of observations - Giving meaning to research findings and observations * Stimulate development of new knowledge - Theoretical premise to generate new hypotheses which can be tested

Question 53

What are the components of theories?

Answer 53

* Concepts: Building blocks of a theory - Allow us to classify empirical observations - We 'label' behaviors, objects, processes that allow us to identify them and refer to/discuss them * Concepts can be non-observable - Known as constructs - Constructs are abstract variables (Ex. intelligence)

Question 54

What are propositions?

Answer 54

*Once concepts are identified they are formed into a generalization or proposition

Question 55

What do propositions do and what are the kinds?

Answer 55

* They state relationships btwn variables * Hierarchial proposition (Maslow's needs) * Temporal proposition (stages of behavioral change)

Question 56

What are models and why do we use them?

Answer 56

* Models are symbolic representations of the elements in a system * Can represent processes - Ex. ICF, Nagi models * Concepts can be highly complex so use models to simplify them - Ex. double helix model in genetics

Question 57

How do you develop theories?

Answer 57

* By inductive or deductive processes * Most formulated using both processes - Observations initiate theory and then hypotheses tested

Question 58

What are inductive theories?

Answer 58

* Data based * Begin with empirically verifiable observations * Multiple studies and observations (Patterns emerge) * Patterns develop into a systematic conceptual framework which forms basis for generalizations

Question 59

What are deductive theories?

Answer 59

* Intuitive approach * Hypothetical deductive theory is developed with few or no observations - Not developed from existing facts, must be tested constantly

Question 60

Do you test theories?

Answer 60

* Theories are not testable * Test hypotheses that are deducted from theories - If hypothesis is supported then theory from which it was deduced is also supported

Question 61

What is theory a foundation for?

Answer 61

*It's a foundation for understanding research findings

Question 62

Describe the importance of authors in research

Answer 62

* Results of studies must be explained and interpreted by authors within the realm of theory * Authors must help readers understand context within which results can be understood - Researchers should offer interpretation of findings - Contribute to the growth of knowledge

Question 63

What constitutes researchers integrity?

Answer 63

* Relevant research question * Meaningful research * Competent investigators * Personal bias in measurement * Misconduct - Falsification of data - Manipulation of statistics * Publish findings * Authorship

Question 64

What are the 3 principles that protect human rights in research?

Answer 64

* Autonomy * Beneficence * Justice

Question 65

What is autonomy?

Answer 65

* Self determination and capacity of individuals to make decisions - Authorized decision maker is available to make decisions for subjects such as those unable to understand

Question 66

What is beneficence?

Answer 66

* Attend to well-being of individuals | - Risk/benefit

Question 67

What is justice?

Answer 67

* Fairness in research process - Selection of subjects appropriate for a given study - Also in randomization process

Question 68

What are some regulations for conduct of research with humans?

Answer 68

* Nuremberg Code of 1949 * Declaration of Helsinki 1964 * National Research Act 1974, 1976 * Belmont Report 1979 * HIPAA 1996

Question 69

What does the IRB do?

Answer 69

* Reviews research proposals - Scientific merit - Competence of investigators - Risk to subjects - Feasibility of the study * Risk-Benefit ratio - Risks to subjects are minimized and outweighed by potential benefits of the study

Question 70

Compare Expedited vs. Exempt review

Answer 70

* Full Review: high risk studies * Expedited: Low risk * Exempt: surveys, interviews, studies of existing records provided data are collected in such a way that subjects can't be identified

Question 71

What are the information elements in informed consent?

Answer 71

* Information elements - Subjects fully informed - Subject info confidential and anonymous - Consent form in lay language - Researcher answers questions at any time

Question 72

What are the consent elements in informed consent?

Answer 72

* Consent elements - Consent must be voluntary - Special consideration for vulnerable subjects - Ex. Mental illness (Legal guardian consents) - Free to withdraw at any time

Question 73

Why should you use measurements in research?

Answer 73

* Clinical decision making * Compare * Draw conclusions * Process governed by rules

Question 74

What is a numeral measurement?

Answer 74

* Symbol or label (ex. 1=older adults) | * Numeral becomes a number when it represents a quantity (ex. 25 kg grip strength)

Question 75

What do variables do in research?

Answer 75

* They differentiate objects or individuals | - take on different values either quantitatively (ex. height in inches) or qualitatively (ex. gender, fall status)

Question 76

What are the different types of variables?

Answer 76

* Continuous variable - quantitative variable that can take on any value along a continuum - limited by precision (exactness) of the instrument - Ex. gait speed (TUG) * Discrete variables - Described in whole units - Ex. HR - Qualitative variables represent discrete categories (ex. faller/non-faller) - Dichotomous variables are qualitative variables with 2 values

Question 77

What is Precision?

Answer 77

* How exact is a measure * it indicates the number of decimal places * Relates to the sensitivity of the measuring instrument * also depends on the variable - Ex. HR measure in whole numbers - Ex. Strength measure to half of a kg

Question 78

What are examples of variables measured directly?

Answer 78

* ROM * Height * Distance walked in the 6MWT

Question 79

What are examples of variables measured indirectly (not directly observable)?

Answer 79

* Temperature * Balance * Strength of a muscle * Health/disability

Question 80

What are the 4 scales of measurement and why do we need them?

Answer 80

* They're a hierarchical based on relative precision of assigned values (nominal up to ratio) * Nominal * Ordinal * Interval * ratio

Question 81

What is the Nominal scale?

Answer 81

* Numbers are labels for identification (Ex. 0=male) * Categories are mutually exclusive * Mathematically can count number in each category (proportions, frequencies, etc.)

Question 82

What is the Ordinal scale?

Answer 82

* Numbers indicate rank order (ex. MMT scale) * Lack of arithmetical properties - Ordinal values represent relative position only - Ex. MMT of 4 is not 2x greater than 2 in terms of strength * Appropriate for descriptive analysis only (Ex. average rank of a group of subjects)

Question 83

What is the Interval Scale?

Answer 83

* Has rank order characteristics of ordinal scale - Equal distances/intervals btwn units (Temp, calendar) - No true/natural zero - So cannot say 20 dg is twice as hot as 10 dg - ex. no ratios "allowed" - Can quantify the difference between interval scale values (ex. from 20-25 means something)

Question 84

What is the ratio scale?

Answer 84

* Interval scale with zero point that has empirical meaning * Equal distances/intervals btwn units * Zero means absence of what is being measured; start measuring at zero * No negative values * Ex. height, weight, strength, age * Represent actual amounts being measured (can say age of 20 yrs is twice as much as 10 yrs)

Question 85

What is reliability?

Answer 85

* It's the extent to what a measurement is consistent, free from error * You conceptualize as reproducible, dependability, agreement * Things that are reliable are the patient, examiner, or instrument

Question 86

What happens without reliability?

Answer 86

* No confidence in the data | * Can't draw conclusions from the data

Question 87

Why are measurements rarely 100% reliable?

Answer 87

* Human element/error | * Instruments

Question 88

What is the observed score?

Answer 88

*True score +/- error

Question 89

What is systematic error?

Answer 89

* Predictable errors * Constant and biased * Unidirectional * Consistent so not a problem for reliability * Can correct your readings (Ex. subtract a constant amount from each reading you take) * Are a problem for validity as measurements do not truly represent quantity being measured

Question 90

What is random error?

Answer 90

* Chance * Unpredictable * Due to mistakes, instrument inaccuracy, fatigue, etc * Assume that if take a lot of measurements then random errors will eventually cancel each other out and average of a lot of scores will be a good estimate of the true score

Question 91

What are the sources of measurement error?

Answer 91

* Individual (rater/tester) * Measuring instrument * Variability of the characteristic (response variable) being measured - Ex. blood pressure, HR, balance confidence * Environment (noise and temp), subjects motivation and fatigue

Question 92

How are sources of error minimized?

Answer 92

* They're minimized by training, equipment inspection, maintenance, etc. * We assume these factors are random and effect cancels out over time

Question 93

What are reliability coefficients?

Answer 93

*Range from 0.00 (no reliability) to 1.00 (perfect reliability) *0.50 = poor reliability *0.50-0.75 = moderate *>0.75 = good (These are guidelines only)

Question 94

What is the relationship between correlation and agreement?

Answer 94

*Perfect correlation does not always mean agreement- which then means poor reliability

Question 95

What is test-retest reliability?

Answer 95

* To establish that an instrument is capable of measuring with consistency * Individuals given same test on 2 occasions under identical conditions * Raters not involved * Ex. self-report surveys of balance confidence (ABC scale); measures of mechanical or digital readouts

Question 96

What is intrarater reliability?

Answer 96

*stability of data recorded by 1 person on 2 or more trials

Question 97

What is interrater reliability?

Answer 97

* Variation/agreement btwn 2 or more raters who measure same group of subject(s) - Preferably at exact same time - They don't discuss results with each other until done recording data

Question 98

What is the classification of the ICC?

Answer 98

* Intraclass correlation coefficient * Designated as ICC (1,1) ICC(2,1), or ICC(3,1) * 1st number is the model and 2nd number is the form

Question 99

What is alternate forms reliability?

Answer 99

* Reliability of 2 equivalent forms of a measuring instrument * Sometimes referred to as parallel forms * Ex. GRE or SAT- given a number of times a year but in different forms, need to establish reliability * Correlation coefficients have been used to evaluate them

Question 100

What is alternate forms reliability based on?

Answer 100

* Based on administering 2 alternate forms of the test to a single group at a single session - Correlating paired observations * Usually used in educational/psych testing * Clinical examples: alternative forms (parallel forms) of strength evaluations and/or gait evaluation

Question 101

what can determination of limits of agreement estimate?

Answer 101

*Can estimate range of error expected when using 2 different forms of an instrument

Question 102

What is internal consistency (or homogeneity)?

Answer 102

* Items in an instrument (ex. scale) measure various aspects of the same characteristic and nothing else * Physical functioning scale should have items only relating to physical functioning * No items relating to psychological characteristics * If psychological characteristics were included then items are not homogeneous * Can be assessed conducting an item-to-total correlation

Question 103

What is Cronbach's coefficient alpha and how is it assessed?

Answer 103

* Internal consistency most often is used to assess this * Evaluates items in a scale to determine if they measure the same construct * Can be used to determine which items could be removed from a scale to improve scale homogeneity

Question 104

What is measurement validity?

Answer 104

* Instrument or test measures what it's intended to measure - Ex. Hand held dynamometer is a valid instrument for measuring strength because we can assess strength from pounds force - MSL is a valid measure of balance * Invalid tests may be reliable

Question 105

What is validity?

Answer 105

* Measurement is relatively free from error - Ex. valid tests are reliable - Low reliability is automatic evidence of low validity

Question 106

What is specificity of validity?

Answer 106

* An instrument or test is usually valid for a given purpose or situation or population * Validity is not a universal characteristic of an instrument - Ex. Assessing disability in pts with PD with instrument A does not mean that instrument A is valid for assessing disability in people with SCI - MMT isn't a valid measure of strength bc of ppl with diseases

Question 107

What are the types of measurement validity?

Answer 107

* Face validity * Content validity * Criterion-related validity - Concurrent or predictive * Construct validity

Question 108

What is face validity?

Answer 108

* Instrument appears to test what it's supposed to (a plausible method) * Weakest form of validity - Difficult to quantify how much face validity an instrument has (no standards to judge it) - Subjective assessment * Often established through direct observation - Ex. instrument that measures ROM; strength; gait

Question 109

What is content validity?

Answer 109

* Variables have a universe of content - characteristics and info that are observable about that variable * Established if an instrument covers all parts of the universe of content - Reflects the relative importance of each part - Important in questionnaires, exams, interviews

Question 110

What must content validity not include?

Answer 110

* Test must not include factors irrelevant to the purpose of measurement - Ex. test of motor performance should not contain items assessing psychological function

Question 111

What does content validity imply?

Answer 111

* Implies test contains all the elements that reflect variable being studied - Ex. visual analog scale reflects only one element of pain (intensity) - McGill Pain questionnaire has greater content validity as it assesses many elements of pain such as location, intensity, duration, etc.

Question 112

What kind of process is content validity?

Answer 112

* Subjective process to establish content validity - No statistics available - Experts determine if the questions cover the content domain - When experts agree that content is adequately sampled, content validity is established

Question 113

What is Criterion-related validity?

Answer 113

* Most practical and objective approach to testing validity * Test to be validated is the target test * This test is compared to the "gold standard" or criterion measure that is already valid * Correlations are calculated * High correlations imply the target test is a valid predictor of performance on the criterion test - Can be used as a substitute for established test

Question 114

What is concurrent validity?

Answer 114

* Target and criterion measure are assessed at approximately the same time - Ex. MSL is a valid measure of balance * Useful to establish concurrent validity when the target test may be more efficient, easier to administer, more practical, safer than the gold standard and can be used instead of gold standard - Sensory screening

Question 115

What is predictive validity?

Answer 115

* A measure will be a valid predictor of some future criterion score - Ex. College admission criteria as a predictor of future success - Ex. TUG as a measure of future risk for falls

Question 116

What is construct validity?

Answer 116

* Ability of an instrument to measure an abstract concept (construct) - Ex. health, disability; confidence * Constructs are not observable but exist as concepts to represent an abstract trait * Constructs are usually multi-dimensional - Ex. how do you measure "health" or "function"?

Question 117

When is there support of construct validity?

Answer 117

*When a test can discriminate btwn individuals who are known to have a condition and those who do not

Question 118

What is the known groups method in construct validity?

Answer 118

*Construct validation is determined by the degree to which an instrument can demonstrate different scores for groups known to vary (Ex difficulty walking versus no difficulty walking)

Question 119

How can construct validity of a test be evaluated?

Answer 119

* It can be evaluated in terms of how it relates to other tests of the same and different constructs * Determine what a test does and doesn't measure- convergence and discrimination

Question 120

What is convergent validity?

Answer 120

* 2 measures reflecting same phenomenon will correlate * Convergence not enough for construct validity - Must show that the construct can be differentiated from other constructs

Question 121

What is discriminant validity?

Answer 121

*Measures that assess different characteristics will have low correlations

Question 122

What do you start with when asking a research question?

Answer 122

* start with selecting a topic of interest - Pt population (ex. geriatrics, HD, CMT) - Intervention - Clinical assessments

Question 123

What is the second step when asking a research question?

Answer 123

* Identify a research problem - Broad statement to focus the direction of the study - What is known and what is not about the topic - Clinical experiences - Clinical theory (ex. motor control theory) - effects of practice/repetition - Literature review: initially a preliminary review (not extensive; an orientation to the issues) - Gaps (areas without info to make clinical decisions - Conflicts/contradictory findings/flawed studies - Replication (to correct for design limitations)

Question 124

What should be considered when reviewing the literature?

Answer 124

* Initial review is preliminary - General understanding of the state of knowledge in the area of interest * Once research problem is formulated begin a full and extensive review - Provides complete understanding of background to assist in formulating the research question * Problem provides foundation for a specific research question answerable in our study

Question 125

What are the components in shaping a question?

Answer 125

Question should be: * Important = results should be meaningful and useful * Answerable = questions involving judgements and philosophy are difficult to study * Feasible for study = researchers must have the necessary skill and resources. Are there sufficient subjects?

Question 126

What is a target population?

Answer 126

* Must be well defined so it is obvious who will be included in the study - Ex. community dwelling adults age 60 or more

Question 127

What should be done for the development of a research rationale?

Answer 127

* Begin a full review of the literature once the research problem is delineated * A full review of the literature will establish the background for the research question - this clarifies the rationale for the study

Question 128

What does research rationale present?

Answer 128

* Presents a logical argument that shows why and how a question was developed - Shows why question makes sense - Rationale provides a theoretical framework for the study - If no rationale for a study, difficult to interpret results

Question 129

What are variables?

Answer 129

*Building blocks of research question

Question 130

What is the independent variable?

Answer 130

* Predictor variable - Condition that ppl have - Intervention used - Characteristics of people that will predict or cause an outcome (young vs. old)

Question 131

What is the dependent variable?

Answer 131

*It's the outcome variable that varies depending on the independent variable, it does not have levels like an independent variable

Question 132

What is a conceptual definition?

Answer 132

* Dictionary definition; general * Leg flexibility is the degree of motion in the leg * No info on what measure of flexibility/motion is used in a particular research study (ex. ROM or SLR)

Question 133

What is operational definition?

Answer 133

* Variable is defined according to its meaning within a particular study - Ex. definition of "balance impairment" in a study

Question 134

What is the final step in delineating a research question?

Answer 134

* clarifying objective of study | * Research objective must specifically and concisely delineate what a study is expected to accomplish

Question 135

How might the objectives be presented?

Answer 135

* Hypotheses * Specific aims * Purpose of research * Research objectives - terms vary according to journals, researchers, disciplines

Question 136

What are the 4 general types of research objectives?

Answer 136

* Descriptive- to characterize clinical phenomena or conditions in a population * Measurement properties of instruments - investigation of reliability and validity * Explore relationships- to determine interactions among clinical phenomena (ex. strength and balance study) * Comparisons- outlining cause and effect relationships using experimental model - evaluates group differences regarding effectiveness of treatment

Question 137

What is the purpose of a study?

Answer 137

*To test the hypothesis and provide evidence to either accept or reject it

Question 138

What is a hypotheses?

Answer 138

* In experimental studies and exploratory studies researcher proposes an educated guess about study outcomes - Statement called a hypothesis - statement that predicts relationship between independent and dependent variables

Question 139

How is a hypotheses made?

Answer 139

* Not proposed on the basis of speculation * Derived from theory * Suggested from previous research, clinical practice/experience, observation

Question 140

What is a research hypothesis?

Answer 140

* States researchers true expectations of results * more often than not research hypotheses propose a relationship in terms of a difference * Some research hypothesess predict no difference btwn variables

Question 141

What is analysis of data based on?

Answer 141

* Based on testing the statistical (null) hypothesis | - always predicts no difference or no relationship

Question 142

What is a non-directional hypothesis?

Answer 142

*Do not predict a direction of change

Question 143

What is a directional hypothesis?

Answer 143

*Predict a direction

Question 144

What is a simple hypothesis?

Answer 144

*Includes 1 IV and 1 DV

Question 145

What is a complex hypothesis?

Answer 145

*More than 1 IV or DV

Question 146

What is important in reviewing the literature?

Answer 146

* Initial review is preliminary - General understanding of the state of knowledge in the area of interest * Once research problem is formulated begin a full and extensive review - Provides a complete understanding of background to assist in formulating the research question

Question 147

What should be in the scope of the literature review?

Answer 147

* Depends on your familiarity with the topic * How much has been done in the area and how many relevant references there are * review info on: pt population, methods, equipment used, operational definition of variables, statistical techniques used

Question 148

What is the difference between primary and secondary sources?

Answer 148

* Primary: research articles | * Secondary: review articles (systematic review) and textbooks

Question 149

What is validity in experimental design?

Answer 149

*Issues in experimental control that must be addressed so that we have confidence in the validity of the experimental outcomes

Question 150

What is the most rigorous form of investigation to test hypotheses?

Answer 150

* The scientific experiment | - Researcher manipulates and controls variables

Question 151

What is an experiment?

Answer 151

*Looking for cause-and-effect relationship btwn independent variable and dependent variable

Question 152

What are experiments designed for?

Answer 152

* Designed to control for extraneous (nuisance) variables that exert a confounding (contaminating) influence - Ex. 2 types of treatment received simultaneously

Question 153

What are the 3 characteristics of experiments?

Answer 153

* Independent variable is manipulated by the researcher * Random assignment * Control (comparison) group must be incorporated into the study

Question 154

Describe "independent variable is manipulated by the researcher"

Answer 154

* intervention (independent variable) is administered to one group (experimental) and not to another (control) * Active variable: IV with levels that can be manipulated and assigned (ex. treatment) * Attribute variable: IV with levels that cannot be manipulated as they represent subject characteristics (ex. occupation, gender, age group) - not a true experiment

Question 155

Describe Random Assignment

Answer 155

* In assigning subjects to groups * Each subject has an equal chance of being assigned to any group * No systematic bias exists that might affect differentially affect the dependent variable * If groups are equivalent at the beginning of a study - Differences observed at end of study are not due to differences that existed before the study began * eliminates bias by creating a balanced distribution of characteristics across groups

Question 156

Describe "control group must be incorporated into the study design"

Answer 156

* to rule out extraneous effects, use control group to compare to experimental group * Must assume equivalence btwn control and experimental groups at start of study - If we see a change in treatment group (experimental) but not control group, can assume it's the treatment

Question 157

What is the research protocol in experimental control?

Answer 157

* To control for extraneous (confounding) factors in a study - Eliminate them as much as possible (implies the researcher must know what they are) - Standardize research protocol so that each subject has a similar testing experience - Ensure they affect all groups equally (Ex. Testing environment, fatigue, instructions to subjects)

Question 158

Why do you maximize adherence to research protocol?

Answer 158

* To limit loss of data - Data losses compromise effect of random assignment - Decreases power of a study

Question 159

What are the reasons for loss of data?

Answer 159

* Subjects may drop out during the study * subjects may cross over to another treatment * Subjects may refuse assigned treatment after allocation * Subjects may not be compliant with assigned treatments

Question 160

Why do you do blinding in experimental control?

Answer 160

* To avoid observation bias * Participants knowledge of treatment status or investigators expectations can influence performance or recording outcomes - double blind study = subjects and investigators are unaware of the identity of groups until after study - Single blind study = only investigator/measurement team is blinded

Question 161

What are the design strategies for controlling for intergroup variability?

Answer 161

* Random Assignment - Eliminates bias by creating a balanced distribution of characteristics across groups - Not perfect and may not always work (groups may not be balanced on important variables) * Can use other strategies beside randomization * Choose homogenous subjects (ex. only males or older adults) * Matching (age and gender) across groups * Use subjects as own controls (repeated measures design) * Analysis of covariance (ANCOVA) - not a design strategy but a statistical strategy - covariates

Question 162

What are the 4 types of design validity that form a framework for evaluating experiments?

Answer 162

* Statistical conclusion validity * Internal validity * Construct Validity * External Validity