Exam 1 Flashcards
Difference between basic and applied research:
Basic:
- Little or direct clinical application
- Gather basic info, test theories or hypotheses, etc.
- Takes place in controlled lab
- Goal is to explain answers to questions
- Example – how do I control my posture when you take sight away.
Applied:
- Direct clinical applicability in a real life setting
- Usually takes place in a lab setting, but goal is to replicate authentic enviornments
- Goal is to provide SOLUTIONS applicable in real world
9 steps / stages / process of scientific research:
1) Identify a topic (broad to narrow)
2) Search and review the literature (broad to narrow)
3) Define a topic
4) State a general question or problem
5) Phrase an operationally defined hypothesis
6) Plan the methods to test the hypothesis
7) Collect data and implement plan
8) Analyze data and interpret results
9) Write about findings (conclusion)
Important aspects to remember in research ethics
And important things to remember in evaluating other research results from others.
Be honest in your research.
Never plagiarize - quote people properly.
*** Never manipulate results to find statistical significance. Avoid selection bias.
Ideally do sampling of subjects in an ethical way.
PTs should take responsibility for their own continued education and reading research.
We as readers of research papers also need to be critical of research we read … read with a critical eye. Not all research is created equal. Don’t accept everything at face value as being true, or having come from a good research project with no bias, totally randomized, sufficient sampling group size, etc.
*** Evaluate strength of research before apply it.
(SOS) Do volunteers in research projects have to consent?
Now days, every volunteer in research studies must sign a consent form and know what research study entails. A disclosure of the risks / benefits to participant.
Bad examples from the past of subjects involved in unethical research tactics.
What did this lead to?
Nuremberg Doctors Trial of 1946 (Nazi human experimentation) … lead to Nuremberg code in 1947 requiring consent.
Declaration of Helsinki: 1964
Belmont Report: 1979
The Tuskegee Syphilis Study from 1932-1972 conducted by the US Public Health Service. US Govt promised free health care if they could monitor / research men with syphilis. Basically wanted to research treatment for syphilis, but funding ran out and they didn’t tell participants. So they were told they were being treated, but weren’t.
This lead to all research participants MUST sign a consent form and be informed about risks of research project. AND the IRB board being created to monitor and police research projects involving participants.
What is the IRB with regards to research projects
CITI = collaborative institutional training initiative (responsible conduct of research/ers)
IRB = Institutional Review Board
A Review Board to ensure any research project is done properly, a disclosure to participants is provided, benefits outweigh risks, ensure ethical and safety of patients. Basically a check to ensure safety of patients.
What is informed consent?
A disclosure of what the research entails. All research participants must read and agree to it before starting, so they are aware of all risks.
The two major tenants of the IRB and informed consent document / disclosure:
Identify all possible risks or potential harm to any human participating in study, and disclose them.
Benefits must outweigh risks
(SOS) What is Evidence Based Practice:
EBP is a process by which decisions about clinical practice are guided from evidence in research based on scientific models.
And to help evaluate and interpret research when applied to clinical practice.
It means integrating your clinical expertise with the best available external clinical evidence from research.
If you summarized EBP into 4 simple steps, it would be:
RECOGNIZE, ASK, RESEARCH, APPLY:
- Recognizing clinical problems
– Asking good clinical questions
– Finding, critically evaluating, analyzing, and
synthesizing evidence
– Applying the most relevant evidence to clinical
decisions and patient care recommendations
Steps for EBP (the “As”):
Assess Ask Acquire Appraise/Analyze Apply
What is the PICO model for asking clinical questions
And which “A’s” is PICO for?
(SOS) She will ask you to give a PICO model example:
P: Population / Patient / Problem
- Patient/Person, PROBLEM, location, characteristics
I: Intervention
- Which main intervention, prognostic factor, or exposure am I considering?
C: Comparison
- What is the main alternative to compare with the intervention?
- Compare this vs. that treatment
- *** Remember with comparison, we don’t compare facilities - we compare interventions / treatment options.
O: Outcome
- What can I hope to accomplish, measure, improve, or affect?
- What do you want to get out of treatment? Or what do we want to accomplish with this patient?
ASSESS and ASK
PICO MODEL EXAMPLE:
P: Geriatric patients 65+ after TKA
I: Use a CPM machine (continuous passive motion)
C: Light exercise + small weight bearing exercise program
O: Which intervention provides greater ROM after 4 weeks
If something is published, is it true?
NO
Is all evidence good evidence?
All evidence is NOT created equal. Just caused it is published, doesn’t mean it is good evidence.
As a PT, you must read with a critical eye and not take everything published at face value and true.
When appraising an article, what 3 steps should you follow:
- Is the study valid?
- What are the results?
- Will the results help my patients?
(LIBRARY LECTURE)
What are 3 main Boolian terms
List examples of each, and why you’d use
AND, OR, NOT
Hip AND fracture in search (narrows search, provides exact results)
Hip OR Os Coxa in search (broadens search, will show either / all. Or is ALL INCLUSIVE, not exclusive)
Hip NOT Pelvic in search (finds one term but not the other, more specific, prevents)
If you wanted to be ALL INCLUSIVE, which Boolian term would you use? Or or And
Or
What is the 3 step process for planning a search (use veggies and cancer as an example):
1) Identify big picture concepts of search (can eating vegetables help decrease risk for cancer)
2) Find similar keyterms (so vegetables might have brocolli, calliflower, veggies; and cancer might have cancers or carcinogens)
3) List various ways to combine all these various terms . (vegetables or brocolli or calliflower … cancer or cancers or carcinegens).
Define controlled vocabulary
A controlled vocabulary is an organized arrangement of words and phrases used to index content and/or to retrieve content through browsing or searching. It typically includes preferred and variant terms and has a defined scope or describes a specific domain.
There are so many terms for something, and controlled vocab is to pick a standardized term. So example is “child” is main term for anything searched with a term like: pediatrics, children, kids, etc. All searches for those various other terms will fall under / get categorized with / show up with the main category and key term of “child” because INDEXERS created the organization.
So if you search “kids” and only articles with “child” come up - it’s ok :) Same thing. It is just the indexers who lump “kids” into general category and put it under the “child” heading/section.
In a controlled vocabulary system, one term or phrase is selected for a subject or concept and all the indexing of that topic must use that standard word or phrase.
4 functions of controlled vocabularies
- They standardize vocabulary by using a single word or
phrase to represent a concept or subject - They define topics or subjects to reduce ambiguity
- They standardize phrasing
- They pre-coordinate (combine) topics.
Remember there are tons of ways to search for the same term. It can be a plural / singular form, or a noun or adjective form, abbreviations, acronyms, synonyms, etc. Examples:
gymnast
gymnastic
gymnastics
gymnasts
injured
injuries
injury
male
man
men
boy
family
genetics
herediatry
deaf
hearing impaired
REM / Rapid Eye Movement CV / Cardiovascular Inj / Injury VO2 or O2 or CO2 or ATP Etc.
Cloudy / Overcast
Sunny / Bright
Ok
What are the 5 steps in Evidence Based Practice (relative to the 5 A’s)
1) Define a clinical problem / RECOGNIZE there is a problem.
2) ASK a question … create a hypothesis
3) Research and AQUIRE knowledge and do a study
4) Analyze the strength of the evidence and appraise it
5) Use the evidence to help yourself and patients in the clinic (APPLY)
(SOS)
Read the Schreiber article. Know it generally - there may be a ? on the exam about it.
Breifly explain what the article is about.
EBP in PT. Generally there is not a lot of EBP in PT, and the profession needs to move towards clinical decisions based on scientific research.
We need to move away from therapy as a result of “advice” from other therapists and what they found worked, or what you’ve been doing forever, and base clinical therapy on science backed by and validated by EBP.
Back in the day PT’s just got directions from Physicians. Now, we are primary health care providers and need to find BEST practices for our patients. So TONS of emphasis has been placed within the profession for PT’s to research, study, and make clinical decisions more on EBP.
Challenges:
1) Research methods
2) Clinicians skills
3) Administrative factors
Good patient care, related to EBP, should apply these 3 things:
1) Valid research findings grounded in theory and science
2) Clinical expertise and practical experience
3) The medical needs, psycho-social interests, and ethical and religious values of the individual patient
Is Evidence based practice supposed to replace clinical judgement?
Does it denounce traditional means of acquiring clinical knowledge?
Is it an agenda by administrators to reduce medical expenses?
Is EBP a once size fits all?
No, no, no, NO
What is research?
What is emperical research?
Research is a careful, logical, and systematic process of investigation.
I have a question and want to study / experiment it.
Emperical research is more than just study … it is approaching a problem to make a decision. It is scientific study of having a questions, collecting data, analyzing data, applying findings.
Ideally, what type of sampling should you do in a research project
Random, non-biased, blinded at times, that is large enough sampling to make accurate assumptions about population as a whole.
(SOS) Question on the box of EBP Hierarchy (WITH TRIANGLE). What essentially is this saying:
Highest box is ideal in EBP, lowest box is worst or less effective in EBP
Highest box examples of good EBP: randomized, non biased, good sample size, blinded, controlled trials, all-or-none studies, published results, clinically applicable, etc.
Lowest box examples of not effective EBP: animal research, non-published, no clinical observations or application
RCT
Cohort studies
Case studies
Animal studies
Difference between 2 Study Designs: Prospective and Retrospective
Which one is better?
1) Prospective: study a subject over time (this is “Gold Standard”)
2) Retrospective: Review results from the past
(SOS) She will give us an article and we need to put it in AMA style. It will be a journal:
What is format for a Print Journal and an Online Journal:
Print Journal Article: (Use month of publication if no volume or issue given.)
PRINT:
Last Name First Initial, Last Name First Initial, et al. TITLE. Journal (italicized). Year;Vol(Iss):Page-Page.
ONLINE:
Last Name First Initial, Last Name First Initial, et al. TITLE. Journal (italicized). Year;Vol(Iss):Page-Page. Website Link. Accessed Date.
________________________
3. Rainier S, Thomas D, Tokarz D, et al. Myofibrillogenesis regulator 1 gene mutations cause paroxysmal dystonic choreoathetosis. Arch Neurol. 2004;61(7):1025‐1029.
Online Journal Article: (Include page numbers if article also available in print. See below.)
- Duchin JS. Can preparedness for biological terrorism save us from pertussis? Arch Pediatr Adolesc Med. 2004;158(2):106‐107. http://archpedi.ama‐ assn.org/cgi/content/full/158/2/106. Accessed June 1, 2004.
What are RCT’s
Why are they good?
Are they Prospective or Retrospective?
Randomized Controlled Trial.
So it is randomized in 2 ways:
1) Selection of patients and assigning to certain groups
2) Interventions are given to patients in a randomized order. Or assignments to a treatment group are randomized.
They are effective so you can control unwanted influences and demonstrate cause and effect relationship … and they represent the entire population better.
And they are always PROSPECTIVE rather than retrospective.
The strength of evidence primarily comes down to 2 things:
1) Sampling Group (which samples/people are more likely to estimate the true population values?)
2) Research Methods:
- Hierarchy for strength of evidence for treatment decisions
- Oxford center of EBMedicine hierarchy (THE TRIANGLE of 5 LEVELS)
The triangle of 5 levels is called:
Oxford center for EBMedicine hierarchy figure
What are cohort studies?
Why do we use them? What is good and bad about them?
A type of study where one a group (called cohorts, who all have the same characteristic/situation/disease) are chosen to study specifically. Thus, it is NOT randomized - the cohorts are chosen and then followed prospectively over time to monitor changes, effects, medications, interventions, etc. Its an observational study with a non-randomized group to continually monitor and evaluate a disease or intervention.
** Cohort studies usually have two groups - an exposed and non-exposed group. One with intervention and one without.
- Can be prospective or retrospective.
- *** Involve the study of groups based on exposure or intervention, assessing differences in outcomes.
- Group of subjects followed over time.
- Lack randomized assignment
(SOS)
The Schreiber and Stern article:
- When did the term EBP begin to appear in PT?
- Purpose of the paper?
- What search engines were used?
- 3 challenges and barriers to implementing EBP
- Mid 1990’s (1991, 1992)
- (See response in above ?)
- CINAHL, OVID, and Medline
- Challenges:
1) Research methods
2) Clinicians skills
3) Administrative factors
CAT’s stand for:
What are they and why do we have them?
Critical Appraisal Topics
A CAT is a SHORT summary of evidence on a topic of interest, usually focussed around a clinical question. Defined as a brief summary of a search and critical appraisal of the literature related to a focused clinical question to be used to help make clinical decisions
A CAT is like a shorter and less rigorous version of a systematic review, summarizing the best available research evidence on a topic. CAT’s are aimed at providing both a critique of the research and a statement of the clinical relevance of results.
Dr’s are busy and can’t review ALL research - this is a quick summary of the research.
Sections in a research article?
- Title
- Abstract
- Body
- Intro
- Methods
- Results
- Discussion
- Conclusion and/or clinical significance
