Exam 2 Flashcards
What is the PEDro scale? List the scores
A scale used to assess the quality and reliability of clinical or randomized controlled trials (RCT)
Scoring is dependent on how many boxes it checks off
Poor: 0-3
Fair: 4-5
Good: 6-8
Excellent: 9-10
What are the 11 (10 being graded) components of the PEDro scale (used to grade a randomized controlled trial)?
(Note: 1st step does not count for the grading)
- Eligibility criteria was specified
- Subjects were randomly allocated to groups
- Allocation was concealed
- Groups were similar at baseline
- Blinding of all subjects
- Blinding of therapists that administered the therapy
- Blinding of assessor
- At least one key outcome was obtained from more than 85% of subjects
- At least one key outcome was analyzed by “intention to treat”
- Between group statistical comparison (compares statistics of one group to another)
- Contains measures of variability (standard deviations, standard error, confidence intervals, ranges)
What are the 3 types of search strategies within the PEDro database?
Simple search: A single text search
Advanced search: Has 13 fields that help refine the search
Consumer search: Contains less technical language for patients
What is a systematic review?
A summary of the literature that uses explicit methods to perform a thorough literature search and critical appraisal of individual studies
List 3 examples of evidence syntheses
- Systematic review
- Scoping review
- Clinical practice guidelines
Which tools are used to assess randomized controlled trial quality?
PEDro scale and Cochrane risk of bias tool
List the type of research questions for systematic reviews
- Intervention
- Diagnosis
- Prognosis
- Qualitative
What is a forest plot?
a graph that summarizes the results of a meta-analysis, or a study of multiple studies, by visually displaying the results of each study
Differentiate between data synthesis and meta analysis
Data Synthesis: A broad process of combining and summarizing information from several sources to form a comprehensive understanding of a topic (qualitative)
Meta Analysis: A specific statistical method used to quantitatively combine results from multiple studies to produce a single, precise estimate of an effect size, typically focusing on numerical data only (typically displayed as a forest plot)
(quantitative)
T or F? When looking at a forest plot, the bottom diamond is the “average” of all other data?
True
Describe a scoping review
- Exploratory
- Has a broad research question
- Methods include systematic search, more expansive selection criteria for study designs, does not involve methodologic appraisal
What is the purpose of critical appraisal?
To determine the scientific merit of a research report and its applicability to clinical decision making
(note: clinicians often express that one of the foremost barriers to EBP is a lack of skill in searching for and appraising the literature)
What are the 3 general questions for appraisal?
- Are the results of the study valid?
- Are the results of the study meaningful?
- Are the results relevant to my patient?
Describe the appraisal process
- Begins with finding a study relevant to your clinical question
- Read the abstract to check relevancy
- Read the full text
List the 5 parts of a research study and provide questions that correspond with each
Introduction
- Is the research question clearly stated?
- What type of research is being done?
Methods
- Were data collection procedures clearly defined?
- Was data analysis appropriate to the research question and data?
Results
- Were results presented clearly in text, tables, or figures?
- Was the effect large enough to be clinically meaningful?
Discussion
- Is the author’s interpretation of results supported by the data?
- Were the study limitations addressed?
Conclusions
- Were the participants in the study sufficiently similar to my patient?
- Is the approach feasible in my setting, and will it be acceptable to my patient?
Define “clinical practice guidelines”
Guidelines are systematically developed statements to assist practitioner decisions about appropriate health care for specific clinical circumstances
What are the 4 primary purposes of clinical practice guidelines?
- Make evidence-based practice efficient and realistic
- Make the best available research evidence directly applicable to clinical practice
- Integrate research evidence with knowledge from clinical experts
- Consider research evidence with consideration for patient perspectives
Differentiate between the primary purpose of a clinical practice guideline and a systematic review
Clinical Practice Guideline (CPG)
- To make recommendations for best clinical practice based on the best available research evidence, clinical expertise, and patient perspectives for a relatively broad set of clinical questions associated with a specific health condition
Systematic Review
- To summarize the research on a specific question, or a specific set of questions, by systematically reviewing and summarizing existing research evidence
T or F? You can use PEDro, Pubmed, National Institute for Health and Care Excellence, and other professional org website (APTA) to find clinical guidelines
True
What are the 3 things that factor into a good clinical practice guideline?
- Applicability
- Quality
- Clinical Utility
Differentiate between levels and grades
Levels: Study design hierarchy
Grades: Confidence behind recommendation
T or F? Involving stakeholders in the development of clinical practice guidelines ensures that a wide range of expertise and perspectives are considered
True
T or F? Use PEDro and Pubmed to identify a clinical practice guideline
True
T or F? For trials evaluating complex interventions (exercise of manual therapy), a total PEDro score of 8/10 is considered “optimal”
True
What are the 4 steps to selecting a systematic review
- Select the studies for review (inclusion/exclusion criteria)
- Search strategy (selection of databases and key terms used)
- Screening citations
- Data extraction (assess the quality of study, collect data for meta analysis)
What should be included in the synthesized data?
- Study design
- Participants
- Interventions
- Outcomes
- Study quality
What are the 3 parts of an “appraisal”?
- Applicability
- Quality
- Clinical utility
T or F? A meta analysis is typically displayed as a forest plot
True
List the grades of recommendation for CPGs
A: Strong evidence
B: Moderate evidence
C: Weak evidence
D: Conflicting evidence
E: Theoretical or Foundational evidence
F: Expert opinion
