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Critical Inquiry > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What experimental design is not a true experiment and why?

A
  • A quasi-experimental design
  • lack randomization
  • lack comparison groups
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2
Q

What is the gold standard of true experimental design?

A

Randomized Control Trial

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3
Q

What occurs in a true experimental design?

A
  • Subjects are randomly assigned to at least 2 comparison groups
  • Experiment enables control over most threats to internal validity and provides the strongest evidence for causal relationships
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4
Q

What is a completely randomized design?

A
  • Between subject design

* Subjects assigned to groups based on a randomization process

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5
Q

What is a randomized block design?

A
  • Subjects classified according to an attribute (blocking variable)
  • Then randomized to treatment groups
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6
Q

What is a repeated-measures design?

A
  • Within-subjects design (everyone gets same interventions)

* Subject acts as own control

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7
Q

How many independent variables do single-factor designs have?

A

*One independent variable

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8
Q

How many independent variables do multi-factor designs have?

A

*Two or more independent variables

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9
Q

What is a single-factor design?

A
  • One way design
  • 1 independent variable is investigated
  • 1 or more dependent variables
  • Looking at how many independent variables there are, not how many dependent variables there are
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10
Q

What occurs with a RCT with 2 groups based on random assignment?

A
  • Pretest-posttest control groups design
  • Independent groups= treatment arms
  • Testing pre and post treatment
  • Changes in experimental group are attributable to the treatment
  • Establishes cause and effect relationship
  • Change in the experimental group is the post result minus the pre result to get the overall result. The change becomes the dependent variable
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11
Q

What occurs in a 2-group pretest posttest design?

A
  • Comparison group recieves a second form of the intervention
  • 2 experimental groups formed by random assignment
  • Control group is not feasible or ethical
  • Compares new treatment with “standard care”
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12
Q

What is a multi-group pretest posttest control group design?

A
  • Multiple intervention groups

* Includes a control group

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13
Q

What are pre-test post-test designs strong in?

A

*Strong in internal validity

*

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14
Q

How can the initial equivalence of groups be established?

A

*By pretest scores (important for inferring causality)

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15
Q

How is selection bias controlled in pretest posttest designs?

A

*Controlled because of random assignments

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16
Q

What should effect groups equally in pretest posttest designs?

A

*History, maturation, testing, instrumentation

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17
Q

How is the analysis of pretest posttest designs often done?

A
  • Often analyzed using change scores
  • difference between posttest and pretest
  • Also can use analysis of covariance (ANCOVA) to compare posttest scores
  • using pretest scores as covariate
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18
Q

What is a posttest only control group design?

A
  • Same as pre-test posttest control group design
  • EXCEPT no pre-test
  • Used when dependent variables can only be assessed following treatment
  • e.g. length of stay in hospital (see example pg 199)
  • Used when pretest is impractical or detrimental
  • Is an experimental design involving randomization and comparison groups
  • Strong internal validity
  • Assumes groups are equivalent prior to treatment
  • works best with large samples to increase probability of “equivalency”
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19
Q

What occurs in a multi-factor design for independent groups?

A
  • single factor designs have 1 independent variable (with 1 or more levels) and do not account for interactions of severable variables
  • Multi-factor designs have 2 or more independent variables
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20
Q

What occurs in a factorial design?

A
  • Factorial design incorporates two or more independent variables, with subjects randomly assigned to various combinations of levels of the two variables
  • Two-way (two-factor) design has 2 independent variables
  • Three-way (three-factor) design has 3 independent variables
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21
Q

What is a survey?

A
  • A series of questions
  • interview
  • questionnaire (written/electronic)
  • Can be used in:
  • experimental studies, exploratory studies, descriptive studies
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22
Q

What occurs in an interview?

A
  • Ask questions and record answers
  • Structured format
  • Unstructured format
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23
Q

What occurs in a structured interview?

A
  • Standard set of questions
  • Same questions in same order to all subjects
  • Same response choices
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24
Q

What occurs in an unstructured interview?

A
  • Less formal
  • Open ended
  • Conversational
  • Often used in qualitative studies
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25
Q

What occurs in questionnaires?

A
  • Structured surveys
  • Self-administered
  • Computerized or pen/paper
  • Efficient as completed on subject’s own time
  • Reduced bias from interactions with an interviewer
  • Disadvantage is the potential for misunderstanding or interpreting questions
  • Mail, electronic distribution
  • Low return rates (30-60%) limit external validity of results
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26
Q

What are data collected via interview or questionnaire based on?

A
  • SELF REPORT!
  • no direct observation by the researcher of subject’s behavior
  • potential for bias or inaccuracy
  • recall bias
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27
Q

What should be asked when making a survey design?

A
  • Delineate the overall research question
  • What are the objectives (guiding questions) of the study?
  • These objectives focus the content of the questionnaire
  • Outline of the questionnaire (relate to objectives)
  • Review existing instruments
  • Can they be adapted for my study?
  • Write questions that address each of the objectives
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28
Q

What do you ask when you distribute your preliminary draft of survey to colleagues?

A
  • Ask for feedback
  • Revise
  • Distribute again
  • Helps establish content validity of the instrument
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29
Q

What size sample should you do a pilot test on?

A
  • Small sample of 5-10 research subjects
  • interview respondents for feedback
  • revise
  • retest
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30
Q

How do you select a sample for surveys?

A
  • All PTs in Michigan

* Purchase mailing lists

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31
Q

How do you contact respondents?

A
  • Cover letter

* Follow Up

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32
Q

What do scales of surveys provide?

A

*Provide rating of degree to which subject possesses a characteristic/attitude/value

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33
Q

What are the scales of surveys?

A
  • Likert:
  • Strongly agree
  • Agree
  • Neutral
  • Disagree
  • Strongly disagree
  • Likert scales coded 1-5
  • Calculate overall score by adding answers
  • 1 item does not carry more weight than others
  • *visual analog scale
  • Place a mark on the 100 mm line
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34
Q

What is the Delphi Technique?

A
  • Experts complete multiple e.g. 3 rounds of questionnaires
  • Researcher reviews and distributes findings after each round
  • Eventually come to consensus on an issue
  • e.g. what should entry level knowledge be for a particular topic
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35
Q

How do you do an analysis of survey data?

A
  • Code the data e.g. male 1, female 0;
  • Fear of falling 1, no fear 0
  • SA=5; A=4; N=3; D=2; SD=1
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36
Q

What does descriptive statistics do?

A
  • Summarize responses
  • Mean age; years of education etc.
  • Categorical data
  • Frequency/percentages: 25 males (33% of sample)
  • 40% SA; 30% A; 20% Neutral etc
  • Scores on a scale may be summed Ex. mean ABC=84%
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37
Q

What does an IRB do?

A
  • Must approve survey research
  • Protection from psychological harm
  • confidentiality
  • Informed consent must be provided by participants
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38
Q

What is the best way for clinicians to seek evidence for interventions and assessments?

A
  • Systematic Reviews

- Cochrane Collaboration

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39
Q

What should a study question be?

A
  • Question is very specific

* Well described purpose statement

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40
Q

What is a narrative review?

A

*There’s a broad question to be answered with search strategies and selection of articles not usually described. Appraisal is not always rigorous and the conclusions are usually descriptive/qualitative

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41
Q

What is a systematic review like?

A

*The question is focused and the search strategies/databases are often described in detail. The selection of articles are rigorous based on specific criteria. Appraisal is very rigorous and the conclusion maybe qualitative or quantivative (meta-analysis)

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42
Q

What are the selection criteria of a systematic review?

A
  • “Subjects” of the review are the studies
  • Specify inclusion/exclusion criteria
  • Based on:
  • Types of studies
  • Types of participants
  • Types of interventions
  • Types of outcome measures
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43
Q

What is the search strategy for a systematic review?

A
  • Select keywords
  • Identify resources
  • Databases
  • Grey literature (unpublished studies)
  • Publication bias
  • Conduct the search and retrieve relevant papers
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44
Q

How do you evaluate quality of selected studies?

A
  • Critical review
  • Record on a form
  • Evaluate quality of design and data analysis
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45
Q

What are the types of study bias?

A
  • Selection bias
  • Performance bias
  • Attrition bias
  • Detection bias
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46
Q

What is the Jadad Rating scale?

A
  • 3 questions
  • Was study randomized (1 point if yes)
  • Was study described as double blind (1 pt yes)
  • Was there a description of withdrawals and dropouts (1 pt yes)
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47
Q

How many items is the PEDro Scale?

A

*11 items

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48
Q

What is Data synthesis?

A
  • Heterogeneity (dissimilarity) or homogeneity of the included studies (variability across studies)
  • Composition of treatment groups (inclusion/exclusion criteria)
  • Design of study (including length of follow up)
  • Management of patients (treatments provided/Presence of complications)
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49
Q

What are the analysis/synthesis of findings?

A
  • Overall conclusions based on quality of evidence obtained

* Often summarize findings in a table

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50
Q

What is a forest plot?

A
  • Represents the overall result of the meta-analysis
  • square is the outcome for that study [relative risk (RR)]; size of square relates to weighting of study based on sample size
  • line represents confidence interval (CI) around the RR
  • diamond is combined overall estimate of results [includes pooled point estimate (center of diamond) and CI (horizontal tips of diamond)]
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51
Q

Describe the confidence interval (CI) of a forest plot?

A

*If a CI of a result crosses the line of no effect, then either a significant difference does not exist b/w the treatment and the control or the sample size was too small to show an effect

52
Q

What is meta-analysis homogeneity?

A

*results of each individual trial are mathematically compatible with the results of the other trials

53
Q

What are heterogeneous studies?

A
  • If the CIs do not overlap; heterogeneous studies

- no common treatment effect across the studies

54
Q

What is a two-way factorial design?

A
  • Incorporates 2 independent variables
  • effect of intensity (vigorous/moderate) on exercise behavior
  • Effect of location (home/community center) on exercise behavior
  • 2x2 design means 2 independent variables and 2 levels of each independent variables (4 groups)
55
Q

What are the two-way factorial design main effects?

A
  • Is there an effect of moderate versus vigorous exercise
  • Is there an effect of exercsing at home or in community
  • This is examining main effect of each independent variable
56
Q

What are two-way factorial design interactions?

A
  • Can also examine interaction effects between 2 independent variables
  • Effect of 1 variable varies at different levels of the second variable
  • e.g. maybe moderate exercise is more effective in changing exercise behavior but only when performed at a community center
57
Q

When is a randomized block design used?

A
  • When there is concern that an extraneous factor such as gender might influence differences between groups
  • build the variable into the design as an independent variable
58
Q

How many independent groups are in a repeated measures design?

A
  • Up to now considered 2 independent groups

- experimental and control groups created by random assignment or by blocking

59
Q

What is a repeated measures design?

A
  • One group of subjects is tested under all conditions
  • Each subject acts as their own control
  • aka within-subjects design
60
Q

What are the advantages to a repeated measures design?

A
  • Subject differences can be controlled
  • Ex: differences between experimental and control groups are nullified bc no groups used
  • Physiological and other factors remain constant throughout the experiment
  • Subjects act as own controls provides most equivalent “comparison group” possible
61
Q

What are the disadvantages of repeated measures design?

A
  • Learning/practice effects when one person repeats measurements over and over
  • Carryover effects when exposed to multiple treatment conditions
  • Must allow enough time for dissipation of previous effects so there’s not cross-over
62
Q

Why might repeated measures designs not be considered true experiments?

A
  • Bc no randomized comparison groups
  • However if they incorporate randomization of the order of repeated treatments/interventions then can be considered experiment
63
Q

What is a one-way repeated measures design?

A

*One group of subjects is exposed to all levels of one independent variable

64
Q

What is Order Effects?

A

*were responses dependent on which condition preceded which other condition?

65
Q

What is the Solution to problem of order effects?

A

*Randomize order of conditions/interventions for each subject so there is no bias in choosing order of testing

66
Q

What is a two-way design with two repeated measures?

A
  • 2 repeated measures (= 2 independent variables)
  • Type of lift (squat/stoop)
  • Orthosis (yes/no)
  • Each person exposed to 4 test conditions
  • 2-way design (2x2 design)
67
Q

What is a Mixed design for multi-factor repeated measure design?

A
  • 2 independent variables
  • Exercise is independent factor
  • -2 independent groups (experimental; control)
  • Time is repeated factor
  • -3 time periods (pretest; time period 1; time period 2)
  • 2-way design (2 x 3 design)
68
Q

What do Quasi-experimental designs lack compared to experimental designs?

A
  • Random assignment
  • Comparison group
  • Or both
69
Q

What are quasi-experimental designs?

A
  • May involve non-equivalent groups
  • May be a reasonable alternative to RCT
  • Conclusions drawn must take into account biases of the sample
70
Q

What occurs in a one-group pretest-posttest design?

A
  • Effect of treatment is determined by change in pre- and posttest scores
  • Pretest—intervention—posttest
  • Vulnerable to threats to internal validity because no control group
  • History
  • Maturation
  • Testing
71
Q

What is a one-way repeated measure design over time?

A
  • Effect of treatment over time
  • Pretest-intervention-posttest 1- posttest 2
  • no control group so internal validity threatened
72
Q

What is a Non-equivalent pretest-posttest control group design?

A
  • Similar to pretest-posttest experimental design EXCEPT subjects not assigned to groups randomly e.g. volunteers self-select groups
  • EXP: Pretest–Intervention–Posttest
  • CON: pretest–no intervention–posttest
73
Q

What is a non-equivalent posttest only control group design?

A
  • Static group comparison
  • EXP: intervention –Posttest
  • CON: no intervention –Posttest
74
Q

What is a single subject design?

A
  • Draw conclusion on treatment effects based on 1 patient’s response
  • Controlled experimental approach
  • Independent variable is treatment
  • Dependent variable is target behavior (outcome)
  • Also called N of 1 study or Time series designs
75
Q

What is the Structure of a single-subject study?

A
  • Repeated Measurements
  • Each session; observe trends
  • At least 2 testing phases:
  • Baseline (A phase)
  • Intervention
  • Target behavior is measured across both phases on multiple occasions
  • Baseline phase: state of target behavior over time in the absence of treatment (control conditions)
76
Q

In a single subject study, what occurs when treatment starts when talking about change?

A
  • When treatment starts, any change from baseline to intervention phase is attributed to the intervention
  • Baseline data
  • comparison for evaluating potential cause and effect relationship between intervention and target behavior
  • Baseline period = A
  • Intervention period = B
  • A-B design
77
Q

How do single subject designs differ from traditional experimental designs?

A

*Multiple assessments in baseline and intervention phases

78
Q

What are the ethical issues regarding baseline conditions with single subject designs?

A

*Withholding treatment

79
Q

What are baseline characteristics?

A
  • 2 baseline data characteristics are important for interpreting clinical outcomes
  • Stability (consistency of response over time): stable or variable
  • Trend: accelerating or decelerating
80
Q

What is the length of phases?

A
  • Best to have equal phase length
  • Often 1 week per phase
  • Daily measurements
  • Minimum of 3-4 measurements per phase to detect trends
  • Greater number of data points easier it will be to identify trends
  • Often measures can be taken more frequently than daily if behavior changes rapidly
  • More than a single session
81
Q

What are Target Behaviors?

A
  • Choose clinically relevant outcomes measures for a particular patient
  • Strength
  • ROM
  • Gait speed
  • Balance measures
  • Pain
82
Q

What are the limitations of A-B Design?

A
  • Experiments can control for threats to internal validity
  • To do this in the A-B single subject design is more challenging
  • Other treatments/events (history effects)
  • What other evidence can we include to strengthen design control ?
  • to increase confidence that treatment caused the changes in target behavior
83
Q

What is additional Control?

A
  • *Replication of effects
  • Repeat phases
  • Withdrawal designs—treatment: no treatment
  • Withdrawing and reinstating baseline and treatment conditions
  • Withdraw intervention and show that target behavior occurs only in presence of treatment
  • -2nd baseline period (A-B-A design)
  • -Could also include a 2nd intervention phase (A-B-A-B design—see over)
84
Q

What is Data analysis- Visual?

A
  • Visual
  • Level (last data point of a phase to first data point of next phase)
  • Trend (direction of change in a phase)
  • -Accelerating or decelerating
  • -Slope of a trend (rate of change in the data)
85
Q

What is a Data Analysis- Celebration line used for?

A
  • Used to estimate trends in the data points

* AKA “split middle line” as it divides the data points in a phase into 2 halves

86
Q

What is Generalization?

A
  • Single subject research can provide data for clinical decision making
  • Not enough to show effect during intervention period on a single patient
  • Must also be able to show changes in the target behavior will occur in other individuals
  • Generalization: external validity for the single case
  • Assume treatment will be effective in others with similar characteristics
87
Q

What is an observational design?

A
  • No manipulation of variables as in experimental designs

* Exploratory or descriptive

88
Q

What is exploratory research?

A
  • Systematic investigation of relationships among variables
  • e.g. association of leg weakness and falls
  • Not used to establish cause-and-effect relationships b/w variables
89
Q

How can you conduct exploratory research?

A

*Retrospectively or Prospectively

90
Q

What is Prospective?

A

Variables measured in the present and follow subjects in a study
**More reliable than retrospective studies

91
Q

What is Retrospective?

A
  • Use of data that have already been collected
  • medical records, databases
  • Researcher can’t control data collection methods
92
Q

What occurs in Longitudinal Research?

A
  • Follow a cohort over time taking repeated measurements
  • Can observe growth and change in individuals over time
  • Often involve large cohorts followed over long periods of time
  • E.g. Framingham Heart Study (been going 40-50 yrs)
  • Threats to internal validity relate to
  • repeated testing
  • attrition
93
Q

What occurs in Cross-sectional research?

A
  • Gather data as a “snap shot” in time
  • Very efficient
  • All subjects tested more or less at same time
94
Q

What is a correlational study?

A
  • Foundation of exploratory studies is process of correlation (degree of association)
  • Covariation in data (extent to which one variable varies with another variable)
  • Look at several variables at once to see which are related
  • can make predictions (predictive correlational study) based on observed relationships between variables
  • -Cholesterol level: age, diet, gender, genetics, etc
  • -Regression (stats procedure)
95
Q

What is the purpose of a correlational study?

A

*Purpose is to describe the nature of existing relationship among variables

96
Q

What is a case-control study?

A
  • Retrospective
  • not randomized
  • Purpose of a case-control study is to determine if the frequency of an exposure (e.g. poor nutrition; smoking) is different in cases and controls
  • Choice of controls is critical
  • match cases and controls for age, gender, SES, etc.
97
Q

What is the selection bias in case-control studies?

A
  • Selection bias: choose cases and controls regardless of exposure history
  • Beware of misclassification ie cases and controls
98
Q

What is observation bias in a case control study?

A

*difference in the way information about disease or exposure is obtained from the groups

99
Q

What is interviewer bias in a case control study?

A

*Person collecting data elicits, records or interprets info differently from cases and controls

100
Q

What is recall bias in a case control study?

A

*Subjects remember exposure differently

101
Q

What is a cohort study?

A
  • Follow a group(s) overtime (prospective)
  • Group 1: Exercisers
  • Group 2: Sedentary (matched)
  • Not randomized
102
Q

What is Causality in Observational studies?

A
  • RCT (experimental): cause-and-effect relationships
  • Case control and cohort studies do not involve experiments or manipulation of variables
  • Causation (cause and effect i.e. did the exposure cause disease) is established by other methods
103
Q

What is Causality?

A
  • Establish a time sequence: exposure precedes disease
  • Strength of association: relative risk
  • Biologic credibility
  • Consistency with other studies
  • Dose-response relationship-
104
Q

What is a methodological study?

A
  • Type of exploratory study

* Use correlational methods to examine reliability and validity of measuring instruments

105
Q

What is a historical study?

A
  • Type of exploratory study
  • A historical study reconstructs the past on the basis of archives and other records to suggest relationships of historical interest to a discipline
106
Q

What populations does descriptive research describe?

A
  • Characteristics
  • Behaviors
  • Conditions
107
Q

What does Descriptive research involve?

A
  • May involve prospective or retrospective data collection
  • Design may be longitudinal or cross-sectional
  • Surveys and secondary analyses of clinical databases often used as data sources for analysis
108
Q

What are the categories of descriptive research?

A
  • Developmental research
  • Normative studies
  • Qualitative research
  • Descriptive surveys
  • Case studies / case reports
109
Q

What does developmental research involve?

A
  • Involves description of developmental change and sequencing of behaviors in people over time
  • motor development in children
  • lifespan
110
Q

What do longitudinal methods of developmental research involve?

A

*Longitudinal methods involve collecting data over time—focus on natural history of a disease (eg CMT study)

111
Q

How can you use a cross-sectional study in developmental research?

A

*Can also use cross-sectional methods and study different age groups at a point in time

112
Q

What is a normative study?

A
  • Purpose is to describe typical or standard values for characteristics of a population
  • Describe norms as a mean and a range of acceptable values
  • Norms are used as a basis for prescribing interventions
113
Q

What is qualitative research?

A
  • Describes how individuals perceive their own experiences within a specific social context
  • What it means to live with a spinal cord injury
  • Helps us understand the patient’s view of the world
  • Important in designing interventions
  • Data collected by interviews and observation
  • Participant observation (researcher embedded in the group)
  • Field observation: nonparticipant
114
Q

What are descriptive surveys?

A
  • Often used as a source of data to collect information about a specific group
  • To describe their characteristics, or risk for disease, or other attributes
115
Q

What occurs in case studies?

A
  • Important for developing a clinical knowledge base
  • In-depth description of a person’s condition or response to treatment
  • Case series involves observations in a number of similar cases
  • Often involve unusual diagnoses that are challenging
  • May highlight avenues for future research
116
Q

What is the case studies format?

A
  • Comprehensive description of the subjects background, present status, and responses to intervention
  • Poses questions for further study
117
Q

What does the introduction do in a case studies format?

A

*Describes background literature to the pts problem

118
Q

what does the pt history do in a case studies format?

A

*Problems, symptoms, prior treatments, demographic and social info

119
Q

What are the results in a case studies format?

A

*pts response and any follow-up data

120
Q

What is the discussion in a case studies format?

A

*Interpretation of outcomes and conclusions

121
Q

What does a case studies format consist of?

A
  • introduciton
  • pt history
  • treatment plan
  • Results
  • Discussion
122
Q

How do you apply literature to patients?

A
  • Systematic Review
  • Critically Appraised Topic (CAT)
  • -Brief Summary of a search and critical appraisal of literature on a clinical question
  • -Standardized format
  • -Provides statement of clinical relevance
123
Q

What is a CAT?

A
  • Initiated by a patient encounter usually due to gap in knowledge
  • Search for and appraises best evidence
  • Summarizes evidence
  • Integrates evidence with clinical expertise
  • Suggest how information can be applied to practice
  • Usually 1-2 pages
124
Q

How are CATs and systematic reviews similar?

A

*They both have the goal of applying their information/findings to people

125
Q

What is the format of a CAT?

A
  • Title
  • Author/date
  • Clinical scenario (description of case that prompted the question)
  • Clinical question (PICO format)
  • Clinical bottom line (summary of how results can be applied)
  • Search history/strategy
  • Citations
  • Summary of the study/ies (design; sample; intervention; outcome measures; data analysis)
  • Summary of the evidence (results summarized)
  • Critical comments on the study (internal/external and statistical validity of the study)
126
Q

When do you use CATs?

A
  • Useful at point of care
  • Can be created out of case conferences
  • “CAT Banks” established by institutions
127
Q

What are some of the limitations of a CAT?

A
  • Limited shelf life as new evidence becomes available
  • Not as rigorous as a systematic review
  • -1-2 references and do not represent full scope of the literature on a topic

Critical Inquiry (3 decks)

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