Exam One Flashcards
Diagnosis
Diagnostic labels may be used to describe multiple dimensions of the individual, ranging from the most basic cellular level to the highest level of functioning as a person in society
Prognosis
the determination of the predicted optimal level of improvement in function and the amount of time needed to reach that level and also may include a prediction of levels of improvement that may be reached at various intervals during the course of therapy
Intervention
Physical therapists purposefully interact with the individual and, when appropriate, with other people involved in his or her care, using various interventions to produce changes in the condition that are consistent with the diagnosis and prognosis
Outcomes
the actual results of implementing the plan of care that indicate the impact on functioning (body functions and structures, activities, and participation)
Purpose of Research: Descriptive
Document extant phenomena and change over time. Can use descriptive studies to generate new research questions and hypotheses
Purpose of Research: Analysis of Relationships
How are variables related to one another. Used for research on the validity and reliability of tests & measures
i.e how do height and weight correlate with each other?
Purpose of Research: Analysis of Differences
Are 2 or more groups different in some important way?
Timing of Data Collection: Retrospective
Data is already recorded. Inquire about past events.
Timing of Data Collection: Prospective
Data is collected after the research is initiated. ONLY prospective data colleciton can be experimental.
Experimental Research
Variables are subject to manipulation by the investigator. In clinical research, this involves assignment to treatment status.
Observational Research
Investigator(s) “observe” what occurs naturally, i.e. in real-world settings. Treatment status is based on patient/system factors, not assigned.
Domain of Clinical Research: Intervention Research
Establishes efficacy or effectiveness, as well as safety, of an intervention in a specific clinical population.
Domain of Clinical Research: Diagnosis Research
Validates a clinical diagnostic test against an established (and valid) “gold standard” for that diagnosis.
Domain of Clinical Research: Prognosis Research
Assess demographis, behavioral and clinical characteristics that predict disease or other outcomes of interest.
Randomized Control Trials
- The most rigorous experimental research design
- Useful only for research on interventions
- Subjects are randomly assigned* (exposed) to an intervention (or not)
- Blinding of intervention status may be applied to participants, clinicians, and/or data analysts
- Timing of data collection always prospective
Cohort Studies
- The most rigorous observational research design
- Study of “naturally” occurring groups
- Subjects initially classified by exposure status and “followed” forward in time for outcome
- Useful for research about
- Etiology and prognosis
- Diagnosis/screening tests
- Interventions
- Timing may be prospective or retrospective
Case-Control Studies
- Used when outcome (disease) is rare or unusual
- Subjects initially classified by outcome status
- Exposures are ascertained in the past (i.e. they have already occurred, or not)
- Useful for research about etiology/prognosis
- Usually not used for intervention or diagnosis research
- Timing is always retrospective
Cross Sectional Studies
- Exposure and outcome are measured concurrently (at the same time)
- Useful for study of disease burden within a community (prevalence)
- May be used in diagnosis research (concurrent validity)
- Utility for research on intervention, etiology, prognosis is limited
- Timing is neither prospective nor retrospective
Systematic Reviews
- Studies that examine multiple primary studies addressing a specific clinical issue (question):
- Intervention effectiveness
- Diagnostic test accuracy
- Prognostic factor
- Included primary studies are rigorously -appraised to assess their credibility
- Data from individual studies is often combined to produce more powerful summary findings (meta-analysis)
Evidence Based Practice
Combines the “best” available exercise with your clinical expertise and the patients values
Pillars of EBP: Clinical Expertise
Ability to use your skills and past experience to identify the patient’s unique problems
- Pt history - Risk factors - Diagnosis/prognosis - Medications - Current health state
Pillars or EBP: Patient values and preferences
- The patient (or client) has unique preferences, concerns or expectations
- Clinical decisions about interventions or diagnostic tests to be applied should be collaborative
- A caveat: patient willingness to participate in in clinical decisions is not universal
Pillars of EBP: Best available evidence
- Empirical measurements about relationships between events based on observation or experiment
- Derives from credible, valid sources (typically peer-reviewed) that use sound methodology and are appropriate for the clinical question
- Availability of evidence may be limited by unanswered clinical questions, or quality of the body of evidence.
The Five Steps to EBP
- Formulating an answerable, clinical question
- Search for, and find the appropriate evidence
- Interpret and appraise the evidence
- Apply the findings: make a recommendation integrating the best available evidence with your clinical expertise AND the patient’s unique values and beliefs
- Evaluate performance
Asking Clinical Questions: Background Question
General knowledge about a condition.
Asking Clinial Questions: Foreground Question
- Focused question about a specific patient with a particular condition
- Pertains to your management of the patient
- Includes several elements that make the question answerable and useful
