Exam Two - Clinical Prediction Rules Flashcards
CPR use a combination of clinical findings to predict:
- presence of a disorder
- likelihood of a treatment outcome
- most likely prognosis
What is the goal of CPR?
intended to simplify and increase the accuracy of clinicians’ diagnostic and prognostic assessments
CPR is used in combination with….
clinical intuition!
- not a replacement for experience
- reduce the influence of bias in clinical judgements
CPRs are especially useful when…
- decision making is complex
- clinical stakes are high
- opportunities exist to avoid unnecessary tests without compromising patient care
CPRs quantify what three aspects of our practice?
- diagnosis
- prognosis
- intervention
Diagnosis CPRs are frequently designed to maximize _______ in order to better rule ______ the diagnosis
sensitivity
out
A _________ diagnostic CPR rules out the fracture
negative
A _________ diagnostic CPR does not rule in the fracture because its not __________
positive
specific
What question does intervention CPRs seek to answer?
what patient characteristics predict a positive outcome following an intervention?
Nearly all intervention CPRs were derived using a ________ study design. Is that good?
“single arm”
nope because there’s no control group or covariation of cause and effect
Single arm study designs seek to answer:
what is similar among responders that is different from nonresponders?
- use multiple logistic regression
describe pathway of single arm intervention CPR
get group, then measure outcome of interest and possible predictors, then apply intervention, then measure change in outcome of interest, the separate the responders from nonresponders
many PT intervention CPRs define “improvement” using the ______- scale
Global Rating of Change (GROC) scale
Prognosis CPRs predict the…
natural course of a condition, or its risk for development
What is a prognostic factor?
a characteristic that increases or decreases a person’s risk for a certain outcome
What are a few types of prognostic factors?
- demographic
- disease-specific
- co-morbidities
- other (insurance, access to healthcare)
What are favorable prognostic factors?
- increase likelihood of a positive event or decrease the likelihood of an adverse event
What are unfavorable prognostic factors
- increase the likelihood of an adverse event or decrease the likelihood of a positive event
nearly all prognostic CPRs were derived using a _____ study design. Is this good?
single arm
yes, it’s good. you aren’t giving an intervention, you’re just letting time pass before you measure outcomes of interest again
describe pathway of single arm prognosis CPR
get participants, then measure possible predictor variables, then let time pass (no intervention), then evaluate outcome of interest again, then separate participants into yes/no
Why are we concerned with intervention CPRs not having a control group?
with no control group, the identified predictors may simply indicate which patients will get netter over time (alone)
If we do a two arm study design for intervention CPRs, what experimental design does it mimic?
RCT
- allows us to test intervention effectiveness
- allows ID of exam findings that predict success with that intervention
What are some cons to a two arm study design for intervention CPRs
more subjects, more expensive, more complicated
Typically, CPR results include:
1 - sensitivity
2 - specificity
3 - likelihood ratios