Intervention Flashcards
Its choice of intervention is basted on
results of exam and eval
Best available evidence is used to
determine efficacy or effectiveness of interventions
Intervention
the reason people come to see PT
Evidence on interventions should be based on
research validity (whether or not a study is designed well and provides results that are appropriate to apply to patient being seen)
Higher research validity allows results to be
believable and reasonably free from bias
Study design with highest research validity in intervention studies
RCTs
Ideally a study will have
pre and post control and tx random group assignments (quasi - lack these) (Non-experimental = case control)
Intervention studies use what type of stats
descriptive: subject characteristics and baseline measures
Effects of treatment are described by
tests of differences which compare groups using means, ranks, or frequencies
ANCOVA adjusts for
covariates
MANOVA look at
one or multiple outcomes
Effects of tx tests only relay information on
Difference - NOT size of effect
Effect size =
magnitude of differences btw two group means
Standardized effect size
compare the magnitude of impact from the same intervention across different outcome measures
Used in power calculations
Absolute risk reduction
control group event rate minus the experimental group event rate
The absolute value of the difference in rates of adverse outcomes btw the intervention group and the control group expressed as a percentage
ARR of 0 = no diff so treatment had no effect
Relative risk reduction
Control group event rate minus the experimental group event rate divided by the control group event rate
The absolute value of the rate of decrease in adverse outcomes for the intervention group relative to the control group expressed as a percentage
RR of 1 means that there is no difference so tx had no effect
RR > 1 = tx inc risk of outcome
RR
How is statistical importance determined
p value
CI
Evidence should have
validity and statistical importance
What will help determine if a patient has potential to benefit from an intervention (greater than risk of harm)
Clinical judgement and patient values
Minimally clinically important difference and number needed to treat assist in making these decisions
Minimally clinically important difference is the
smallest treatment effect that would result in change in patient management - part of power calculations
Number needed to treat is the
estimate of the number of subjects that must receive an intervention in order of one subject to increase benefit or reduce risk
Monograms are used to determine NNT
Use of evidence on interventions must take what into account?
Potential risk of injury or pain If benefit will outweigh the risks Cost including financial, resources, time Patient confidence in providers Belief in value of scientific evidence
Was the assignment of patients to treatments randomized
What is the best?
methods
Centralized computer randomization is the best
Were the groups similar at the start of the trial
results
Aside from allocated treatment, were groups treated equally
methods
Were all the patients who entered the trial accounted for
results
Losses should be minimal - preferably less than 20%
Were measures objective/were patients and clinicians kept blind to which treatment was being received
methods
