Intro to Evidence Based Practice (8/30b)

Question 1

Evidence Based Medicine (EBM)

Answer 1

“The integration of best research evidence with clinical expertise and patient values”

Question 2

6S Model - Tiers bottom to top (6S Model)

Answer 2

Single studies
Synopses of studies
Syntheses
Synopses of syntheses
Summaries
Systems

Question 3

Examples of 6S Tiers (6S Model)

Answer 3

Single studies - original article published in journal

Synopses of studies - evidence based abstraction journal

Syntheses - systematic reviews (EX: cochrane library)

Synopses of syntheses - evidence based abstraction journals (EX: DARE, health-evidence.ca)

Summaries - clinical practice guidelines; evidence based textbooks

Systems - computerized decision support systems

Question 4

5 Single Study Designs (6S Model)

Answer 4

RCT
Cohort studies
Case control studies
Cross sectional studies
Case reports/studies

Question 5

Randomized Control Trials (RCTs) (6S Model)

Answer 5

Experimental – level 2

Participants are randomly assigned, experimental or control group

Question 6

Cohort study (6S Model)

Answer 6

Observational – level 3

Prospective-longitudinal, group of participants with similar condition followed over time (may be compared to a similar group without the condition)

Question 7

Case control (6S Model)

Answer 7

Observational – level 4

Retrospective, a comparison group is used

Question 8

Cross sectional studies (6S Model)

Answer 8

Observational – level 4

Population based, participants selected based on inclusion/exclusion criteria, investigator follows the study to assess exposure and outcomes at the same time

Question 9

Case studies (6S Model)

Answer 9

Descriptive – level 4

Single group followed

Question 10

Use ___ ___ to investigate diagnosis, prognosis, intervention (6S Model)

Answer 10

individual studies

Question 11

Best individual study designs to use when possible (6S Model)

Answer 11

cross-sectional studies, longitudinal studies, and experimental studies (RCT)

Question 12

Systematic Review (6S Model)

Answer 12

a review of existing studies that includes

A systematic/comprehensive/transparent search strategy, clear eligibility criteria and methodology, evaluation of individual study quality, ordered way to deal with lots of evidence, can also be very long

Results can be summarized via Forest plot

Question 13

Meta-Analysis (6S Model)

Answer 13

a statistical approach that pools data from multiple studies to estimate the overall“effect” of an intervention

Commonly associated with a systematic review, but not always

The effect is the magnitude of the differences found in the study, believed to be due to intervention

Question 14

Summaries (6S Model)

Answer 14

A peer-reviewed document written by a panel of experts that makes recommendations for treatment

Based on a systematic search & review of available evidence
Include ratings of the quality of the evidence and the strength of the recommendation

Level of evidence of individual articles used in CPG: Level I (high quality) through V

Grade of the evidence = overall strength of the evidence: “A” Strong evidence

Can be hundreds of pages long

Question 15

Examples of places to find evidence

Answer 15

—PT Now (APTA)

—RehabMeasures

—StrokeEngine

—PubMed

—Cochrane Database of Systematic reviews

—PEDRO (PT specific)

—Clinical Key

—NIH Toolbox

Question 16

Evidence Based Practice Steps (EBP Steps)

Answer 16

Ask
Acquire
Appraise
Apply
Adjust/Analyze

Question 17

Ask (EBP Steps)

Answer 17

Answerable clinical question formulated

Background questions - help understand the nature of the problem

Foreground questions - treatment, PICO questions

Can ask questions about Intervention, Diagnosis, Prognosis, Outcomes

Question 18

PICO Questions (EBP Steps)

Answer 18

P - Patient
I - Intervention
C - Comparison
O - Outcome

Question 19

Acquire (EBP Steps)

Answer 19

Systematic literature review

EX: Google scholar (broad, terminology) VS PubMed (refined, advanced)

Question 20

Appraise (EBP Steps)

Answer 20

Research evidence is critically analyzed

Question 21

Apply (EBP Steps)

Answer 21

Research is integrated with expertise and patient circumstances

Question 22

Adjust/Analyze (EBP Steps)

Answer 22

Steps evaluated

Question 23

Estimate error with Standard Error of Measurement (SEM) with 95% confidence interval (CI)

Answer 23

What range would I expect for the measurement 95% of the time?

Calculated value (from SD and reliability)

Expressed as 17.5° (14.5°, 20.5°)

Question 24

Minimal Detectable Change (MDC)

Answer 24

the minimum amount of change in a patient’s score that ensures the change isn’t the result of measurement error

Used to decide if change is beyond error

Calculated from SEM, calculated for a specific Pt type/group

Question 25

Minimal Clinically Important Difference (MCID)

Answer 25

a published value of change in an instrument that indicates the minimum amount of change required for your patient to feel a difference in the variable you are measuring

The smallest change that might be considered important to a clinician

At least MDC

Defined for a “population” or patient group

Question 26

Examples of resources on measurement tools

Answer 26

Rehab Measures

Center for Rehabilitation Outcomes Research (CROR) at Rehab Institute of Chicago

Question 27

What individual study to use for diagnosis

Answer 27

cross-sectional study

Question 28

What individual study to use for prognosis

Answer 28

cohort study

Question 29

What individual study to use for intervention

Answer 29

randomized control trial