L2 CPG

Question 1

Purpose of systemic review

Answer 1

secondary research study to summarize the evidence on a specific topic

can review interventions, diagnostic tests, outcome measures, or prognostic factors

should be done apriori

Question 2

Types of reviews

Answer 2

narrative
systemic
metanalysis

Question 3

Purpose of CPGs

Answer 3

systemically developed statements designed to facilitate evidence-based decision-making for the management of specific health conditions

includes explicit recommendations for decisions

can be broader than SR, address multiple aspects of care, associated with health condition

Question 4

General info about SR

Answer 4

1. Summarize existing research evidence
2. Results in meta, quantitative, qualitative analysis
3. shorter length
4. peer-reviewed
5. rarely grant funded

Question 5

CPG general info

Answer 5

1. summarize evidence and make recommendations for best clinical practice
2. experts interpret the research and provide when research evidence is lacking
3. can be very large documents
4. peer-reviewed AND feedback from stakeholders
5. funded by government or professionals

Question 6

What is a CDR?

Answer 6

prediction tool, uses an explicit set of criteria about pt to direct treatment choice, combines effects of treatment effect modifiers, represented as classification tree

Question 7

Steps for Appraising Systematic Reviews

Answer 7

1. Determine the applicability
2. Determine the quality
3. Interpret the results
4. Summarize the clinical bottom line

Question 8

Vote-counting analysis

Answer 8

descriptive statistics
can be used for qualitative or quantitative studies

methods to report SR

Question 9

Mean difference

Answer 9

also called effect size
difference between treatment and control groups

Question 10

Standardized mean difference

Answer 10

used if units of measurements are different

Question 11

Forest plots

Answer 11

visual representation of a meta-analysis

Question 12

What is the objective of using a CPG as a PT?

Answer 12

enable PTs and PTAs to understand the state of evidence in an effort to decrease unwarranted variations in practice, minimize gap from evidence to practice, optimize movement

Question 13

What are the qualities of an OPTIMAL CPG?

Answer 13

Applicability
Quality
Clinical Utility

Question 14

Methodology for CPG

Answer 14

Literature search
Screen Abstract
Screen full text
Appraisal and extraction
Results in master spreadsheet
Create Evidence Table
Synthesize/write recommendation

Question 15

“should be provided”

Answer 15

weight of the evidence supports substantial benefit as compared to other or conventional strategies

benefit outweighs harm

Question 16

“may be considered”

Answer 16

evidence to support intervention vs other strategies is unclear or evidence supports intervention as compared to no intervention

benefit and harm would be equal

Question 17

“should not be provided”

Answer 17

weight of the evidence does not indicate a substantial benefit above other strategies

harm outweighs benefit

Question 18

Meta-analysis

Answer 18

statistical technique that combines quantitative outcomes across multiple primary studies

Question 19

Narrative reviews

Answer 19

overview of literature
description of content of articles
helps provide general info about topic and express a perspective
subject to bias

Question 20

Appraise the quality of a SR

Answer 20

Cochrane Review
Literature search was comprehensive
Was an objective, reproducible and reliable method used to judge the quality of studies?
Standardized method used to extract data?
Clinical heterogeneity for meta-analysis?

Question 21

Clinical heterogenity

Answer 21

measures if the study population, interventions, and outcome measures were similar amongst studies

Question 22

What methods were used to report the SR?

Answer 22

Vote counting analysis
Meta-analysis

Question 23

What characteristics should you consider when looking over CPGs?

Answer 23

age of study
sponsoring organization
topic
clarity of info
depth
availability of full text

Question 24

Process of writing CPG

Answer 24

comprehensive search of numerous databases
PICO question
Appraisal of articles
Extraction of data
grading levels of evidence
inclusion and exclusion criteria
includes clinical expertise, pt perspective

Question 25

Appraising the quality of CPG

Answer 25

stakeholder involvement
Rigor of development (SR should be written for each question)

Question 26

Stakeholder involvement in CPG

Answer 26

risk of bias depending on authors and topic
ensure authors are from a broad range of interest groups
pts views and target users of CPG should be clearly defined

Question 27

Master spreadsheet

Answer 27

all appraisals and extraction data entered
one master sheet per intervention

Question 28

Evidence table

Answer 28

summary of available data per intervention
discussion to minimize bias, achieve consensus

Question 29

Applying CPG

Answer 29

CPG development is an evidence-based method of systematically searching, selecting, appraising, and summarizing evidence

it is ok if patient doesn’t match every criteria, but focus on what is safe & applicable for your patient