L9 Evidence Based Practices

Question 1

What feeds into clinical decision making?

Answer 1

Best available research evidence
Patients values and preferences
Clinical expertise
- Synthesizer
- Researcher
- Clinician
- Patient

Question 2

What is evidence based practice?

Answer 2

Integration of the best available research with clinical expertise in the context of the patient (Institute of Medicine, 2001)
Treatment that works based on the best available research
1. latest research
2. values and preferences as a patient
3. therapists clinical experience/expertise

Question 3

What is the effectiveness of psychological practices in the latest research?

Answer 3

Supported by a substantial body of evidence from diverse research designs and methodologies
Systematic reviews
Reasonable effect sizes
Statistical and clinical

Question 4

How do EPBB link to patient’s characteristics?

Answer 4

Most effective when responsive to the patient’s specific problems
Many patient characteristics are known to be related to therapeutic outcomes
Goal of EBPP is to maximise patient choice

Question 5

What is the importance of clinical expertise?

Answer 5

Integration:
- Objective - evidence with clinical data
- Context - patients preferences
- Outcome - deliver services with a high probability of achieving goals

Self-awareness - recognise limits of knowledge and skills
Consideration - address cognitive and affective heuristics
Understanding - recognise interaction of own characteristics, values, context

Question 6

What is the order of least biased to best biased practices?

Answer 6

Systematic reviews
Metanalysis
RCT’s
Cohort studies
Case control
Cross sectional studies
Case series and reports
Ideas, opinions, editorial, anecdotal

Question 7

What are RCT’s ?

Answer 7

Randomised control trials
Rigorous ways to determine cause-effect relation
- Random allocation to intervention groups
- Allocation concealment
- Blinded assessment
- Estimate the sizes of the difference on pre-specified outcomes between the intervention groups
- Power calculation
This is the only study to ensure that everyone stays on the same starting level

Question 8

What did Schulz 2000 find about the importance of randomisation?

Answer 8

Found much more positive test results when the intervention groups were not randomised
By eliminating cofounding variables there was a higher number of negative results

Question 9

What is the impact of inadequate allocation concealment (Schulz 1995)?

Answer 9

Methodological issues and exaggeration of odds ratio
- Inadequate allocation = larger by 41%
- Unclear treatment allocation = larger by 30%
- Trials not double blind = larger by 17%

Question 10

What are the pros and cons of RCT’s?

Answer 10

+ Only way to determine causal relationship between treatment and outcome
+ Only way to determine reliable effect sizes
+ Protect against bias
- Large numbers needed making it hard to recruit and expensive
- Ethical issues
- Translation to the real world? Less control in the real world

Question 11

What is a systematic review?

Answer 11

Attempts to identify, appraise and synthesise all the empirical evidence that meets pre-specified eligibility criteria
Use explicit methods aimed at minimising bias, in order to produce more reliable findings that can be used to inform decision making

Question 12

What are the Cochrane steps of the systematic reviews?

Answer 12

Identify relevant studies from a number of different sources
Selection of studies for inclusion and evaluation of their strengths and limitations on the bias of clear, predefined criteria
Systematic collection of data
Appropriate synthesis of data
They already do a quality check as part of the systematic review

Question 13

What is the PICO plan for operationalizing EBP?

Answer 13

Falzon 2010
Population = people with PTSD
Intervention = eye movement desensitisation and reprocessing
Comparison = Cognitive behavioural therapy
Outcome = Improvement in symptoms and prevention of disorder recurrence e.g. nightmares, concentration, irritability

Question 14

How do you operationalise EBP?

Answer 14

Collaborative practice:
- Goal setting
- Appraise options with young people
- Explaining treatment elements and options

Reflective practice:
- Therapeutic alliance feedback
- Review of progress and making decisions in light of this
- Interpreting outcomes to inform practice including taking info

Question 15

What is Gibbs’ 1988 reflective cycle model?

Answer 15

Description - Feelings - Evaluation - Analysis - Conclusion - Action plan - Description

Question 16

What are the outcomes of EBP?

Answer 16

Standardised measures:
- Valid, reliable
- Compare across studies in reviews/meta-analysis
When to measure:
- Baseline, post-treatment, follow-up
How to measure:
- Blind assessment crucial
- Employ someone unrelated to study
- Attrition
- Intention to treat

Question 17

What is the intention to treat?

Answer 17

Attrition bias - those dropping out
ITT = takes all outcomes into account
Ps are analysed according to their initial group allocation - regardless of whether completed, changed group or left study early

Question 18

How does outcomes inform practice in EBP?

Answer 18

Being focused from the outset on what you are trying to achieve and how you will measure success
Routinely evaluating any initiative whether is it based on existing evidence or whether it is a new approach
Weighing up costs and benefits
This does not mean: collecting lots of data with no clear plans for interpretation

Question 19

What are cofounding variables and how can you get over them?

Answer 19

Defined as variables correlate with both the DV and the IV
CV affect the variables being studied
Randomisation - This reduces potential for CV by generating groups that are comparable with respect to known and unknown CV

Question 20

What are the critiques of EBP in psychology/

Answer 20

It doesn’t eliminate all clinical judgement
It doesn’t prevent practitioners from administering unvalidated interventions
They can be modified or tailored to individual clients
EBP considers evidence from observational studies, quasi-experimental designs and well-designed within subject designs