MMD Exam 1 Lecture Flashcards
treatment threshold is determined by _____ probability and _____ ______
pretest, likelihood ratios
a ____ _____ is useful if it can distinguish between diagnoses that mimic each other which moves the clinician closer to the treatment threshold
diagnostic test
the following are stats for a ____ test
- pretest and posttest probability
- sensitivity and specificity
- positive and negative likelihood ratios
“good”
1st step in the decision-making process or creating your “hypothesis”
based on a combo of:
– Prevalence rates
– History & MOI
– Results of any prior work-up – Clinician’s experience
pretest probability
____ _____ is the “truth”; the diagnostic test that best identifies a specific condition (ex. arthroscopic findings for ACL tear)
reference standard
(ideal/poor) study: blind, prospective with a consecutive group of subjects subjected of having the target dx
ideal
sensitivity is the true ____ rate
positive - the tests ability to detect those who actually have a disorder as indicated by the reference standard
high sensitivity = few false negatives
sensitivity or specificity? negative result rules out condition
sensitivity (SnNOUT)
sensitivity or specificity? positive result rules in condition
specificity (SPIN)
specificity is the true ____ rate
negative - the tests ability to detect those who actually do NOT have a disorder as indicated by the reference standard
high specificity = few false positives
_____ _____ express the change in odds favoring the disorder given a positive or negative test
likelihood ratios
likelihood ratios: large positive LR (>5)
(increases/decreases) odds favoring diagnosis given positive test
helpful for ruling (in/out) condition
increases, in
likelihood ratios: small negative LR (<0.3)
(increases/decreases) odds favoring diagnosis given negative test
helpful for ruling (in/out) condition
decreases, out
_____ _____ _____ are tools used by clinicians to determine the likelihood a patient is presenting with a certain disease based on certain variables; and to identify patients most likely to benefit from specific treatment intervention
clinical prediction rules
T/F: most clinical prediction rules in PT practice are validated
false, NOT validated
must remain secondary to sound clinical judgement although they have the potential to improve outcomes, increase patient satisfaction, and decrease costs of care
what is the minimal critically important difference (MCID)?
the smallest change score associated with a patient’s perception of a change in health status; an important concept when looking at effect size and clinical relevance of research findings
interpreting “positive” trials:
if the lower boundary of the confidence interval (the end that suggests the smallest benefit from treatment) is greater than the MCID, you can conclude the trial is a ____ positive trial
definitive
interpreting “positive” trials:
if the lower boundary of the confidence interval (the end that suggests the smallest benefit from treatment) is less than the MCID, you can conclude the trial is a ____ positive trial
trivial
the practice of evidence-based medicine means integrating what 3 things?
best research evidence, clinical expertise, and patient values
name pitfalls in making clinical decisions based on “tradition and authority”
tradition: “that’s how they taught me to treat x in PT school”
authority: power of persuasion by flashy techniques/doctors
what is the chief virtue of the scientific method?
reduction of bias
____: justifications for treatment based on basic or applied work designed to answer the question of why something should work
theory
_____: justifications for treatment based on applied work (on patients) designed to answer the question of if something works
evidence
_____: the term that names the primary dysfunction which directs treatment
PT diagnosis
T/F: the PT diagnosis is all about probabilities and limiting uncertainty
true
pretest probability (baseline) and post-test probability (application of diagnostic test alters baseline probability a patient has a certain condition)
the instant realization that the patient conforms to a previously learned pattern of disease; usually reflexive not reflective (observing scoliosis)
pattern recognition
the formulation from the earliest clues of a “short list” of potential diagnoses
- subsequent tests are performed which will most likely reduce the length of the list
- requires an understanding of probability (zebras versus horses)
hypothetico-deductive method
match the following approaches: exhaustive or hypothesis-driven
A. bold hypotheses are proposed and then exposed to severe criticism; requires understanding of confirmatory/disconfirmatory tests
B. empty the mind of all preconveived notions; watch nature in action; draw conclusions after all facts are in
A. hypothesis-driven
B. exhaustive
the effectiveness of a hypothesis-driven approach hinges on:
appropriate selection and interpretation of diagnostic tests
remember - every element of the history and physical exam should be considered & clinicians must appraise the literature regarding diagnostic tests
name 4 prognostic factors
demographic, individual patient behaviors, disease-specific, co-morbidities
rank the 5 levels of evidence
- RCTs
- cohort studies
- case-control studies
- case-series
- expert opinion
strong/grade A evidence vs. moderate/grade B evidence
one or more level 1 systematic reviews = strong
one or more level 2 systematic reviews or a preponderance of level 3 systematic reviews = moderate
be familiar with the following terms regarding outcome measures:
MDC
Test-retest Reliability
Content Validity
Responsiveness to change
MDC - minimal detectable change outside of measurement error
Test-retest Reliability - consistency of results when repeated
Content Validity - testing what it intends to test
Responsiveness to change - detect change over time
biomedical approach to patient care assumes:
all pain has a distinct physiologic cause and clinicials should be able to find and treat that physiologic problem
the biomedical model is not supported with
chronic pain
pathology but no sxs
cognitive-behavioral factors and patient expectations are strongly associated with patient ____ and pain _____
prognosis, outcomes
the biopsychosocial model is particularly useful for treating patients with ___ pain
chronic
the biopsychosocial model begins with ___, second is ____, and followed by ___ and ___ ____
nocioception, pain, suffering, pain behavior
nocioception vs. pain
encoding of damaging or potentially harmful noxious stimuli vs. unpleasant sensory and emotional experience associated with actual or potential tissue damage
T/F: sensitivity of nociceptors to painful stimuli is modifiable
true, increases or decreases in response to peripherally applied mechanical, thermal, or chemical stimuli
the following are characteristics of ____ ______:
- increases in random firing of nociceptors, responseness, and receptive field size
- increased responsiveness of nociceptive neurons to normal input
- activation with subthreshold input and silent nociceptors
- occurs within nociceptors receptive field
- basis for primary hyperalgesia
peripheral sensitization
