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KIN 424 - Medical Aspects of Sport > Module 1 - Evidence Based Sport Medicine > Flashcards

Module 1 - Evidence Based Sport Medicine Flashcards

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1
Q

What are Randomized Control Trials?

A
  • Randomly Assigned 2 groups
  • One gets intervention, other gets SHAM
  • Control for Confounding Variables
  • Equal distribution between the groups
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2
Q

What are confounding variables?

A
  • Alternate explanation for an observation
  • Must be associated with the exposure and the outcome of interest
  • Must not be on causal pathway
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3
Q

What are Case-Control Studies?

A
  • Starts with group of cases
  • Look back at history to identify exposures that lead to outcomes
  • Compare control and cases to identify unique exposure
  • Retrospective
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4
Q

When are Case-Control Studies most useful?

A
  • Great for rare diseases
  • Best for rare outcomes
  • best for multiple exposures
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5
Q

Why are Case-Control Studies useful? Why arent they?

A

Useful
- Fast and Cheap
Not Useful
- Weak Evidence

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6
Q

Describe Cohort Studies

A
  • Start with Exposure of Interest
  • Find Analogous Group with no exposure
  • Look Forward, to see what outcomes emerge
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7
Q

When are cohort studies used?

A
  • Rare Exposures
  • Multiple Outcomes
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8
Q

Why are Cohort Studies used? Why not used?

A

Used
- Good Strong Evidence
Not USed
- Slow and Expensive

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9
Q

What is Sensitivity?

A
  • All the people who are positive for disease that test positive
  • True Positive
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10
Q

What is Specificity?

A
  • All the people who are negative for a disease that test negative
  • True Negative
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11
Q

What is Selection Bias?

A
  • Error in choosing the individuals or groups to take part in the research
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12
Q

What is Measurement Bias?

A
  • Poorly measuring the desired outcome (e.g. Calibration)
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13
Q

What is Interviewer Bias?

A
  • Opinion/Prejudice/Influence on part of interviewer
  • Affects the outcome of research
  • May affect interviewees behaviour
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14
Q

What is Response Bias?

A
  • Individual preference/local practices determine subjects are recruited
  • More severe cases get sent to academic centres/research studies (thus recruitment comes from them)
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15
Q

What is Reporting Bias?

A
  • Selective reporting or suppression of information or findings (ie. publication bias against negative studies)
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16
Q

Why is Evidence-Based Practice/Medicine important?

A
  • relies on scientific evidence for guidance and decision-making
  • Do not rely on Tradition, Intuition, Unproven Methods
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17
Q

What are the levels of Evidence-Based on Study Design?

A
  • 1a. Systematic Review of Randomized Control Trials
  • 1b. Individual RCT (narrow confidence intervals)
  • 2a. Systematic Review of cohort studies
  • 2b. Individual Cohort Study
  • 2c. “outcome” Research, Ecological Studies
  • 3a. Systematic Review of case-control studies
  • 3b. Individual Case-control study
    1. Case-series
    1. Expert Opinion
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18
Q

What are all Studies categorized into?

A
  • Descriptive
  • Analytic
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19
Q

What are the two types of Descriptive Studies?

A
  • Survey
  • Qualitative (interview/questionnaire)
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20
Q

What are the two types of Analytic Studies?

A
  • Experimental
  • Observational Analytic
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21
Q

What are the two types of Experimental Studies?

A
  • Randomized Parallel Groups
  • Randomized Crossover
22
Q

What are the 3 types of Observational Analytic Studies?

A
  • Cohort Study
  • Cross-sectional
  • Case-control study
23
Q

What does PICO Stand for?

A

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

24
Q

Describe the P in PICO

A

Patient
- Sex, gender, age, race
- Primary complaint
- disease History

25
Q

Describe the I in PICO

A

Intervention
- What do you want to do for them?
- Prescribe a drug?
- Order a test?

26
Q

Describe the C in PICO

A

Comparison
- To what alternatives do you want to compare the intervention?

27
Q

Describe the O in PICO

A

Outcome
- What do you hope to accomplish, improve or affect?
- Relieve or reduce symptoms?
- Improve Function or Improve Test Scores?

28
Q

What are the first questions to ask when identifying the aim of the study?

A
  • Does it describe a population? = descriptive
  • Does it quantify the relationship between factors? = Analytic
29
Q

What question do you ask if the study is analytic?

A

Was the intervention randomly allocated?
- Yes = Randomized control trial
- No = Observational Study

30
Q

How are Observational Types determined?

A
  • Ask when the outcomes were determined
31
Q

How does the outcome timing determine the observational study types?

A
  • After exposure: Cohort Study
  • At the same time as exposure: Cross-sectional Study
  • Before Exposure was determined: Case-Control Study
32
Q

What are the advantages of a Randomized Control Trial?

A
  • Unbiased Distribution of Confounders
  • Blinding More Likely
  • Randomisation Facilitates Statistical Analysis
33
Q

What are the Disadvantages of a Randomized Control Trial?

A
  • Expensive: time and money
  • Volunteer Bias
  • Ethically problematic at times
34
Q

What are the advantages of a Crossover Design?

A
  • All subjects serve as their own controls and error variance is reduced thus reducing the sample size needed
  • All subjects receive treatment (at least some of the time)
  • Blinding can be maintained
35
Q

What is a crossover design?

A
  • Each study participant has both therapies
  • Randomized treatment to Group A first, then to Group B later
  • Only relevant if the outcome is reversible with time
36
Q

What are the disadvantages of a Crossover Design?

A
  • All subjects receive a placebo or alternate treatment at some point
  • Washout period lengthy or unknown
  • Cannot be used for treatment with permanent effects
37
Q

What are the advantages of a case-control study?

A
  • Quick and Cheap
  • Only Feasible Method for very rare disorders with long lag between exposure and outcome
  • Fewer subjects needed than cross-sectional studies
38
Q

What are the disadvantages of a case-control study?

A
  • Reliance on recall or records to determine exposure status
  • Confounders
  • Selection of control groups is difficult
  • Potential bias: recall and selection
39
Q

What are the advantages of Cohort Studies?

A
  • Ethically Safe
  • Subjects can be matched
  • Can Establish timing and directionality of events
  • Eligibility criteria and outcome assessment can be standardised
  • Administratively easier and cheaper than RCT
40
Q

What are the disadvantages of a cohort study?

A
  • Controls may be difficult to identify
  • Exposure may be linked to a hidden confounder
  • Blinding is difficult
  • Randomisation not present
  • For rare disease, large sample sizes or long follow-u necessary
41
Q

What is a True Positive?

A
  • Sick people correctly diagnosed as sick
42
Q

What are false positives?

A
  • Healthy people incorrectly identified as sick
43
Q

What are true negatives?

A
  • Healthy people are correctly identified as healthy
44
Q

What are False Negatives?

A
  • Sick People incorrectly identified as healthy
45
Q

What is the equation for identifying Sensitivity in a test?

A
  • True Positive / All cases of the condition (true positive + false neg)
46
Q

What is the equation for identifying specificity in a test?

A
  • True Negative / All non-cases of the condition (true neg + false positive)
47
Q

What does the term SPIN and SNOUT mean?

A

SPIN
- SPecific rules IN
SNOUT
- SeNsitive rules OUT

48
Q

What are tests with high sensitivity good for? example?

A

Good for:
- ruling condition out
Example
- Bone Scan for Stress Fracture
- Negative bone scan = confident that no fracture

49
Q

What are tests with high specificity used for? example?

A

Used for
- Ruling conditions out
Examples
- CT scan for a stress fracture
- Positive CT scan = confident of fracture

50
Q

What are Surrogate Outcomes? examples?

A
  • Laboratory Measure/physical intended as a substitute for a clinically meaningful endpoint
  • Changes to surrogate endpoint = reflect changes in a clinically meaningful endpoint
    ex
  • Blood pressure change
51
Q

What are Clinically Meaningful Endpoints? example?

A
  • Direct measure of how an individual feels, functions, or survives
    ex.
  • Reduction in pain

KIN 424 - Medical Aspects of Sport (11 decks)

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