OCS Chap 1 Flashcards
what is rational thinking
generating a hypothesis (abductive reasoning), collecting data (deductive, inductive or probabilistically) to make a conclusion w/ best available evidence
what is rationalization
starts w/ the answer then uses hypotheses and data that supports the answer with disregard for the data that do not (is a logical fallacy)
what is reasoning?
process of thinking about something in a logical manner
deductive reasoning
logic - attempts to use a reasoned approach to link all the components of evidence together in a linear fashion to prove that something is true beyond a reasonable doubt
inductive reasoning
collects disconnected pieces of evidence that increases the probability of something being true - never create absolute proof that something is true
abductive reasoning
used to generate and modify hypotheses
most common logical fallacies: post hoc ergo proper hoc and cum hoc ergo proper hoc
after this therefore because of this and with this therefore because of this
ad hominem
individual attacks somebody personally instead of discussing the problems w/ evidence
appeal to authority
individual will state that something is true because an authoritative source has said that it is true
straw man
somebody counter argues a point that a person has made by creating an argument to refute a point that the individual never made
appeal to ignorance
assumption that a statement must be true if it cannot be proved false
bandwagon
suggest because everybody else is doing it that it is the best way to do it
red herring
info that misleads the clinician or distracts the clinician from what is important
confirmation bias
clinician only uses evidence that supports their point of view and disregards the higher quality evidence with a low risk of bias that does not support their POV
hindsight bias
after events unfold, clinician treats the outcome as being predictable or foreseeable
anchoring bias
clinician is overly influenced by the first evidence they collect and the hypothesis it generates
false consensus bias
clinician overestimates how much his/her peers agree with their clinical approach
recall bias
tendency of a clinician to remember their favorable results and not remember the less than spectacular outcomes
scientific method
reasoning process that uses observational inductive reasoning to formulate questions
frequentist statistical methodology
traditional, most frequent use, makes several assumptions (sample reps population, statistical tools choice made before data collected, use p-value to accept or reject the null hypothesis, what is meaningful, reports the truth)
Bayesian Statistical Methodology
not one and done, iterative process that uses prior knowledge and outcomes to construct the probability of something being accurate or true (what the truth is probabilistically) - process most like the clinical reasoning process
EBP
process that starts by asking a clinically meaningful question, seeks to find the best available evidence that can be used to answer the question, combines the best available evidence in the context of the clinician’s clinical experience, and the values of the patient, and evaluates the efficacy of the process based on the pt’s response
interactive reasoning
deductive and/or inductive involves strategic communication to establish a therapeutic alliance w/ the patient
collaborative reasoning
deductive and/or inductive communicative process used to ensure that the clinician’s values and beliefs align w/ the pt’s values and beliefs
diagnostic reasoning
deductive - attempts to create a linear relationship between the pt’s activity/participation restrictions, physical impairments, pathology of body structures, pain mechanisms, personal factors, and environmental factors
musculoskeletal pain irritability
related to persistence of pain and the aggrav activities that produces a pt’s symptoms
narrative reasoning
inductive - gather info related to personal and environmental factors relevant to the pt
intervention procedures reasoning
deductive and/or inductive - includes the choice and execution of interventions that should help the pt if the hypothesis formulated is accurate
predictive reasoning
deductive and/or inductive - using musculoskeletal pain irritability and the response of the hypothesis testing through intervention during the first visit to establish a prognosis
pt edu reasoning
deductive and/or inductive - formulating diff ways to edu pt and ensuring that the edu was received
ethical reasoning
deductive and/or inductive - doing what is in the best interest of the pt given the best available info
Bayesian reasoning
application of probability theory to deductive and inductive reasoning
what causes errors in clinical reasoning
inadequate knowledge, faulty data gathering, faulty data processing, faulty metacognition, inability to recognize logically fallacious thinking and cognitive biases
therapeutic alliance
relationship between the PT and the pt that involves mutual agreement on clinical goals and the interventions that will be used to attain those goals
deductive errors related to diagnosis - premature closure clinic
clinician fails to consider other alternatives after initial dx is made
deductive errors related to diagnosis - framing effect
clinician may frame the question in the positive or negative related to the pt
deductive errors related to diagnosis - commission bias
somebody erroneously thinks that they need to use a specific intervention to make the pt feel better when they may likely just get better as a result of natural recovery
deductive errors related to diagnosis - extrapolation error
extend previous and occurring events into those that may arise in the future
deductive errors related to diagnosis - verification bias
results of a single diagnostic test keep the clinician from selecting a more accurate test
symptom modification approach
to reduce symptoms and to improve function using a variety of clinical approaches
3 mechanisms based sources of symptoms
central sensitization, peripheral neuropathic, nociceptive
nociplastic (central sensitization)
pain that is disproportionate, non mechanical, unpredictable and diffuse
nociplastic symptoms strong association w/
maladaptive behaviors related to presence of neg beliefs (fear-avoidance), lack of positive beliefs related to self-efficacy and dyskinetic movement related to kinesiophobia
peripheral neuropathic (radicular or referred)
symptoms that are referred in a dermatomal (radicular) or cutaneous (referred) distribution - have hx of nerve injury, pathology, or mechanical compromise of the nerve w/ symptom provocation w/ mechanical testing
nociceptive
symptoms that are localized to an area or injury or dysfunction, provocation and/or alleviation are clearly identifiable and proportionate, match known mechanical and anatomical distribuitions, symptoms are usually intermittent and start w/ the onset movement or mechanical provocation, and the quality of symptoms may be constant dull ache or throb at rest
novice clinical reasoning
use type 2 processing (process of analysis), hypothetico-deductive approach, have very few patterns to recognize, standardized and data driven, do not recognize that clinical reasoning is a collaborative process between the clinician and pt
experts clinical reasoning
use type 1 processing (involves snap judgements), rely on pattern recognition, use hypothetic-deductive approach w/ complex pts, reasoning is individualized to the pt and includes the context element related to pt-clinician interaction
metacognitive process
thinking about thinking through reflection
reflection on action
most often used by novice, clinical reasoning “on action” is the reflective metacognitive process on (what went well, what did not go well, what should be done in the future)
reflection in action
use by expert, clinical reasoning “in action” can recognize what is going well, what isn’t going well, and involves the ability to make on the spot corrections in real time
clinical questions should be formulated using PICO
P- patient or problem
I - intervention
C - comparison intervention
O - outcomes
PEDro scale
11 criteria (1st criteria related to presence of inclusion and exclusion criteria in the study’s external validity. 2-11 used to determine the internal validity of the study) 6 or greater for criteria 2-11 is required to determine if the study has respectable level of internal validity
sensitivity
SnNout - a test with high sensitivity that is negative helps to rule out
Specificity
SpPin - high specificity that is positive helps to rule something in
likelihood ratio
test’s ability to modify the pretest probability of a dx being present or absent to the post test probability of a dx being present or absent
positive likelihood ratio
reflects the probability that a person who tests positive DOES have the disorder (>5)
negative likelihood ratio
reflects the probability that a person who tests negative really DOES NOT have the disorder (<.20)
common biases in diagnostic studies - sampling bias
only screened participants that were thought to meet inclusion/exclusion criteria instead of screening all potential participants with the condition
common biases in diagnostic studies - verification bias
when not all participants are assessed by the reference standard in the same fashion (can lead to overestimation of accuracy)
common biases in diagnostic studies - incorporation bias
reference standard is included in the diagnostic test being studied
common biases in diagnostic studies - spectrum bias
participants are not representative of the population in which the test is likely to be used
prognosis
predicted level of function that the pt will attain within a specific timeframe
what is clinical reasoning
reflective process of inquiry and analysis carried out by a health professional in collaboration with pt with the aim of understanding the pt, their context, and their clinical problems in order to guide EBP
