Quiz 4 Flashcards
1) What are clinical prediction guides/rules?
1A) An example of a clinical prediction guide?
2) What are clinical practice guidelines?
3) Big difference between these 2
4) Pros and Cons of clinical practice guidelines
5) The grading system of levels of evidence are:
1) Mathematical tools that are intended to guide clinicians in their everyday decision making. Developed from a cluster of exam findings or characteristics and may assist in the evaluative or treatment phase of patient care … helps clinicians make a diagnosis.
1A) Ottowa Ankle Rules … pts with a lateral ankle sprain will go through a test to determine if they have an ankle sprain or not (to help know if they need to get a radiograph or not).
2) General industry wide statements to assist the practitioner and patient decisions about appropriate health care. They are large general statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options.
3) The guidelines are developed by a team of clinicians and scholars after extensive review of literature and research (rather than from a single investigation), so they are more generally accepted and comprehensive. The guidelines are general and broadly applicable to clinicians and they make statements based on evidence and provide recommendations based on literature and research for patient care.
4)
- Pros: very useful, based on evidence, broadly accepted, are a great quick reference for clinical decisions/treatment
- Cons: just cause they are broadly accepted may not mean they are best for each patient
5)
- Grade A: Highest levels of evidence (systematic reviews of RCT’s are 1a … RCT’s are 1b)
- Grade B: Derived from pt cohort studies (systematic reviews of cohort studies are 2a, individual cohort studies are 2b)
- Grade C: Lower quality case-control
- Grade D: Case reports, Expert opinions, logical applications
Review …
1) What is an outcome measure
3) What is Regression Analysis
4) What is the Fear Avoidance Beliefs Questionnaire
5) What are predictor variables
1) An outcome measure is the RESULT of a test or intervention that is used to objectively determine the baseline function of a patient at the beginning of treatment. Once treatment has commenced, the same instrument can be used to DETERMINE PROGRESS and treatment efficacy.
3) In statistical modeling, regression analysis is a set of statistical processes for estimating the relationships (CORRELATION) among variables. … Regression analysis is also used to understand which among the independent variables are related to the dependent variable, and to explore the forms of these relationships.
4) The FABQ measures patients’ fear of pain and consequent avoidance of physical activity because of their fear. This questionnaire consists of 16 items, with each item scored from 0-6. … A strong relationship exists between elevated fear avoidance beliefs and chronic disability secondary to LBP.
5) A predictor variable is a variable used in regression to predict another variable. It is sometimes referred to as an independent variable if it is manipulated rather than just measured.
Key points from Chapter 17:
- Clinical prediction guides are formed from a cluster of exam findings and may HELP with FORMING A DIAGNOSIS or the treatment of a pt
- POSITION STATEMENTS are often clinical practice guidelines developed to improve health care practice
- Implementation of clinical practice guidelines can be hindered by factors including organizational rules, availability of proper resources, and tradition
- The goal of clinical practice guidelines is to combine the best evidence and provide the most useful recommendations for the patient care.
- Clinical practice guidelines should be regularily updated in order to reflect the best evidence to date
- Clinical prediction guides can help with identifying a problem when a single examination does not provide results.
- Clinical prediction guides can be used to help determine the need for referral for radiographic examination and other diagnostic work-up.
- Clinical practice guidelines are professional edicts developed by a team of clinician-scholars
- While clinical practice guidelines are valuable resources, the practice of evidence based care calls for the integration of patients values and clinician experience into clinical decision making. Thus, a patient’s values and preferences must be taken into consideration when deciding the appropriate course of action.
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What is a systematic review:
A high-quality systematic review is described as the most reliable source of evidence to guide clinical practice. The purpose of a systematic review is to deliver a meticulous summary of all the available primary research in response to a research question.
A research process where the researchers identify previous studies that address a particular question, summarize findings, and when possible collapse data for meta-analysis (a process where statistical analysis is performed on data combined from multiple studies).
*** A systematic review provides the clinician with results compiled from multiple clinical trials in a single document, sometimes with the effect of defining the best current practice.
*** Systematic reviews are used to provide clinicians with the most well-supported evidence of solutions to clinical problems.
*** And systematic reviews increases your sample size, which adds validity, statistical significance, etc. That is why it is at the top of the hierarchy of evidence.
1) Hierarchy of Evidence:
2) Why are systematic reviews so good?
3) Clinicians seeking to have a EBP faces 2 significant obstacles:
1)
- Systematic reviews and meta analysis
- RCT’s
- Cohort studies
- Case controlled studies
- Case reports
- Ideas, editorials, opinions
- Animal research
2) Because clinicians have little time. We can’t read 100 articles on a certain topic, and of those 100 articles, there is different results and conclusions. So a systematic review summarizes all of that for us to see if there is statistical significance across multiple studies for an intervention, etc.
3)
1) Every patient is different
2) There is SO much info and research, it’s hard to synthesize it all or have time to read it all.
1) What is meta-analysis:
2) What is data synthesis:
3) Before doing a meta analysis or combining data from different studies, what do you need to make sure:
4) Can you do qualitative data analysis, or just quantitative?
5) T or F: Systems reviews are always done with meta-analysis?
6) T or F: Because systematic reviews is a research process, the research methods impact the validity of the data and the conclusions drawn?
1) A process where statistical analysis is performed on data from a combined or many systematic reviews or studies.
A subset of systematic reviews; a method for systematically combining pertinent qualitative and quantitative study data from several selected studies to develop a single conclusion that has greater statistical power. This conclusion is statistically stronger than the analysis of any single study, due to increased numbers of subjects, greater diversity among subjects, or accumulated effects and results.
*** Data from studies using SIMILAR research methods and measurements can be combined through meta-analysis.
2) Data Synthesis: process through which data from multiple studies are combined. Data from studies using similar research methods and measurements can be combined through meta-analysis. This increases the sample size essentially, thus giving more statistical power and narrowing confidence intervals.
3) Make sure it studies similar questions, the participants are similar, methods were similar, units of measurement were similar … same parameters for each study.
4) Both
5) False. The can include meta-analysis, or not
6) TRUE
What is the difference between traditional LITERATURE review and systematic review?
Basically a systematic review starts with a question and follows a formal process. Traditional reviews typically don’t have a clear methodological approach with subjective summaries (maybe from a biased author/expert).
** A literature review is often limited because it supports a position taken by the author, whereas a systematic review begins with an answerable question and works through a planned process.
What 3 things need to be factored in to your clinical decision?
1) Evidence / research
2) Clinical experience
3) Patient’s preferences
