Research and Critical Appraisal

Question 1

What does PICO stand for?

Answer 1

Population
Intervention/Issue
Comparison
Outcome
Time

Question 2

What are the types of clinical questions that may be asked?

Answer 2

• most appropriate assessment for client group
• treatment effectiveness
• cost
• client experiences and concerns
• likely course of disability/disease

Question 3

List population factors as part of the PICO

Answer 3

age group, diagnosis, geographic location, gender

Question 4

What is the issue in the PICO? What are some common issues?

Answer 4

what the population is exposed to.

Intervention, test/assessment and predictor of interest

Question 5

What are some comparisons used in the PICO?

Answer 5

alternative intervention gold standard measure or nothing

Question 6

What are some outcomes in the PICO?

Answer 6

reduction in symptoms measurement in impairment improved quality of life reduced number of deaths, reduced costs and improved service delivery

Question 7

What does time mean when used in the PICO?

Answer 7

over what time period is of interest

Question 8

List the boolean operators and what they do

Answer 8

AND - gives results with both subjects limiting the field
OR - gives results about variants of a PICO element broadening results obtained
NOT - prohibits irrelevant results coming up

Question 9

What is the process of acquiring evidence?

Answer 9

• begin with clearly defined clinical question
• conducting comprehensive and efficient searches using the PICO
• searching in the right places
• choosing the right evidence and right research design

Question 10

What are the two main sources of evidence?

Answer 10

• filtered: already appraised resources

- unfiltered: sources not appraised

Question 11

List filtered sources of evidence

Answer 11

Cochrane library, OT seeker, clinical guidelines, PEDro, Trip etc.

Question 12

List unfiltered sources of evidence

Answer 12

CINAHL, Medine and PsychInfo

Question 13

What are some filtered research designs?

Answer 13

systematic reviews, critically appraised topics and critically appraised individual articles

Question 14

What are some unfiltered research designs?

Answer 14

randomized control trials, cohort studies, case series/reports and case-controlled studies

Question 15

What are the types of research designs?

Answer 15

systematic reviews, critically appraised topic, randomized control trials, cohort study, case-control and cross-sectional study

Question 16

What is a systematic review?

Answer 16

an article in which the authors have systematically searched for, appraised and summarized all of the medical literature for a specific topic.

Question 17

What is considered the best research design?

Answer 17

systematic reviews

Question 18

What is a critically appraised topic?

Answer 18

a short summary of an article from the literature to answer a specific clinical question

Question 19

What is a randomized control trial?

Answer 19

a group of patients is randomized into experimental groups and are followed up for variables/outcomes of interest

Question 20

What research design is considered the ‘gold standard’ of trials?

Answer 20

Randomized Control Trials

Question 21

What is a cohort study?

Answer 21

Includes the identification of two groups of patients - one receives the exposure of interest, the other does not. Cohorts are followed to obtain the outcome of interest

Question 22

What is a case-control study?

Answer 22

identifying patients who have the outcome of interest and control patients without the outcome and looking to see if they had the exposure of interest

Question 23

What is a cross-sectional study?

Answer 23

sample population at some point in time and determine factors associated with outcome by measuring them to see who has the outcome or comparing between the established test and new test.

Question 24

What is quantitative research?

Answer 24

provides numerical results and statistics to support or refute a hypothesis to focus on absolute or relative probabilities of events occurring.

Question 25

What is qualitative research?

Answer 25

provides word data, themes and theories to provide a detailed description of beliefs knowledge or experiences. Gains insider's view into the situation and thus tend to be more indicative than defined and confirmatory.

Question 26

What may quantitative research be used to determine?

Answer 26

- intervention effectiveness - diagosis - prognosis - causation

Question 27

What are typical qualitative research designs?

Answer 27

systematic reviews, randomized control trials and cohort studies

Question 28

What may qualitative research be used for?

Answer 28

understanding meaning, experiences and other phenomena

Question 29

What are typical qualitative research designs?

Answer 29

grounded theory, ethnography and phenomenological

Question 30

What research design would be useful in determining the effectiveness of an intervention?

Answer 30

Randomized Control Trial

Question 31

What research design would be useful in diagnostic screening?

Answer 31

cohort study where all subjects receive the study test and gold standard test to assess the accuracy of the test. RCT to assess effect of test on health outcomes

Question 32

What research design would be useful in determining prognosis?

Answer 32

longitudinal cohort study

Question 33

What research designs would be useful in determining aetiology and risk factors?

Answer 33

- RCT - cohort for rare exposure with common outcomes - case-control for rare exposure with outcomes with common exposure

Question 34

Why does using the right study design matter?

Answer 34

The way in which people are selected to be in a study, measurements that are taken about people and what happens to them while in the study will determine the results' applicability to the clinical question.

Question 35

What is bias?

Answer 35

tendency to favor one outcome over another

Question 36

What is systematic error?

Answer 36

Any process occurring at any stage of an investigation tending to produce results which depart systematically from the true values

Question 37

What are the different types of bias?

Answer 37

- allocation bias: inclusion of study objects - measurement bias: during taking a measurement or recording of info - blinding bias: does the conductor know the variables? - confounding bias - other factors i.e. medications used at the time

Question 38

What is the I level of evidence?

Answer 38

a systematic review of all relevant RCTs

Question 39

What level of evidence has the least bias?

Answer 39

a systematic review of all relevant RCTs (level I)

Question 40

What is the II level of evidence?

Answer 40

properly designed RCT

Question 41

What is the III - 1 level of evidence?

Answer 41

Pseudo-randomized control trial

Question 42

What is the III - 2 level of evidence?

Answer 42

comparative studies with allocation not randomised , cohort studies and case-control studies

Question 43

What is the III - 3 level of evidence?

Answer 43

comparative studies with historical control, interrupted time series with no results

Question 44

What is the IV level of evidence?

Answer 44

case series, post-test or pre/post-test

Question 45

What are the 3 questions to ask when looking at the research?

Answer 45

1) What was the research question and why was the study needed? 2) What was the research design? 3) Was the research design appropriate to answer the research question

Question 46

What is critical appraisal?

Answer 46

The process of carefully and systematically examining research to judge its trustworthiness ad its value and relevance in a particular context

Question 47

What are the principles of critical appraisal?

Answer 47

understand - components that relate to quality of a study - bias and types of bias - gain experience in assessment of quality of a health promotion or public health study - provides a rationale or justification of decisions

Question 48

What is a study with minimal bias said to have?

Answer 48

internal validity

Question 49

What is validity?

Answer 49

The degree to which a result from a study is likely to be true and free from bias

Question 50

What is internal validity?

Answer 50

The extent to which the observed effects are true for people in a study

Question 51

What can influence the level of bias in a study?

Answer 51

- data collection methods | - withdrawals and drop-outs

Question 52

What is external validity?

Answer 52

generalisability and applicability of the evidence

Question 53

What results should be considered for external validity?

Answer 53

results from an internally valid study

Question 54

What does appraising the methodological quality of evidence include?

Answer 54

- consider how the study has been designed: sample size, blinding, bias, randomization and controlling for confounding factors

Question 55

Explain the difference between level of evidence and quality of evidence.

Answer 55

- Level of evidence: about the design of the study determined using an evidence hierarchy - Quality of evidence: how well the individual study was conducted determined by your critical appraisal of it.

Question 56

What should the introduction in a reliability paper include?

Answer 56

describing the measurement, procedure under investigation and its relevance to clinical practice. Should briefly outline what is known from previous studies about instrument's reliability and should justify the importance of the study

Question 57

What are the three issues of samples?

Answer 57

patient characteristics, assessor characteristics and sample size

Question 58

What must participants in a study be?

Answer 58

- heterogenous on the variable being measured

Question 59

What are the negative factors of homogeous samples?

Answer 59

little participant variation produces lower reliability which may lead to incorrect conclusions