Week 1

Question 1

Define absolute risk, categorical measure, ceiling & floor effect, confidence interval, and continuous measure

Answer 1

1. Absolute Risk: The probability of an event occurring in a specific group, often expressed as a proportion or percentage.
2. Categorical Measure: A variable measured in categories, such as gender, race, or yes/no responses.
3. Ceiling & Floor Effect: Phenomena where data points cluster at the highest or lowest possible scores, limiting the variability and interpretation of results.
4. Confidence Interval: A range of values that estimates a population parameter with a certain level of confidence, typically 95%.
5. Continuous Measure: A variable that can take on any value within a range, such as height, weight, or time.

Question 2

Define dichotomous measure, effect size, hazard ratio, inferential statistics, interarater reliability, and intrarater reliability

Answer 2

6. Dichotomous Measure: A variable with only two possible values, such as success/failure or yes/no.
7. Effect Size: A quantitative measure of the strength of a phenomenon, often used to assess the magnitude of treatment effects.
8. Hazard Ratio: A measure of the effect of an intervention on the time to an event, often used in survival analysis.
9. Inferential Statistics: Techniques used to make generalizations or predictions about a population based on sample data.
10. Interrater Reliability: The degree of agreement among different raters or observers measuring the same phenomenon.
11. Intrarater reliability: The consistency of measurements made by the same rater across multiple instances

Question 3

define mean, median, minimal detectable change, minimal clinically important difference, negative likelihood ratio, and nominal level of measurement

Answer 3

12. Mean: The arithmetic average of a set of numbers.
13. Median: The middle value in a data set when the numbers are arranged in order.
14. Minimal Detectable Change: The smallest change in a measurement that can be detected beyond measurement error.
15. Minimal Clinically Important Difference: The smallest change in a measurement that has a meaningful impact on a patient’s condition.
16. Negative Likelihood Ratio: The likelihood that a negative test result is seen in a patient with the condition versus one without it.
17. Nominal Level of Measurement: Data classified into distinct categories without any inherent order (e.g., colors, types).

Question 4

Define number needed to treat, odds ratio, ordinal level of measurement, positive likelihood ratio, power, and P-value

Answer 4

18. Number Needed to Treat: The number of patients that need to be treated to prevent one adverse event.
19. Odds Ratio: The odds of an event occurring in one group compared to another.
20. Ordinal Level of Measurement: Data classified into ordered categories, but the intervals between categories are not equal (e.g., ranking scales).
21. Positive Likelihood Ratio: The likelihood that a positive test result is seen in a patient with the condition versus one without it.
22. Power: The probability that a statistical test correctly rejects the null hypothesis (i.e., detects a true effect).
23. p-value: The probability of observing the test results under the assumption that the null hypothesis is true.

Question 5

Define relative risk, risk reduction, sensitivity, Specificity, and standard deviation

Answer 5

24. Relative Risk: The ratio of the probability of an event occurring in one group to the probability in another group.
25. Risk Reduction: The decrease in risk achieved by an intervention, often expressed as a percentage.
26. Sensitivity: The ability of a test to correctly identify those with the condition (true positive rate).
27. Specificity: The ability of a test to correctly identify those without the condition (true negative rate).
28. Standard Deviation: A measure of the amount of variation or dispersion in a set of values.

Question 6

Define type I error, type II error, validity, and variability

Answer 6

29. Type I Error: Incorrectly rejecting a true null hypothesis (false positive).
30. Type Il Error: Failing to reject a false null hypothesis (false negative).
31. Validity: The extent to which a test measures what it claims to measure.
32. Variability: The degree to which data points differ from each other and the mean.

Question 7

Explain ignorance vs ineptitude

Answer 7

• Ignorance: Limited understanding of relevant factors or knowledge gaps, historically addressed through scientific advancements (e.g., penicillin, evidence-based treatments).
• Ineptitude: Failure to apply existing knowledge appropriately. In modern times, this is a more pressing challenge than ignorance.

Question 8

Explain EBP

Answer 8

• Introduced to reduce ignorance by promoting clinical decisions based on rigorous scientific evidence.
• Numerous tools and resources now exist to support EBP, yet ineptitude persists in practice due to slow adoption of proven innovations.
• Evidence-Based Practice requires new skills of the clinician
• application of formal rules of evidence in evaluating the clinical literature.
• efficient literature searching

Understanding, and practicing, how best to put questions that arise in your practice into a searchable format is VERY important.

Question 9

Explain the diffusion of innovations

Answer 9

• Everett Rogers’ framework explains how innovations spread through perceptions, adopter characteristics, and contextual factors.
• Key perceptions include relative benefit, compatibility, complexity, trialability, and observability of innovations.

Future Focus:
* Emphasis on not just creating innovations but also accelerating their dissemination to overcome ineptitude.

Question 10

explain contextual barriers

Answer 10

• Challenges include decentralized clinical networks, traditionalist tendencies, and a lack of alignment between research outputs and clinical practice needs.
• Effective diffusion requires bridging the gap between research institutions and practitioners.

Question 11

What are the 5 personalities of innovation adopters

Answer 11

1. Innovators:
   
   • Enthusiastic about novelty and willing to take risks. Often the first to try new practices.
2. Early Adopters:
   
   • Opinion leaders who cross-pollinate ideas and advocate for change within their communities.
3. Early Majority:
   
   • More cautious, relying on personal trust and familiarity over scientific evidence to adopt changes.
4. Late Majority:
   
   • Risk-averse and adopt changes only when they are widely proven and accepted as the new norm.
5. Laggards:
   
   • Resistant to change, preferring traditional approaches and relying on personal experience.

Question 12

what are the steps to create searchable clinical questions?

Answer 12

1st: formulate an answerable clinical question

Clinical question -> search terms -> literature search -> appraise, apply, adjust

Question 13

What are clinical questions designed to do?

Answer 13

increase understanding about a situation or disease that is different than those used to facilitate clinical decisions.

Question 14

Define background questions and give examples

Answer 14

Background questions: ask for general knowledge
- Anatomic, physiologic, pathophysiologic nature of the problem
- Medical/surgical management

Example:
- How does heart failure reduce exercise capacity?
- What are the signs and symptoms of a Multiple Sclerosis exacerbation?

Question 15

Define foreground questions and give examples

Answer 15

foreground questions: ask for specific knowledge to inform clinical decisions
- are the “meat” of evidenced based PT practice
- help the PT make decisions about the specific management of the problem or issue
- need to be specific (but not too specific)

Purpose:
* Benefits/risks of particular treatments (intervention)
* Usefulness of diagnostic test
* Factors predicting future status (prognostic)
* Identify, classify, quantify a clinical measure
* Measurement of success (outcomes)

Question 16

Define PICO

Answer 16

• The PICO format is considered a widely known strategy for framing a “foreground” research question.
• Sackett et al. pointed out that breaking the question into four components will facilitate the identification of relevant information.

Foreground questions have 4 components:
1.“P” patient population
2.“I” Intervention
3.“C” Comparison (sometimes)
4.“O” Outcome

Question 17

Explain intervention questions

Answer 17

What the physical therapist does to
produce a change in the patient.
– Focus on benefits or risks of treatment
– Identify which treatment approach will produce the desired effect in a manner consistent with the patient’s preferences and values.

Question 18

What is the type of question in this scenario:
A 7 year old boy with diplegia is coming up on your schedule. You want to know if prolonged supported standing is a more effective treatment for restoring core trunk stability than reaching activities?

Answer 18

intervention question

Searchable question:
P: in children with cerebral palsy
I: is supported standing
C: better than exercise
O: for improving strength

Question 19

Explain diagnosis questions

Answer 19

Physical therapist labels or classifies
a patient’s problem or need.
– Want to know which tests provides the most accurate, timely information
– Tests used during the Examination provide the data for the diagnostic process

Question 20

What is the type of question in this scenario:
A 35 y/o male tennis player presents to your clinic with shoulder pain. You want to know the value of the Neer’s test in detecting rotator cuff impingement.

Answer 20

Diagnosis question

Searchable question:
P: in adult tennis players with shoulder pain
I: is the Neer’s test useful to diagnose
C:
O: rotator cuff impingement?

Question 21

Explain prognosis questions

Answer 21

The therapist makes a prediction about the future health status of a patient.

– What information (i.e., factors) are most important to consider when predicting the outcome of an intervention - or inaction.

Question 22

What is the type of question in this scenario:
You are performing a fall risk assessment on a 79 y/o woman who recently received new prescription bifocals. You want to know if type of eye glasses is associated with fall risk?

Answer 22

prognosis question

Searchable question:
P: in older adults
I: are bifocals
C:
O: associated with falls

Question 23

Explain clinical measures questions

Answer 23

Physical therapist labels or classifies a
patient’s problem or need.
– Are distinct from Diagnosis questions.
– Used to quantify a patient’s impairments in a standardized way
– Usually focus on measurement reliability, validity, and responsiveness.

Question 24

What type of question is in this scenario:
A 26 year old man with unilateral chemotherapy- induced peripheral-neuropathy of the peroneal nerve is referred to your clinic. You want to know if manual muscle testing is valid and reliable for assessing muscle weakness on the affected side?

Answer 24

clinical measures question

Searchable question:
P: in adults with peripheral neuropathy
I: is manual muscle testing
C:
O: valid and reliable

Question 25

Define outcomes questions

Answer 25

The end result of the patient management process. – Focus on the end results experienced by patients following an episode of care – Usually pertain to results that are meaningful to the patient.

Question 26

What type of question is in this scenario: A 58 y/o man s/p heart attack asks you if participation in a cardiac rehabilitation program will increase his likelihood of returning to work?

Answer 26

outcomes question Searchable question: P: in adults with myocardial infraction I: does cardiac rehabilitation C: O: increases likelihood of return to work

Question 27

What are the aspects of a well developed and searchable clinical question?

Answer 27

* Saves time when researching the literature * Keeps the focus directly on the patient’s need * Suggests the appropriate form that a useful answer may take * Suggests the type of research most likely to provide the best answer

Question 28

What does EBP always begin and end with?

Answer 28

the patient

Question 29

What is EBP a mix of?

Answer 29

integration of 1) clinical expertise 2) patient values and preferences 3) the best research evidence into the decision-making process for patient care. EBP highlights the use of research based EVIDENCE to inform clinical decisions because of its potential to provide objective unbiased results

Question 30

define evidence in EBP

Answer 30

evidence: empirical observation about the apparent relation between events constitutes potential evidence – is used to inform decision making. – does not replace clinical expertise. – does not make the decision for you, but can inform your clinical decision.

Question 31

what does the use of evidence in clinical decisions making represent?

Answer 31

represents a movement away from unquestioning reliance on knowledge gained from authority or tradition.

Question 32

What does knowledge derived solely from an authority or tradition reflect?

Answer 32

Usually reflects initial understanding of clinical phenomena based on biologic plausibility and anecdotal experience. – Biological plausibility: The reasonable expectation that the human body could behave in the manner predicted.

Question 33

Assess the claim, statement, and conclusion: (Green smoothies devastates health) Oxalate occurs in many plants, where it is synthesized via the incomplete oxidation of carbohydrates. The vegetables used in green smoothies are usually high oxalate foods. 75-90% of kidney stones are oxalate related. CONCLUSION: if you drink green smoothies, you will get giant kidney stones

Answer 33

P: in community dwelling adults I: is oxalate level in the diet C: O: associated with prevalence of kidney stones? Search string: adults AND oxalate AND diet AND “kidney stones”

Question 34

List the areas of focus in EBP in PT

Answer 34

* Clinical Measures / Examination & Evaluation * Diagnosis * Prognosis * Intervention * Outcomes

Question 35

What are the tiers of evidence hierarchy?

Answer 35

Question 36

List types of reasoning errors

Answer 36

Ascertainment bias Confirmation bias Recency effect Representativeness exclusivity Value bias

Question 37

Explain the nature of the problem and clinical management consequences for Ascertainment bias

Answer 37

Nature of the Problem Occurs when a clinician draws a conclusion based on previously held expectations of a particular outcome (e.g., a physical therapist determines that a woman is catastrophizing her back pain experience because she has expressed job dissatisfaction). Clinical Management Consequences The physical therapist forgoes clinical examination procedures that would have identified joint restrictions in the woman’s lumbar spine.

Question 38

Explain the nature of the problem and clinical management consequences for confirmation bias

Answer 38

Nature of the problem Occurs when a clinician selectively focuses on information that confirms a hypothesis (e.g., a physical therapist remembers only those people with adhesive capsulitis of the shoulder who improved following application of ultrasound and forgets those people who did not improve with the same technique). Clinical management consequences The physical therapist applies ultrasound to all people with adhesive capsulitis of the shoulder regardless of their response to the modality

Question 39

Explain the nature of the problem and clinical management consequences for recency effect

Answer 39

Nature of the problem Occurs when a clinician believes that a particular patient presentation or response is a common phenomenon because it is easily remembered (e.g., a physical therapist believes that fibromyalgia is more common in men than in women because her last two patients with this diagnostic label were male). OR Occurs when a clinician believes that a particular patient presentation or response is an uncommon phenomenon because it is not easily remembered (e.g., a new graduate physical therapist does not remember how to differentiate among various sources of painful conditions that express themselves in dermatomal patterns). Clinical management consequences The physical therapist classifies all men with generalized pain in the upper back as having fibromyalgia. OR The physical therapist mistakes pain due to herpes zoster for radicular pain due to vertebral joint restriction in a person with an idiopathic acute onset of symptoms.

Question 40

Explain the nature of the problem and clinical management consequences for representativeness exclusivity

Answer 40

Nature of the problem Occurs when a clinician draws conclusions about patient presentation or response based only upon those people who return for scheduled treatment sessions (e.g., a physical therapist believes all people with Parkinson’s disease benefit from a particular balance program based on experience with people who have completed an episode of treatment versus those who have not). Clinical management consequences The physical therapist applies the balance program exactly the same way for all people with Parkinson’s disease who are referred to him for management.

Question 41

Explain the nature of the problem and clinical management consequences for value bias

Answer 41

Nature of the problem Occurs when the importance of an outcome in the eyes of the clinician distorts the likelihood of the outcome occurring (e.g., a physical therapist’s concern about undiagnosed fractures in acute painful conditions outweighs the data about prevalence of fractures under specific situations). Clinical management consequences The physical therapist forgoes application of validated clinical prediction rules and refers all people with acute painful conditions for radiographic testing.