Week 3: evidence based practice Flashcards
What are the primary objectives of Evidence-Based Practice (EBP) in exercise science?
The primary objectives of EBP in exercise science are to integrate the best research evidence with clinical expertise and patient values, deliver high-quality and cost-effective healthcare, and develop patient-centered exercise prescriptions based on reliable evidence.
Describe the difference between observational and experimental study designs in EBP.
Observational studies involve observing individuals without intervention to identify relationships or patterns (e.g., cohort, case-control studies), while experimental studies, like Randomized Controlled Trials (RCTs), involve manipulating variables to establish cause-and-effect relationships by randomizing participants into different groups.
What is the role of Randomized Controlled Trials (RCTs) in Evidence-Based Practice, and why are they considered the gold standard?
RCTs are considered the gold standard because they minimize chance, bias, and confounding variables through randomization, allowing for the establishment of cause-and-effect relationships, which are critical for influencing policy, clinical practices, and exercise prescriptions.
What are some common types of biases in research, and how can they affect study outcomes?
Common biases include selection bias, observation bias, recall bias, and misclassification bias. They can distort study outcomes by introducing systematic errors in how participants are selected, how data is recorded, or how information is recalled or classified.
Explain the concept of confounding and its significance in observational studies.
Confounding occurs when an additional variable influences both the exposure and the outcome, potentially leading to incorrect conclusions about the relationship between variables. It is significant in observational studies as it can falsely suggest causality.
How can exercise practitioners use the PEDro scale and Cochrane Risk of Bias Tool in evaluating the quality of evidence?
Practitioners use these tools to systematically assess study quality, evaluating aspects such as randomization, blinding, and participant allocation, which helps determine the validity and reliability of the evidence for informing exercise prescriptions.
What is meant by “clinical meaningfulness” in EBP, and how does it differ from statistical significance?
Clinical meaningfulness refers to the practical importance or impact of a study’s findings in real-world clinical settings, whereas statistical significance indicates whether the results are likely due to chance. Clinically meaningful results must translate into tangible benefits for patients.
Describe the importance of generalizability (external validity) in evaluating research studies for EBP.
Generalizability refers to the extent to which study findings can be applied to broader populations beyond the study sample. It is crucial in EBP to ensure that the evidence is applicable and relevant to diverse clinical settings and patient groups.
How can exercise practitioners refine their search strategies when using databases to find relevant research evidence?
Practitioners can refine search strategies by identifying main concepts, using synonyms and alternative spellings, applying logical operators (AND/OR), setting appropriate limits (e.g., date, country), and choosing specific fields like title or abstract to narrow down relevant studies.
What factors should be considered when tailoring exercise prescriptions for patients with cardiometabolic diseases using EBP?
Factors include a thorough pre-exercise history, patient goals, identification of contraindications, conditions requiring exercise modifications, current and past exercise habits, symptoms indicating risk, and ensuring the exercise prescription aligns with evidence-based guidelines.
How can the Hawthorne effect and halo effect introduce bias into Randomized Controlled Trials, and what methods can be employed to minimize these biases?
The Hawthorne effect occurs when participants alter their behavior due to awareness of being observed, while the halo effect occurs when knowledge of group assignment influences outcomes. Minimizing these biases involves blinding participants, interventionists, outcome assessors, and analysts, as well as using placebo controls.
Why is the concept of ‘overload principle’ critical in designing exercise interventions, and how does failing to consider it impact the validity of exercise-based studies?
The overload principle suggests that exercise must exceed normal levels to induce adaptation. Failure to apply it results in interventions that do not elicit significant physiological changes, thereby reducing the validity and effectiveness of the study’s outcomes.
In what scenarios might a prospective cohort study be more appropriate than an RCT, despite RCTs being the gold standard in EBP, and what are the inherent limitations of cohort studies?
A prospective cohort study is more appropriate for ethical reasons or when randomization is impractical, such as long-term exposure studies. Limitations include the potential for confounding variables, longer follow-up periods, and the inability to establish causality as strongly as RCTs.
Explain how stratification and restriction are used in study design to address confounding, and discuss the limitations of these approaches.
Stratification involves analyzing subgroups separately to control for confounding, while restriction limits the study population to reduce variability. However, both methods may limit generalizability and may not fully account for all confounding variables, especially unknown or unmeasured ones.
Discuss the implications of a high loss-to-follow-up rate in an RCT and how it affects the study’s internal and external validity.
A high loss-to-follow-up rate reduces internal validity by introducing attrition bias, potentially distorting treatment effects. It also threatens external validity as the remaining participants may not represent the original sample, limiting generalizability to broader populations.
