article summary studies
used to help optimize patient care by informing clincal practice guidelines
types of article summary studies
systematic reviews
meta-analysis
systematic reviews
- comprehensive analysis of current literature focused on specific questions using the scientific method
- uses rigorous a priori search
what influences the validity of a systematic review
the quality of the study
narrative (literature review)
- compiled qualitative summary of articles
- doesnt use a rigorous search
- doesnt aim to answer a specific clinical question
meta-analysis studies
- quantitiative synthesis of data from systematic reviews
- used to observe the overal mean effect
- strict methods portion highlighting the use of inclusion and exclusion criteria
how are the studies for meta-analysis chosen
- based on similar characteristics to
- like use of the same outcome measures, time collections, etc.
JOSPT grades of recommendation
used to grade how the clinical recommendation is supported by evidence
grade A recommendation
strong evidence
uses a level I or level II study to support
grade B recommendation
moderate evidence
single high quality RCT or preponderance of level II study
grade C recommendation
weak evidence
single level II study or preponderacne of level III or level IV
grade D recommendation
conflicting evidence
higher quality studies conducted on this topic disagree with conclusion
grade E recommendation
theoretical foundational evidence
preponderance of evidence from animal or cadaver studies
clinical practice guidelines
- systematically developed statements written by expert panel with clinical scholars
- more comprehensive than a sincle study
weighted average
- more weight is given to stronger evidence pieces
- based on sample size and variance of the data
what increases validity of these stidoes
use of hogh quality studies
detailed metods portion
summarization of main findings, discussing limitaions
ways to present results
forrest plit
funnel plot
forest plot
- insight into the effect of indiviudal studies and the combined treatment effects
- normally uses squares and diamonds
what does the vertical line mean in the forest plot
- the null effect line
- there is no difference between evidence
- if the CI of the study crosses that line it is not a statisically sig study
funnel plot
- illustration to observe publication bias
- you want an even plot to show that there is inclusion of negative and positve studies
clinical prediction guides
quantifies individual contributions from various components to predict an outcome
types of prediction guides
diagnositc
prognostic
intervention
what are steps to the clinical predictor guide
derviation phase
validation phase
impactd
derivation for clinical predictor guide
- identify factors with predictive values
- find clinical outcomes that predict diagnosis, prognosis, or intervention
- lacks a control group
