1
Q
Front
A
Back
2
Q
What is the primary purpose of critical appraisal in evidence-based physiotherapy?
A
To distinguish between well-designed and poorly designed research to avoid biased conclusions.
3
Q
What are the three key questions to assess the validity of randomized trials?
A
- Were intervention and control groups comparable? 2. Was there complete/near-complete follow-up? 3. Was there blinding of patients and assessors?
4
Q
Why is randomization important in clinical trials?
A
It ensures probable comparability between groups by eliminating allocation bias.
5
Q
What is concealment of allocation, and why is it critical?
A
Concealing allocation prevents researchers from influencing group assignment, maintaining randomization integrity.
6
Q
What percentage of loss to follow-up is generally acceptable to minimize bias?
A
Losses ≤15% are acceptable; >20% raises concerns about bias.
7
Q
What is intention-to-treat (ITT) analysis, and why is it preferred?
A
ITT analyzes all participants in their original groups, preserving randomization benefits and reflecting real-world outcomes.
8
Q
How does blinding reduce bias in trials?
A
Blinding minimizes placebo effects (participants) and measurement bias (assessors).
9
Q
What is the difference between pragmatic and explanatory trials?
A
Pragmatic trials test real-world effectiveness; explanatory trials test efficacy under ideal conditions.
10
Q
What are the key criteria for assessing systematic reviews?
A
- Clear inclusion/exclusion criteria. 2. Comprehensive search strategy. 3. Quality assessment of included studies.
11
Q
Why is representative sampling important in prognosis studies?
A
It ensures findings apply to the target population, avoiding skewed estimates.
12
Q
What is an inception cohort?
A
A group recruited at a uniform early point in their condition to avoid survivor bias.
13
Q
What is the risk of using case-control designs in diagnostic test studies?
A
They overestimate accuracy by testing obvious cases rather than clinically uncertain ones.
14
Q
Why should diagnostic test studies use blinded assessors?
A
To prevent interpretation bias when comparing test results to the reference standard.
15
Q
What is a sham intervention, and when is it used?
A
A placebo mimicking the active treatment to blind participants, used to control for placebo effects.
16
Q
What did Hrobjartsson & Gøtzsche’s study reveal about placebo effects?
A
Placebo effects are small (~0.25 SD) and often exaggerated in biased studies.
17
Q
What is the PEDro scale used for?
A
To assess the methodological quality of physiotherapy trials (e.g., randomization, blinding, follow-up).
18
Q
Why are exhaustive literature searches important in systematic reviews?
A
To minimize publication/language bias by including unpublished/non-English studies.
19
Q
What is triangulation in qualitative research?
A
Using multiple methods/researchers to validate findings and enhance credibility.
20
Q
What are the key features of a high-quality qualitative study?
A
- Appropriate sampling. 2. Comprehensive data collection. 3. Rigorous, transparent analysis.
21
Q
Why is loss to follow-up problematic in prognosis studies?
A
It can skew estimates if dropouts have systematically different outcomes.
22
Q
What is the CONSORT statement?
A
Guidelines for transparent reporting of randomized trials, including flow diagrams for participant tracking.
23
Q
What distinguishes cohort studies from case-control studies in diagnostic research?
A
Cohort studies sample patients with diagnostic uncertainty; case-control studies use confirmed cases/controls.
24
Q
What is the role of a reference standard in diagnostic test studies?
A
It provides a near-perfect benchmark to evaluate the test’s accuracy.
25
Why might clinical trials provide biased prognosis data?
They often exclude non-compliant or hard-to-recruit patients, reducing representativeness.
26
What is snowball sampling in qualitative research?
Recruiting participants via referrals from other participants to access hard-to-reach groups.
27
How does stratification improve randomization?
It ensures balance between groups for specific variables (e.g., disease severity).
28
What is the "powerful placebo" myth?
The overstated belief that placebos have large clinical effects, debunked by rigorous studies.
29
Why are per-protocol analyses potentially biased?
They exclude non-compliant participants, undermining randomization.
30
What is the difference between internal and external validity?
Internal: freedom from bias. External: generalizability to other populations/settings.
31
What are the limitations of using surrogate outcomes in trials?
They may not correlate with clinically meaningful endpoints (e.g., pain vs. function).
32
Why is blinding statisticians important?
It prevents analysis methods from being influenced by knowledge of group allocations.
33
What is the Delphi technique in developing quality criteria?
A structured consensus method among experts to identify key methodological standards.
34
How does publication bias affect systematic reviews?
It skews results by omitting negative/unpublished studies, overestimating effects.
35
What is the "file drawer problem"?
The tendency for negative/null results to remain unpublished, distorting the literature.
36
Why are quasi-random methods (e.g., birth dates) inferior to true randomization?
They can be predicted or manipulated, introducing allocation bias.
37
What is the purpose of a run-in period in explanatory trials?
To exclude non-compliant participants before randomization.
38
How does attrition bias differ from selection bias?
Attrition: post-randomization dropout. Selection: pre-randomization sampling flaws.
39
What is the "declaration of Helsinki"?
Ethical guidelines for clinical research, emphasizing informed consent and risk minimization.
40
Why are subgroup analyses often misleading?
They increase false-positive findings due to multiple comparisons unless pre-specified.
41
What is the role of effect size in interpreting trial results?
It quantifies the magnitude of an intervention’s effect, independent of statistical significance.
42
How does the Hawthorne effect impact trial outcomes?
Participants may alter behavior due to awareness of being observed.
43
What is the difference between efficacy and effectiveness?
Efficacy: ideal conditions. Effectiveness: real-world conditions.
44
Why are N-of-1 trials useful in physiotherapy?
They personalize evidence by comparing interventions in a single patient over time.
45
What is the "number needed to treat" (NNT)?
The number of patients needing treatment for one to benefit, calculated as 1/(absolute risk reduction).
46
How does the placebo effect differ from the nocebo effect?
Placebo: benefit from inert treatment. Nocebo: harm from negative expectations.
47
What is the "intraclass correlation coefficient" (ICC) used for?
To assess reliability of measurements (e.g., inter-rater agreement).
48
Why are confidence intervals more informative than p-values?
They estimate the precision and range of possible effect sizes.
49
What is the "funnel plot" used for in meta-analyses?
To visually detect publication bias (asymmetry suggests missing studies).
50
How does the "Bonferroni correction" address multiple testing?
It adjusts significance thresholds to reduce false positives (α/number of tests).
51
What is "clinical equipoise" in trial ethics?
Genuine uncertainty about which treatment is better, justifying randomization.
52
Why are crossover trials sometimes problematic?
Carryover effects from prior treatments may confound results if washout periods are inadequate.
53
What is the "McMaster critical appraisal framework"?
A structured approach to evaluate research validity, relevance, and results.
54
front
back
55
Definition of evidence-based physiotherapy
Integration of best research evidence, clinical expertise, and patient values in clinical decision-making
56
Five steps of evidence-based practice
1. Ask clinical questions 2. Search for evidence 3. Appraise evidence 4. Apply evidence 5. Evaluate outcomes
57
PICO framework
Patient/Problem, Intervention, Comparison, Outcome - used to structure clinical questions
58
Hierarchy of evidence
Systematic reviews > RCTs > Cohort studies > Case-control > Case series > Expert opinion
59
AGREE II instrument
Tool for appraising clinical guideline quality across 6 domains including rigor and applicability
60
McKinlay's 7 stages of medical innovation
1. Promising report 2. Professional adoption 3. Public acceptance 4. Standard practice 5. RCTs 6. Denunciation 7. Extinction
61
Protocol for new therapies
1. Lab/clinical observation 2. Clinical exploration 3. Pilot studies 4. RCTs 5. Refinement 6. Dissemination
62
Types of research questions
Therapy, Diagnosis, Prognosis, Etiology, Experiences
63
Key databases for physiotherapy
PEDro, Cochrane Library, MEDLINE, CINAHL, Embase
64
Critical appraisal of RCTs
Assess: randomization, allocation concealment, blinding, ITT analysis, follow-up
65
Critical appraisal of diagnostic tests
Assess: reference standard, blinding, spectrum of patients, reproducibility
66
Critical appraisal of qualitative studies
Assess: theoretical framework, sampling, data collection, analysis rigor
67
PEDro scale
11-item scale rating RCT quality (0-10); >6 = high quality
68
CONSORT statement
Reporting standards for randomized controlled trials
69
Absolute risk reduction (ARR)
Difference in event rates between treatment and control groups
70
Number needed to treat (NNT)
1/ARR; patients needed to treat for one additional positive outcome
71
Likelihood ratios
LR+ = sensitivity/(1-specificity); LR- = (1-sensitivity)/specificity
72
Forest plots
Graphic display of meta-analysis results showing effect sizes and confidence intervals
73
Heterogeneity in meta-analysis
Variability between studies (I² statistic >50% = substantial heterogeneity)
74
Clinical audit cycle
1. Set standards 2. Measure practice 3. Review 4. Implement changes 5. Re-measure
75
Barriers to evidence-based practice
Time constraints, lack of skills, resistance to change, limited access to resources
76
Effective implementation strategies
Educational outreach, audit/feedback, reminders, opinion leaders, multifaceted
77
Ottawa Model of Research Use
Implementation framework assessing barriers, adopters, and environment
78
Bandura's social cognitive theory
Behavior change influenced by incentives, expectations, and self-efficacy
79
Stages of change model
Precontemplation → Contemplation → Preparation → Action → Maintenance
80
Continuous quality improvement
Ongoing process of evaluating and enhancing care delivery systems
81
Outcome vs process measures
Outcomes measure results (e.g., pain); processes measure care delivery (e.g., guideline adherence)
82
N-of-1 trials
Single-patient crossover designs establishing treatment effectiveness for individuals
83
Sham interventions
Placebo controls in RCTs (e.g., inactive ultrasound) to control for placebo effects
84
Intention-to-treat analysis
All randomized participants analyzed in original groups, maintaining randomization benefits
85
Allocation concealment
Protecting randomization sequence to prevent selection bias
86
Blinding types
Single (participant), double (participant+assessor), triple (plus analyst)
87
Natural history effect
Spontaneous improvement over time without intervention
88
Placebo effect
Improvement due to patient expectations rather than treatment
89
Recall bias
Systematic error from inaccurate memory of past exposures/events
90
Spectrum bias
When study population doesn't represent clinical population
91
Verification bias
When only positive tests receive reference standard verification
92
Clinical prediction rules
Multivariable models predicting diagnosis/prognosis (e.g., Ottawa ankle rules)
93
Minimal clinically important difference (MCID)
Smallest change patients perceive as important
94
Standardized mean difference
Effect size for continuous outcomes (Cohen's d: 0.2=small, 0.5=medium, 0.8=large)
95
Funnel plots
Graphic test for publication bias in meta-analyses
96
GRADE system
Grades evidence quality (high → very low) and recommendation strength (strong/weak)
97
Knowledge translation
Process of moving research into practice (dissemination + implementation)
98
Academic detailing
One-on-one education by trained experts to change clinician behavior
99
Clinical pathways
Structured multidisciplinary care plans for specific conditions
100
Reflective practice
Critical analysis of clinical experiences to improve future practice
101
Peer review
Colleague evaluation of clinical practice through case review/discussion
102
Patient-reported outcomes
Direct patient assessments of symptoms/function (e.g., SF-36)
103
Prognostic factors
Variables predicting disease course (e.g., age, severity, comorbidities)
104
Incidence vs prevalence
New vs existing cases in population during time period
105
Pre-test probability
Disease likelihood before diagnostic test
106
Post-test probability
Disease likelihood after diagnostic test (using likelihood ratios)
107
Sensitivity
True positive rate (ability to detect disease)
108
Specificity
True negative rate (ability to exclude disease)
109
What are the three key questions to assess the relevance of a randomized trial?
1. Are the participants similar to my patients? 2. Were interventions applied appropriately? 3. Are the outcomes useful?
110
What is the main limitation of subgroup analyses in clinical trials?
Subgroup analyses are prone to statistical errors (false positives/negatives) and typically require much larger sample sizes than main analyses.
111
What is the paradox regarding clinical trial applicability?
When we least know who benefits most from therapy, clinicians are most reluctant to accept trial findings - just when they're most needed.
112
What are the two types of health-related quality of life measures?
1. Generic measures (e.g., SF-36) 2. Disease-specific measures (e.g., Chronic Respiratory Disease Questionnaire)
113
What is a key limitation of using surrogate outcomes in trials?
Surrogate outcomes may become uncoupled from clinically important outcomes, potentially misleading about true treatment effects.
114
What three conditions must a valid measure of "smallest worthwhile effect" satisfy?
1. Must involve patient values 2. Must consider intervention costs/risks 3. Must be defined as difference in outcomes with/without intervention
115
What is the benefit-harm trade-off method?
A technique where patients are asked if they'd choose an intervention at varying effect sizes to determine the smallest worthwhile effect.
116
How is a 95% confidence interval for continuous outcomes approximated?
Difference in means ± (3 × average SD)/√(average sample size)
117
What does a number needed to treat (NNT) of 5 mean?
5 people need to be treated for 1 person to benefit (e.g., prevent 1 adverse event)
118
What is the key difference between absolute and relative risk reduction?
Absolute risk reduction is the actual difference in risk between groups, while relative risk reduction expresses this as a proportion of control group risk.
119
Why is meta-analysis superior to vote counting?
Meta-analysis provides quantitative estimates of effect sizes and has greater statistical power than simply counting significant/non-significant studies.
120
What are the GRADE criteria for quality of evidence?
High: Further research very unlikely to change confidence in estimate. Moderate: Likely important impact. Low: Very likely important impact. Very low: Any estimate very uncertain.
121
What is the key limitation of qualitative research?
Findings may not be generalizable beyond the specific study context (limited external validity).
122
What are the two main types of prognostic information?
1. Risk of events (dichotomous outcomes) 2. Expected values of continuous outcomes
123
What makes likelihood ratios superior to sensitivity/specificity?
LRs directly indicate how test results should modify diagnostic probabilities, while sensitivity/specificity don't provide this clinical utility.
124
What is a positive likelihood ratio of 10 interpreted as?
A positive test result is 10 times more likely in people with the condition than without it.
125
How do you calculate post-test probability?
Use a nomogram combining pre-test probability and likelihood ratio, or calculate: post-test odds = pre-test odds × LR
126
What is the minimal clinically important difference (MCID)?
The smallest treatment effect that patients perceive as beneficial enough to justify treatment given its costs/risks.
127
What are the three components of critical appraisal for therapy studies?
1. Is evidence relevant? 2. What does evidence say? 3. Does therapy do more good than harm?
128
Why are large trials often weighted more heavily in meta-analyses?
They provide more precise estimates of treatment effects due to larger sample sizes.
129
What is the key limitation of stratified analyses in meta-analyses?
They share limitations of subgroup analyses - prone to false positives and ecological fallacies.
130
What characterizes a good diagnostic test?
High positive LR (>10) and low negative LR (<0.1), meaning results substantially alter diagnostic probabilities.
131
How does baseline risk affect treatment effect interpretation?
Higher baseline risks lead to larger absolute risk reductions even with same relative effect, making treatments appear more impactful.
132
What is the key advantage of meta-analysis over levels of evidence approaches?
Meta-analysis provides quantitative effect size estimates rather than just qualitative judgments about evidence strength.
133
What are the two ways to weigh benefit and harm?
1. Therapist develops personal policies 2. Negotiate individually with patients based on their preferences
134
What is the key problem with vote counting in systematic reviews?
It lacks statistical power and may miss true effects, plus provides only dichotomous (effective/not) conclusions.
135
How can prognosis information inform treatment decisions?
It sets upper limits on potential treatment benefits and helps scale effects to specific patient risk levels.
136
What are the two components of a good qualitative research report?
1. Clear statement of findings with supporting quotes 2. Explanation of how conclusions were derived from data
137
What is the key difference between natural and clinical course prognoses?
Natural course: Untreated outcomes. Clinical course: Outcomes with usual treatment.
138
Why are confidence intervals important for interpreting trial results?
They indicate the precision of effect estimates - wide CIs mean greater uncertainty about true effect size.
139
What are the three main types of trial comparisons?
1. Intervention vs no intervention 2. Standard + new vs standard alone 3. Two active interventions
140
What is the key limitation of using p-values alone?
They don't indicate effect size magnitude, just statistical significance, which may not be clinically meaningful.
141
How can patient preferences be incorporated into treatment decisions?
By discussing expected benefits vs costs/risks and tailoring decisions to individual values and preferences.
142
What makes an outcome measure clinically useful?
It measures something that matters to patients (e.g., function, quality of life) rather than just physiological parameters.
143
What is the key advantage of continuous over dichotomous outcomes?
Continuous outcomes typically provide more statistical power and can detect smaller, still meaningful effects.
144
Why are clinical prediction rules potentially problematic?
Many are derived from uncontrolled studies and may not reliably identify true treatment responders.
145
What is the key consideration when applying trial results to practice?
Whether the treatment effect (considering CI) exceeds the smallest effect patients would consider worthwhile.
146
How can prognostic factors refine prognosis estimates?
By identifying patient characteristics that modify baseline risk, allowing more personalized predictions.
147
What is the key challenge in interpreting meta-analyses?
Determining if pooled studies are sufficiently similar in patients, interventions, and outcomes to justify combining.
148
Why are qualitative research findings often presented with quotes?
To demonstrate that conclusions are grounded in actual participant data rather than just researcher interpretation.
149
What is the key difference between explanatory and pragmatic trials?
Explanatory: Test efficacy under ideal conditions. Pragmatic: Test effectiveness in real-world practice.
150
How can test accuracy vary by clinical setting?
Tests may perform better in settings with higher disease prevalence or when administered by more skilled clinicians.
151
What is the key advantage of the number needed to treat (NNT)?
It makes treatment effects more intuitively understandable by framing them in terms of patients needed to treat.
152
Why are standardized mean differences used in meta-analyses?
To combine results from studies using different measurement scales for the same construct.
153
What is the key limitation of relative risk reductions?
They can make effects appear larger than they are, especially when baseline risks are low.
154
How can qualitative research inform physiotherapy practice?
By providing insights into patient experiences, behaviors, and therapist-patient interactions that quantitative methods may miss.
155
What is the key consideration when evaluating diagnostic test studies?
Whether the test was administered in a similar way and by similarly skilled clinicians as in your practice.
156
Why are pre-test probabilities important in diagnosis?
They determine how much a test result should change diagnostic certainty - same result affects probability differently depending on initial suspicion.
157
What is the key advantage of the levels of evidence approach?
It considers both study quality and consistency of findings across studies.
158
What is the key limitation of the levels of evidence approach?
Different systems use varying criteria, leading to inconsistent conclusions about the same evidence.
159
How can clinical experience complement trial evidence?
By helping modify average treatment effects based on individual patient characteristics not fully captured in trials.
160
What is the best database to find evidence on the effects of physiotherapy interventions?
PEDro or the Cochrane Library.
161
What does PEDro stand for?
Physiotherapy Evidence Database.
162
What types of studies are indexed in PEDro?
Randomized trials, systematic reviews, and evidence-based clinical practice guidelines.
163
What is the primary advantage of using the Cochrane Library?
It provides full-text access to Cochrane systematic reviews and indexes trials across all health areas.
164
How can you refine a search in PEDro to focus on high-quality studies?
Use the Advanced Search and filter by methodological quality score.
165
What is the purpose of using wildcards (e.g., *) in database searches?
To capture word variants (e.g., 'lumb*' searches for 'lumbar,' 'lumbosacral').
166
How are AND and OR used in search strategies?
AND narrows searches (all terms must appear), OR broadens searches (any term can appear).
167
What is a key limitation of PEDro's Advanced Search?
It does not allow mixing AND and OR in a single search.
168
What is the Clinical Queries function in PubMed designed for?
To efficiently find studies on therapy, prognosis, diagnosis, or etiology.
169
What is the best database for finding qualitative research on patient experiences?
CINAHL or PubMed.
170
What is MeSH in PubMed?
Medical Subject Headings, a controlled vocabulary for indexing articles.
171
How can you access full-text articles if you lack institutional subscriptions?
Use FreeMedicalJournals.com, HINARI, or professional association resources.
172
What is the purpose of critically appraised papers (CAPs)?
To provide concise summaries of high-quality, clinically relevant research.
173
What is an example of a pre-appraised resource for physiotherapists?
Journal of Physiotherapy's CAPs or Evidence-Based Medicine.
174
What is the recommended search strategy for prognosis studies in PubMed?
Use Clinical Queries with 'prognosis' and 'narrow' scope for specificity.
175
Why is CINAHL particularly useful for qualitative research?
It has extensive subject headings for qualitative methodologies.
176
What is the main challenge when searching for qualitative studies?
Lack of standardized indexing terms across databases.
177
How can you combine multiple search terms in PubMed effectively?
Use brackets to group terms (e.g., (stroke OR CVA) AND (rehabilitation)).
178
What is the benefit of using subject headings (MeSH) in PubMed?
They standardize terminology and improve search precision.
179
What is the role of the 'Related Citations' feature in PubMed?
To find studies similar to a relevant article you've already identified.
180
What is the key difference between sensitive and specific searches?
Sensitive searches maximize recall (more results), specific searches minimize irrelevant results.
181
What is a common pitfall when using the NOT operator in searches?
It may exclude relevant studies that mention the term incidentally.
182
How can you search for studies published within a specific date range in PEDro?
Use the 'Published Since' field with a range (e.g., 1990...1995).
183
What is the focus of the Physiotherapy Choices database?
Consumer-friendly summaries of evidence for patients and families.
184
What is the primary limitation of Google Scholar for clinical research?
It lacks transparency in content coverage and returns too many results.
185
What are decision support tools like BMJ BestPractice used for?
Point-of-care information based on evidence, guidelines, and expert opinions.
186
How can you search for synonyms of a term in PubMed?
Use MeSH to identify standardized terms and their variants.
187
What is the best way to find systematic reviews of diagnostic tests?
Use PubMed Clinical Queries with the 'diagnosis' category.
188
Why might MEDLINE miss some physiotherapy-relevant studies?
It indexes few physiotherapy-specific journals.
189
What is the advantage of using the 'Explode' function in MeSH searches?
It includes narrower terms in the hierarchy for greater sensitivity.
190
What is the main drawback of Embase?
It requires a subscription and is not freely accessible.
191
How can you improve search efficiency when terms have many synonyms?
Combine terms with OR (e.g., (walking OR gait OR ambulation)).
192
What is the purpose of the 'History' function in the Cochrane Library?
To combine previous searches with AND/OR for complex queries.
193
What is a key tip for searching qualitative research in CINAHL?
Combine subject terms (e.g., 'Qualitative Studies') with topic terms.
194
How can you access the Cochrane Library without a subscription?
Check if your country provides free access (e.g., HINARI for developing nations).
195
What is the recommended strategy for browsing new research?
Read pre-appraised papers like CAPs in the Journal of Physiotherapy.
196
What is the key benefit of PubMed's automatic MeSH term inclusion?
It expands searches without requiring manual entry of MeSH terms.
197
How can you limit PubMed search results to systematic reviews?
Use Clinical Queries and select 'Systematic Reviews' under the category.
198
What is the primary use of the Social Sciences Citation Index?
To find multidisciplinary research, including qualitative studies.
199
Why is PsycINFO useful for physiotherapists?
It indexes psychological interventions relevant to rehabilitation.
200
What is the best way to handle a search that returns too many results?
Add more specific terms or filters (e.g., publication date, study type).
201
How can you find full-text articles for free in developing countries?
Use HINARI (Health InterNetwork Access to Research Initiative).
202
What is the key feature of the 'Advanced Search' in PEDro?
It allows filtering by therapy, body part, methodology, and quality score.
203
What is the risk of using too many search terms in PEDro?
It may return no results (AND) or too many irrelevant results (OR).
204
How can you search for a phrase exactly in the Cochrane Library?
Enclose it in quotation marks (e.g., 'continuous passive motion').
205
What is the purpose of the 'Shopping Basket' in PEDro?
To save selected records for later review.
206
Why is it important to avoid plural forms in wildcard searches?
The wildcard already captures plurals (e.g., 'knee*' includes 'knees').
207
What is the key takeaway from the Bleakley et al. (2010) CAP?
Early exercise improves short-term function after ankle sprain.
208
How can you stay updated with new evidence efficiently?
Subscribe to journals offering CAPs or use evidence-alert services.
209
What is the main strength of PubMed for prognosis studies?
Clinical Queries offers validated filters for sensitivity/specificity.
DPT 7'25"
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