why we should engage with research
-public expects medical care to be based in science
-in PT, evidence must be generated/implemented in clinical practice
-agencies (insurance) expect evidence based care to be provided
2 types of bias
-confirmation bias
-recall bias
confirmation bias
when people appraise/interpret information such that it reinforces their own beliefs
recall bias
the tendency for people to better remember substantial/impressive events
-ex: we remember the patients that GET BETTER
KNOW
contribution to outcome change
-natural history
-regression to mean
-placebo effect
-hawthorne effect
-specific treatment effect
KNOW
natural history
contribution to outcome change
conditions resolve on their own
KNOW
regression to mean
contribution to outcome change
patients with most SEVERE symptoms are likely to improve
KNOW
placebo effect
contribution to outcome change
patient expectations
KNOW
hawthorne effect
contribution to outcome change
patients modify their behavior in response to being observed
KNOW
specific treatment effect
contribution to outcome change
??
KNOW
practicing EBP- THE PROCESS
- NEED- should grow from a need for information provided by the patient
- QUESTION- need should be transferred into an answerable question
- SEARCH- best evidence must then be consulted (literature research)
- APPRAISE- evidence must be appraised
- APPLIED- if deemed valid + applicable, it is applied to patient
- EVALUATE- performance must be monitored/evaluated both for individual patients/groups of similar patients
3 types of clinical decisions
-abdication
-induction
-deduction
abdication
decision based primarily on the advice of an expert
-teachers, instructors, sales reps, textbooks, etc.
-lacks clinical evidence (at times)
induction
decision based on uncontrolled clinical experience or the extension of basic science to clinical settings
-does NOT limit error/bias
-may not be relevant to actual patients (ex: animal studies)
-surrogate endpoints
deduction
decision based on prospective studies designed to answer specific clinical questions or specific clinical research hypotheses
-what we are promoting as EBP clinicans
-PRIMARY ENDPOINTS
KNOW
is abdication, induction, or deduction recommended
deduction
2 types of end points
-primary end point
-surrogate end point
primary end point
-length of time: long enough to make strong conclusions
-characteristic: of interest to patient/society
surrogate end point
-length of time: too short
-characteristic: of interest to healthcare provider (or researcher)
