1
Q
What is research?
A
The careful, logical and systematic process of investigation
2
Q
What is empirical research?
A
An approach to problem solving in which decisions are based on
- Data from observation and experiments
- Analyzing data (variables and their relationship)
- Data analyzed to determine results
- Findings and conclusions established
- Results influence future research
3
Q
Basic research
A
Little direct clinical application, takes place in a carefully controlled lab and goal is to address theoretical issues or to explain questions in basic science
4
Q
Applied research
A
Offers direct clinical application, takes place in laboratory or non-laboratory settings designed to replicate authentic and functioning environment and goal is to provide direct solutions to practical problems and contribute to theory-based knowledge
5
Q
Dr. K wants to understand how gait is affected in individuals with Parkinson’s disease. What kind of research is this?
A
Basic
6
Q
Dr. K wants to study the effect of hippotherapy on the social behavior of children with Autism Spectrum Disorder. What kind of research is this?
A
Applied
7
Q
Stages of the scientific research process
A
- Identify a topic
- Search and review the literature
- Define a topic
- State a general question or problem
- Phrase an operationally defined hypothesis
- Pan the methods to test the hypothesis
- Collect the data
- Analyze data and interpret results
- Write about findings
8
Q
What is Nuremberg doctor’s trial of 1946?
A
Focused on heinous nazi human experimentation. Prisoner participation was forced and torture was an extreme example of coercion tactics
9
Q
What is the Nuremberg Code of 1947?
A
Voluntary consent, benefits outweigh risks, ability to withdraw
10
Q
What is the Declaration of Helsinki in 1964?
A
Concern for interest of the participant must prevail
11
Q
What is the Belmont Report in 1979?
A
Respect for persons, beneficence and justice
12
Q
What does respect for persons mean?
A
Recognizes that individuals should not be pressured into doing something that they feel uncomfortable doing or that violates their own personal system
13
Q
What is beneficence?
A
Refers to the ability of the practitioner to secure and stabilize the well-being of the client while that client is receiving treatments or involved in a research project
14
Q
What is justice?
A
Who should benefit from the findings of the research produced?
If benefactors of medical research are coming from a better social class, ideal health, age or weight and financial standing, then an injustice has occured
15
Q
What is informed consent?
A
Disclosure of what the research entails
16
Q
What are safeguards taken to protect human subjects?
A
CITI training, conflict of interest and the IRB
17
Q
EBP is a systematic inquiry process in which you…
A
- Assess
- Answer
- Acquire
- Appraise
- Apply evidence to answer clinical problems
This is Hayward’s Evidence-Based Information cycle
18
Q
What is the 3 part approach to patient care?
A
- Valid research findings grounded in theory and science
- Clinical expertise and practical experience
- The medical needs, psycho-social interests and ethical and religious values of the individual patient
19
Q
What is EBP essentially about?
A
- Recognizing clinical problems
- Asking good clinical questions
- Finding, critically evaluating, analyzing and synthesizing evidence
- Applying the most relevant evidence to clinical decisions and patient care recommendations
20
Q
When you assess and ask you must be….
A
Specific, clear and answerable
21
Q
When asking a focused clinical question, what model do you follow?
A
PICO
Population, intervention, comparison and outcome
22
Q
What is included in population?
A
Person, location and condition/patient characteristic
23
Q
What is included in intervention?
A
Length, location and type
24
Q
What is included in comparison?
A
Another intervention, no intervention and location of the intervention
25
What is included in the outcome?
Decrease incidence of falls, decrease incidents of falls and effects, decrease incidence of falls or severity, avoid hospitalization and avoid subsequent falls
26
To access research literature efficiently, you must...
Find current, valid and high-quality evidence and conduct an exhaustive search
27
What does it mean to critically appraise literature?
Determining if the study is valid and calculating the importance of research findings; the 'so what'
28
How do you conduct an article appraisal?
Ask 3 questions:
1. Is the study valid?
2. What are the results?
3. Will the results help my patients?
29
Is all evidence created equal?
No
30
What are the two sources of differences in strength of evidence?
Sampling (number of participants) and research methods (Hierarchy for strength of evidence for treatment decisions and the Oxford Center for Evidence Based Medicine Hierarchy)
31
What is the Oxford Center for Evidence-Based Medicine Hierarchy figure?
Best type of study you can find is a level 1
32
What is the gold standard of study designs?
Prospective designs; followed over time
33
What are retrospective study designs?
Studies that already have the impairment of interest
## Footnote
Ex: After an ACL tear, you look back at the preseason and see lack of flexibility
34
What is a within patient, randomized treatment order trial?
Patients receive all interventions in a random order and patients serve as their control to minimize differences between patients.
## Footnote
Limitations: Not seen very often and if you are doing all interventions to the same patient, you can't go back to their original state
35
What happens in a Systematic Reviews of Randomized Trials?
- Data acquired from existing literature through a planned search process
- May undergo statistical analysis - meta analysis
- Because data from multiple studies are combined statistical power is increased
36
What happens in a randomized clinical trial?
- Assigns individuals to a treatment group through a random allocation
- It is always prospective to allow for greater control over factors that confound the identification of cause-effect relationships
- It is the most effective approach with controlling unwanted influences and demonstrating cause and effect
- Used for intervention studies
37
What are cohort studies?
- May be prospective or retrospective
- Involve the study of groups based on exposure or intervention, assessing for differences in outcomes
- Group of subjects are followed over time
- Lacks random assignment
38
What are case-controlled studies?
- Retrospective approach
- Subjects are known to have the outcome of interest and compared to the control group
- Determine whether an association exists between a disease and a particular risk factor
- Study groups defined by outcome
- Comparisons are made between groups of subjects based on an outcome rather than an exposure or intervention
39
What do case series and case studies do?
- Provide detailed descriptions of a series or a single case
- Do not provide statistical comparison but describe the course of care
- Because only a single or a few cases are reported, it is NOT possible to make inferences with regard to cause and effect or generalize the outcome of the cases with confidence
40
What are laboratory studies?
- Oxford Center for Evidence Based Medicine: Bench and animal research
- Conclusions drawn cannot be generalized directly to human patients
- Very important for the advancement of our science and social theory
41
What is anecdotal evidence?
- Unpublished clinical observations, unsystematic clinical observations
- Clinician experience plays an important role
42
What is the relevance of hierarchy of evidence to a clinical problem?
Problems occur when the evidence is not strong or conflicting and the patient differs from those described within the research
43
What is the goal of using evidence to help you and the patient?
To summarize the findings and determine how or if the evidence connects the clinical problems and provides a clear answer. Also establishes conclusions directly supported by the evidence
44
When did the term EBP begin to appear in PT?
1990s
45
What was the purpose of the article by Schreiber and Stern?
Gather info and show how we can use EBP in PT
46
What were the 3 discussed challenges and barriers to implementing EBP?
1. Research methods (critical appraisal, skills to identify if an article is good or not)
2. Clinician skills (skill set of the clinicians)
3. Logistical considerations (time and access to articles)
47
How can prognostic studies help?
Assist in identifying treatments that are most likely to lead to a favorable outcome
48
Independent variable
1. Manipulated by the researcher
2. Believed to cause a change in the DV
49
Dependent variable
1. What your measure in the experiment
2. Responds to the IV
3. Depends on other factors
50
Will electrical stimulation decrease low back pain? What is the independent variable?
Electrical stimulation
51
Will stochastic vibration during treatment improve sitting postural control in infants with moderate to severe CP? What is the dependent variable?
Sitting postural control
52
What does replication of the scientific method ensure?
That the findings can be generalized to a broader population
53
Hypothesis testing is typically performed to assess what?
1. Difference in the scores of a dependent variable between two or more groups
2. Difference in the scores of a dependent variable over time within the same group
54
What are the most common measures of central tendency used in health care?
Mean (median and mode are used less often)
55
What is the mean?
Arithmetic average of scores across all sampled subjects
56
What is the median?
The individual score that separates the higher half of scores from the lower half of scores
(n+1)/2
57
What is the mode?
Score that occurs most frequently out of all included oberservations
58
What is dispersion?
Variability, of often observed values
59
What is the range?
The arithmetic difference between the highest and lowest scores in the data set
60
What is the standard deviation?
How much the scores of individual subjects tend to deviate from the mean
61
What are outliers?
Individual scores at the low and/or high extremes of the data set
62
What does a large SD indicate?
The more spread out variable scores are around a mean
63
What is normal distribution?
68% of data points for the entire data set lie within +/-1 SD of the mean
95% lie within +/- 2 SD of the mean
99% lie within +/- 3 SD of the mean
64
What is variance?
SD squared (s^2)
Measure of spread: Variance shows the degree of variation within a data set.
Relationship to the mean: It considers the deviation of every data point from the mean to give a comprehensive view of the data's spread
65
What is the alternative hypothesis?
The investigator assumes that the independent variable is going to cause a change in the dependent variable
66
What is the null hypothesis?
It is assumed that the independent variable will NOT cause a change in the dependent variable
67
What is the relationship between the mean and SD?
The normal curve
68
In the normal curve, the mean, median and mode is the _____?
Same
69
What is a type I error?
False positive; difference in my data but no difference in the overall population
70
What is a type II error?
False negative; difference in my data does not exist, but there is a difference in the overall population
71
What is a more serious error?
Type I
72
Experiments are performed on a representative ______ of subjects rather than on the entire ______ of individuals
sample; entire population
73
What does the sampling frame represent?
The group of individuals who have a real chance of being selected for the sample
Investigators need to establish specific inclusion and exclusion criteria for the subjects in the study
74
Convenience sampling
Potential subjects are selected based on the ease of subject recruitment
75
Purposive sampling
Nonrandom sampling that entails potential subjects from a predetermined group to be sought out and sampled
76
Is convenience or purpose sampling better?
Purpose; data is more meaningful
77
What is a one-shot posttest study design?
XO
Do the intervention then the group that receives evaluation after intervention
78
What is a one-group pre-test posttest design?
OXO
Test partcipants before, do the intervention then test them again after
79
What is a static-group pretest-posttest design?
OXO
O O
Two groups, one group receives the intervention and the other group is the control. They receive an eval before and after the intervention
80
What is a static-group posttest design?
XO
O
Two groups, no pretest, just posttest
81
What is a true experimental design?
Contains randomization of subjects to groups
82
What is a randomized posttest design?
R XO
R O
Two randomized groups with an evaluation after the intervention. One experimental group and one control group
83
What is a randomized pretest-posttest design?
R OXO
R O O
Two randomized groups, one experimental and one control with a pretest and posttest
84
What is the best type of design?
Randomized pretest-posttest design
85
What is categorical (nominal) data?
Involves a finite number of classifications for observations
Ex: gender, blood type
86
What is ordinal data?
Ordering based on numerical classification
Ex: Surveys
87
How do you navigate searches with controlled vocabularies?
Use major and minor subject headings
Major
1. Concept is the main focus of the article
2. Will search for the concept as both major or minor concept
3. Broader search
Minor
1. Content is discussed to some degree but is not the main focus
2. Will show as MM tag
3. More narrow
88
Boolean operators
1. AND narrows search
2. OR makes more
Be careful of "and not" as it may exclude too much information
89
What is biomedical research?
Field in which questions related to the functions of the body, disease, responses to medications, injury mechanisms, disease an injury patterns, among others, are addressed
90
What is basic science or bench research?
Conducted in a lab environment under tightly controlled conditions
91
What is field research?
Conducted away from the laboratory, often in a natural setting
92
What is translational research?
Used to describe investigations that apply the results from basic science to the care of patients
Evidence Based Practice
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