EBP: Class 2

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EBP: Class 2
2012-08-25 17:06:05
evidence based pratice

review of Class 2 from EBP
Show Answers:

  1. What is EBP?
    integration of best research evidence with our clinical expertise and our patient's unique values and circumstances
  2. Name the 3 sources for evidence?
    • patient's unique values and circumstances
    • best research evidence
    • clinical expertise
  3. KEY POINT: The best research evidence, our clinical expertise, and our patient's unique values and circumstances should INFORM our practice.
    • as therapists, we make the decisions about patient care.
    • These decisions should be intelligent ones
  4. What is Step 1 for EBP?
    Ask a focused clinical question
  5. In step 1 for EBP, what makes a clinical question well-built?
    • question should be directly relevant to problem at hand
    • question should be phrased to facilitate searching for a precise answer
  6. What are the types of clinical questions that should be asked in step 1 of EBP?
    foreground and background questions
  7. What are background questions?
    • Ask for information about a condition
    • Have two essential components
    • -a question root (who, what, where, when, how, why) with a verb
    • -a condition or an aspect of a condition
    • Can cover a range of biologic, psychological, or sociological questions
  8. What are foreground questions?
    • ask for specific information about managing patients with a condition
    • Have 3 essential components:
    • -patient and/or problem
    • -exposure (intervention) or comparison intervention
    • -clinical outcomes
  9. What type of question:
    Who are the people most affected by hypertension?
  10. What type of question:
    What are the common characteristics of people with agenesis of the corpus callosum?
  11. What type of question:
    In young children with spastic cerebral palsy, what predicts if they will eventually walk?
  12. What type of question:
    When do complications following rotator cuff surgery usually occur?
  13. What type of question:
    In patients who have had a head injury, does neurodevelopmental therapy improve upper extermity function more than constraint induced therapy?
  14. What type of question:
    In older patients with stroke, what frequency and duration of constraint induced therapy is most effective?
    foreground question
  15. What type of question:
    How do surgeons correct for valgus deformity when performing a total knee arthroplasty?
  16. What is the Occupational therapy process?
    • 1. Evaluation
    • -occupational profile
    • -analysis of occupational performance
    • 2. Intervention
    • -plan
    • -implementation
    • -review
    • 3. Outcomes
  17. What is the physical therapy patient/client management?
    • 1. examination
    • 2. evaluation
    • 3. diagnosis
    • 4. prognosis
    • 5. intervention
  18. What are the 3 parts of a clinical question (PECO)?
    • 1. Participants (patients you want to treat)
    • 2. Exposure (an intervention if about therapy) and/or Comparision (there is always an alternative-another therapy, nothing...)
    • 3. Outcome (usually a disease or condition you want to prevent or manage)
  19. Clinical questions can relate to:
    • intervention
    • prevention
    • harm/risk
    • cause/etiology
    • differential diagnosis
    • diagnostic testing
    • prognosis
    • cost effectiveness
    • quality of life
  20. What is step 2 for EBP?
    search for the best research evidence to find answers to your question
  21. What are major sources of knowledge/information for step 2 in EBP?
    • tradition
    • authority
    • trial and error
    • logical reasoning
    • scientific method (research)
  22. Step 2: Major source of knowledge/information:
    • something thought to be true simply because people have always known it to be true -- we inherit knowledge and accept precedent
    • accepted as truth, even if proven not to be true
    • rehabilitation science is steeped in tradition as a guide to practice and as a foundation for treatment
  23. Step 2: Major source of knowledge/information:
    • sources of information based on specialized training or experience
    • content of continuing education courses often is based on authority
  24. Step 2: Major source of knowledge/information:
    Trial and Error
    try something, if it seems to work satisfactorily, keep doing it
  25. Step 2: Major source of knowledge/information:
    Logical reasoning
    • all of us use this to try to answer questions and aquire new knowledge
    • combines personal experience, intellectual faculties, and formal systems of thought
    • IF-THEN kinds of reasoning
  26. Step 2: Major source of knowledge/information:
    Scientific Method (Research)
    • definition: a systematic, empirical, controlled, and critical examination of hypothetical propositions about associations among natural phenomena
    • systematic: logical sequence from identificiation of problem, organized collection and analysis of data, and interpretation of findings
    • Empirical: documentation of reliable data through direct observation--grounded in reality, not in the bias of the observer
    • controlled: control factors not directly related to variables being studied. control extraneous influences
  27. Types of Evidence:
    • not all information or types of information are equal
    • some types of information answer certain questions, such as background and foreground questions, better than other types of information
    • when you search for published information, start by looking for the most credible evidence first
  28. Peer reviewed publications:
    • evaluation of work by other people in same field in order to maintain or enhance quality of work in field
    • based on concept that a larger and more diverse group of people will usually find more weaknesses and errors in a work and will be able to make a more impartial evaluation of it than will just the person or group responsible for creating the work
    • uses independence, and in some cases ananymity, of reviewers in order to discourage cronysim (favoritism) and obtain an unbiased evaluation
  29. KEY POINT: Even among peer reviewed journals, there is no consistent process/level of rigor
    How much trust will you put into the review of others?
    • for effective EBP in your practice, you want to have a good degree of skill in reading and appraising journal articles
    • -includes understanding research design and statistical analysis
    • -course is not about making you researchers, but help you become smart consumers of research
  30. Hierarchy of Study Types:
    • 1. Evidence-based clinical guidelines
    • 2. Systematic reviews and meta-analyses of randomized controlled trials
    • 3. Randomized controlled trials
    • 4. Non-randomized intervention studies
    • 5. Observational studies
    • 6. Qualitative studies
    • 7. Case series, case reports
  31. Strength of Evidence Ratings for Guideline Recommendations: A=
    • strong research based evidence
    • -multiple relevant, high quality studies
  32. Strength of Evidence Rating for Guideline Recommendations: B=
    • moderate research based evidence
    • -one relevant, high quality study
  33. Strength of Evidence Rating for Guideline Recommendations: C=
    • limited research based evidence
    • -one adequate study, somewhat relevant
  34. Strength of Evidence Rating for Guideline Recommendations: D=
    • panel opinion
    • -based on information not meeting criteria for A-C
  35. Name the Levels of Evidence from better to less good:
    • systematic reviews and meta-analyses
    • randomized controlled/clinical trials
    • cohort studies
    • case-control studies
    • case series
    • cases studies/reports
    • narrative reviews, expert opinion, textbooks
  36. Systematic reviews:
    • literature reviews focused on a single question that try to identify, appraise, select and synthesize all high quality research evidence relevant to that question
    • like scientific investigations in themselves, using pre-planned methods an assembly of original studies that meet their criteria as 'subjects'. They synthesize the results of an assembly of primary investigations using strategies that limit bias and random error
  37. Meta-analyses:
    • The statistical analysis of a large collection of results from individual studies for the purpose of integrating the findings.
    • Adopted by many fields to document empirically-based practices.
    • Used to synthesize research findings and evaluate the effectiveness of treatments or accuracy of diagnostic tools.
  38. Randomized Controlled/clinical Trials:
    • Randomized controlled clinical trials are experimental studies of cause and effect relationships between treatments and outcomes.
    • -treatment=independent variable
    • -outcomes=dependent variables
    • Randomization is the best control for bias
    • 3 ways to randomize for a study, each of which may or may not be part of the design
    • -random selection of a sample from the sampling frame of the population
    • -random assigment of the sample to groups
    • -random assignment of groups to treatments and control conditions
  39. Cohort Studies:
    observational studies in which a defined group of people (the cohort) is followed group of people (the cohort) is followed over time (also known as longitudinal studies). The outcomes of people in subsets of the cohort are compared, to examine people who were exposed or not exposed (or exposed at different levels) to a particular intervention or other factor of interest
  40. Case Control Studies:
    • Observational research comparing subjects who have a specific condition (the cases) with patients who do not have the condition but are otherwise similar (the controls)
    • No intervention is provided on the part of the researchers. People who already have the condition of interest are compared to a group of people without the condition
  41. Case Series:
    • Descriptive research. A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information and information on diagnosis, treatment, response to treatment, and follow-up after treatment
    • A medical research study that tracks patients with a known exposure given similar treatment or examines their medical records for exposure and outcome (also known as a clinical series)
  42. Case Studies/Reports:
    • describe practice. They often focus on a patient or a group of patients, but they may also focus on facilities, education programs, or other definable units. Topics often include patient/client management, ethical dilemmas, use of equipment or devices, etc.
    • Case reports can't prove effectiveness, test hypotheses, or prove cause and effect, and the outcomes that they report can't be generalized to patients or entities
  43. Narrative Reviews, Expert Opinion, Textbooks:
    • typically based on observation and experience, however sometimes based on "that's how it's always been done"
    • Different from the "clinical expertise" aspect of EBP, which relates to the expertise of the individual therapist strivign to inform her/his practice through use of the evidence and the patient's unique values and circumstances.
  44. Is age of an article important condsideration for clinical practice guidelines and systematic reviews?
    • yes
    • clinical practie guidelines are considered obsolete after 5.8 years
    • cochrane collaboration policy is that systematic reviews are updated every two years
  45. Is age of an article important consideration for RCTs, Cohort, Case-Control, Case Series, Case Reports, and Qualitative Studies?
    • it is less important
    • -some influential studies are over 20 years old
    • -do search for replication studes of germinal articles
  46. KEY POINT: Often when you're looking at a reference list or list of articles in a database, you can determine what kind of article and publication it is. If you can, it helps you narrow down the type of information that would be most helpful to answer your question-
    a review article, a research article, an opinion piece, a text book or book chapter, etc.
  47. KEY POINT: We must critically appraise the integrity of each source of evidence:
    • clinical expertise
    • best research evidence
    • patient's unique values and circumstances