clinical Inquiry
Primary studies
"original studies"
Secondary Research studies
"studies of studies" that summarize information from multiple primary studies
How many steps are in EBP process
5
What do you want the Index variability to be under
50% is moderate
Clinical Expertise
Ability to use our clinical skills and past experience to rapidly identify each patients unique health state and diagnosis, their individual risks and benefits of potential interventions, and their personal values and expectations
Data that may be generated from a patient History
Activities and participation, current conditions, family history, General demographics, general health status, growth and development, living environment, social history, social/health habits, review of systems, medications, medical history
4 steps to appraising a systematic review
Applicability, quality, Results, Clinical bottom line
Background questions
Ask about general information and are not specific to an individual patient
What can clinical questions be divided into
Background and foreground
Patients Values include: (3)
Beliefs, preferences, expectations
The 3 different outcome measures levels of ICF
Body structure and functions, activity, and participation
Who developed the Gold Standard method for conducting systematic reviews
Cochrane Collaboration
Tertiary
Collection of primary and secondary source material (authorship not always clear)
A high-quality, clinically applicable systematic review provides what 3 things in one document
Comprehensive literature review, appraisal, and synthesis of study results
What is step two in the EBP process
Conduct a search to find the best possible research evidence to answer your question
What is step three in the EBP process
Critically appraise the research evidence for applicability and quality
MeSH Terms
Designed to provide a common and consistent language across published articles. narrow search
Where is the purpose usually found in a Systematic Review
End of the introduction
What is step five in the EBP process
Evaluate the effectiveness and efficacy of your efforts in steps 1-4 and identify ways to improve them in the future
Six Essential elements of the patient/client management model
Examination, Evaluation, Diagnosis, Prognosis, Intervention, Outcomes
What are the 5 steps of EBP designed to do
Facilitate a structured approach to EBP
Searchable Clinical Questions
Foreground questions about a patient that are structured to help you find the necessary research evidence as efficiently as possible
What is step one in the EBP process
Identify the need for information and develop a focused and searchable clinical question
Clinical Expertise
Implicit and explicit knowledge about physical therapy diagnosis, treatment, prevention, and prognosis gained from cumulative years of caring for patients with disease and injury and working to improve and refine that care
What is step four in the EBP process
Integrate the critically appraised research evidence with clinical expertise and the patient's values and circumstances
What does ICF stand for
International Classification of Functioning, disability and Health
Clinical Research
Involves human subjects and answers questions about diagnosis, intervention, prevention, and prognosis in relation to disease or injury
Clinical Reasoning
Is a non-linear, recursive cognitive process in which the clinician synthesizes information collaboratively with the patient, caregivers, and the health care team in the context of the task and the setting. The clinician reflectively integrates information with previous knowledge and best available evidence in order to take deliberation action
Applicability
Is this article sufficiently similar to answer my PICO
Where is the outcome measures found in a Systematic Review
Methods
What does PICO stand for
Patient (population), Intervention, Comparison, Outcome
3 elements to focused, searchable, clinical questions
Patients characteristics, Patient mangement, outcome of interest
Most commonly appraisal tool for physical therapy literature
Physiotherapy Evidence Database (PEDro) Scale
PEDro
Physiotherapy evidence database
Narrative Reviews
Provide an overview of literature and are commonly published in peer-reviewed research journals. Not researched studies. risk for author bias
Small squares
Represent the mean effect size for each individual study
Diamond
Represents the mean effect size from the meta-analysis
"Pooled"
Represents the results of the meta-analysis
Language Bias
Results when important study results are excluded from a systematic review because of language
What 3 sources does EBP come from ?
Scientific research, Clinical expertise, Patient values and circumstances
Foreground Questions
Specific to a particular patient, condition, and clinical outcome of interest
Meta analysis
Statistical method used to summarize outcome across multiple primary studies, usually as a part of a systematic review
Systematic Reviews
Studies that combine other studies
What type of studies are at the top of the evidence based pyramid
Systematic reviews but meta analysis are even better
Publication Bias
Tendency for studies with positive results to be published more often than studies with nonsignificant results
What do tests of statistical heterogeneity assess
The likelihood that the variability between studies is due to chance
Barriers to EBP
Time, lack of generalizability of research, Lack of research skills, Lack of understanding of statistics, lack of search and appraisal skills, Lack of information resources, Inconsistent culture of EBP in PT
What is the purpose of EBP
To use the best available evidence from all sources to optimize our patients benefit from PT
Assessment of clinical Heterogeneity
When authors conduct a qualitative analysis of these variables among the included studies. Patients characteristics, interventions, outcomes
Best Research evidence
clinically relevant research into accuracy and precision of diagnostic test, power of prognostic markers, efficacy and safety of therapeutic, rehabilitative and preventive regimens, identification and prevention of harm
Patients Circumstances include: (3)
co morbidities (pass medical history), access to care, support network
Database
compilation of research evidence resources, primarily lists of peer-reviewed journal articles, designed to organize the large amount of research published every year
Scientific research
empirical evidence acquired through Systematic testing of a hypothesis
Six components to Patient Management
examination, evaluation, diagnosis, prognosis, intervention, outcome measurements
Forest Plots
graphical representation of the studies included in a systematic review.
What is clinical decision making
how we make decisions about the best way to treat patients . many definitions
What quantifies heterogeneity
index variability I^2
Evidence based Practice
method of clinical decision making and practice that integrates the best available scientific research evidence with clinical expertise and a patients unique values and circumstances
Bias
occurs when a study results are affected by unknown or unacknowledged errors resulting from the studys design to protocol
Basic Science Research
often involves non-human research and is fundamental to evidence based physical therapy
Appraisal
process of determining whether an article is applicable to your question and if it is of sufficient quality to help you make a decision
horizontal lines
represent the confidence interval for each study's effect sizes
Vertical line or Line of No Effect
represents the point on the scale at which neither treatment is favored over the other.
Abstract
summary of a study
Best available research evidence
the clinically relevant research available at the time the question is asked
Search Engine
user interface that allows specific articles to be identified in a database
Boolean
using AND and OR