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