DPT 611 Quiz 1
Inductive theories
-Data based and evolve through a process of inductive reasoning, beginning with empirically verifiable observations -Through multiple investigations and observations, researchers determine variables that are related to a specific phenomenon and those that are not. -Patterns that emerge from these studies are developed into a systematic conceptual framework, which forms the basis for generalizations. -Used by Skinner
Disablement Model
-Framework for assessing the effect of acute and chronic conditions by emphasizing functional consequences and social role -Demonstrates the relationships among pathology, impairments, functional limitations, and disability.
Biomedical model of health
-Health is viewed as the absence of disease -Assumes that disease/injury can be treated and cured -Focuses only on physical aspects of health -Does not consider how the patient is affected by illness -"Quick fix" or "band-aid" approach -This model is inadequate with the common problems of aging, chronic disease and disability, which do not fall within the rubric of "treat and cure"
Sources of data
-Most research involves direct data collection based on the performance of subjects according to a defined protocol. -Surveys or questionnaires are often used to collect data on subject characteristics or opinions, as part of descriptive, exploratory, or experimental studies. -As large databases begin to develop, researchers often use secondary analysis as a mechanism for exploring relationships.
IRB
-Must review research proposals prior to implementation to ensure that the rights of research subjects are protected. •Must be composed of at least five members. •It may not consist of all males, or all females or all members of one professional group. •At least one member must be concerned primarily with nonscientific issues and may be a lawyer, clergyman, or ethicist. •One member, a "public" member, cannot be affiliated with the institution where the research is to be conducted. •Reviewers determine if risks and discomforts to the subject have been minimized and are sufficiently outweighed by the potential benefits of the proposed study - the risk benefit ratio. •IRB examines the procedures for selecting subjects, ensuring voluntary informed consent.
Quasi-experimental Studies
-Not truly randomized -Degree of control is limited by a variety of factors, but interpretable results can be obtained -Used when true experimental conditions cannot be achieved, these designs permit comparisons, but they also acknowledge the limitations placed on conclusions.
Theory and research
-Observable outcomes of research can be organized and ordered to build theories using inductive reasoning. -Theories must be tested by subjecting deductive hypotheses to scientific scrutiny.
Beneficience
-Refers to obligation to attend to the wellbeing of individuals -All who engage in clinical research are bound to "maximize possible benefits and minimize harm" -Risks may be physical, economical, social or psychological Potential Benefits -New knowledge that can be applied to future subjects or patients -Knowledge that may have direct impact on study participants Risks must be reasonable in relation to anticipated benefits
Quantitative propositions
Based on frequency or duration of a specific behavior Ex. Theories of fatigue are based on concept of repetitive exercise and muscular endurance
Propositions
Formed once the concepts that relate to a theory are characterized into a generalization State the relationship between variables, which can be described in several ways.
Scientific Method
Incorporates elements of deduction and induction in a systematic and controlled analysis of phenomena Systematic, empirical, controlled, and critical examination of hypothetical propositions about the relationships among natural phenomena
Informed consent must be written in ____ terms
Lay -Informed consent process implies subjects understand what they are told and what they are reading. -Language must be clear and basic so that the average reasonable individual can follow it. -'Perform a maximal isometric contraction' - unacceptable language -Language should be written for the lowest educational level that would be expected for subjects.
What does a synthesis of literature provide clinicians with>
critical analysis of current research that can be sued for clinical decision making
Testing a theory
-A single research study does not 'test a theory'. -Results of research will demonstrate certain facts, which will either support or not support the hypothesis. -If the hypothesis is supported, then the theory from which it was deduced is also supported.
Concepts
-Abstractions that allow us to classify natural phenomena and empirical observation -We develop these within the context of experience and feelings so they meet reality -We supply labels to sets of behaviors, objects, or processes that allow us to identify them and discuss them. -Can be manipulated as variables -Variables become concepts used for building theories and planning research
How clinicians utilize theory in practice
-Clinician engage in theory testing on a regular basis in practice. Theories should guide clinicians in making decisions. -Specific therapeutic modalities are chosen for treatment because of expected outcomes that are based on theoretical assumptions. -Theory is tested each time the clinician evaluates treatment outcomes. -When a theory is used as the basis for a treatment, the clinician is hypothesizing that the treatment will be successful.
Constructs
-Concepts that represent nonobservable behaviors or events -Names for abstract variables that cannot be seen directly but are inferred by measuring relevant or correlated behaviors that are observable
Hypothetical-deductive theories
-Developed with few or no prior observations, and often requires the generation of new concepts to provide adequate explanation. -Theory is developed on the basis of great insight and intuitive understanding of an event and the variables most likely to impact that event. -Freud's theory of personality - Id, ego, superego -Must be continually tested in the "real world" to develop a database that will support them. Einstein's theory of relativity
Applied research
-Directed toward solving immediate practical problems with functional application and testing theories that direct practice -Usually carried out under actual practice conditions on subjects who represent the group to which the results apply to -MOST CLINICAL RESEARCH
Basic research
-Done to obtain empirical data (observational data) that can be used to develop, refine, or test theory -Directed toward obtaining new knowledge for its own sake, motivated by intellectual curiosity -Lacks reference to potential practical use of results -Typically done in a lab -Often called "bench research"
Measurement of Outcomes in Rehab
-Historically, outcomes were often related to improvements in impairments or pathologies. -Effects of intervention now includes patient satisfaction, patient preferences, self-assessment of functional capacity and QOL. -Consumers and reimbursement policies have obligated health care practitioners to define and document outcomes, and to prove the efficiency and effectiveness of treatment.
Use of control groups
-Research often requires a control group, or placebo group, for experimental comparison. -RCTs are used to determine whether an intervention has a significant effect on subjects who receive the treatment compared to those who receive no treatment or a placebo -Random assignment of subjects to the treatment or control group, allows researchers to control confounding variables that could affect the outcome of the study. -Researcher is obligated to inform the potential participants when a study is planned that includes a control group. -Subjects should know that there is a chance that they will receive the treatment being studied and a chance that they will not receive the treatment. -Researchers are obligated to discuss alternative treatments that would be appropriate for each patient-subject if such alternatives are employed in clinical practice.
Experimental research
-Researcher manipulates and controls one or more variables and observes the change in other variables -Purpose is to compare conditions or intervention groups, to suggest cause-and-effect relationships -Provides basis for comparing two or more conditions for the purpose of determining cause and effect relationships
Models
-Serves as an analogy for a real phenomena -Structural representation of the concepts that comprise the theory -Ex. Model of DNA, model of muscle spindle -Scientists use animal models to mimic specific anatomical or physiological deficits in humans to examine the effects of pathology, trauma, and intervention. -Models can be a schematic representation, such as an architect's plans or a map. -Therapists might use this type of model when evaluating a client's home for architectural barriers. -Decision making models are used to suggest the most effective progression of intervention with specific disorders.
Steps of EBP
-Starts by asking a relevant clinical question -This question will provide direction for decision making related to a patient's diagnosis, prognosis or intervention -Questions may relate to the cause of the patient's problem, the validity of clinical guidelines, safety or cost-effectiveness of care.
What is the purpose of a theory?
-Summarize existing knowledge, giving meaning to isolated empirical findings -Used to explain observable events by showing how variables are related -Allow for prediction of what should occur -Provide basis for predicting phenomena that cannot empirically verified -Help to stimulate the development of new knowledge by providing motivation and guidance for asking significant clinical questions.
What are the three paradigm shifts that have recently emerged in rehab and medicine?
-The focus of outcomes research to document effectiveness -The application of models of health and disability -Most recently attention to EBP
What are the limitations of inductive reasoning?
-To be absolutely certain of an inductive conclusion, the researcher would have to observe all possible examples of the event. -Often not feasible to observe all possible examples - we rely on imperfect induction based on incomplete observation -Used in the discussion section of a research report where generalizations or conclusions are proposed from the data obtained in the study. -Does not allow us to reach infallible conclusions.
Law
-When a theory does reach the level of absolute consistency in outcomes -Generally have a wider scope than theories and allow precise predictions. -Are not established in the applied sciences as they are in the physical sciences. -The nature of human beings and their interactions with the environment does not allow our theories to become so precise in their prediction.
When was the Declaration of Helsinki adopted and what did it do?
1964 •Addressed the concept of independent review of research protocols by a committee of individuals who are not associated with the proposed project •Principles have been incorporated into the U.S. Department of Health and Human Services (DHHS) Rules and Regulations.
Most theories are formulated using which type of theory?
A combo of the two types
Clinical Research
A structured process of investigating facts and theories and exploring relationships -A systematic way to examine clinical conditions and outcomes -Establishes relationships among clinical phenomena -Generates evidence for decision making -Incentive for improving methods of practice
Deductive reasoning
Acceptance of a general proposition, or premise, and the subsequent inferences that can be drawn in specific cases. 1) A major premise 2) Minor premise 3) Conclusion -All living things must die -Man is a living thing -Therefore all men must die
What established rules and regulations that govern conduct of research in the US?
Belmont Report 1979
What is Step 5 of the research process?
Communication of Findings -Research done in a vacuum is of little use to anyone. -Researchers have a responsibility to share findings with the appropriate audience so others can apply the information to clinical practice or to further research. -Sharing information can take many forms: journal articles, abstracts, oral presentations, and poster presentations.
We can never _______ or ______ a theory
Confirm or prove -We can only demonstrate that a theoretical premise does or does not hold true in a specific situation. -When a research hypothesis is tested and it is not rejected - the study turns out the way we expected -we cannot state that the underlying theory is definitely true
Randomized Control Trials (RCT)
Considered the "GOLD STANDARD" of experimental designs Typically involves controlled comparison of an experimental intervention and a placebo
Theory
Created out of a need to organize and give meaning to a complex collection of individual facts and observations A plausible general principle or body of principles offered to explain phenomena Scientific theory deals with the empirical world of observation and experience, and requires constant verification
What is Step 4 of the research process?
Data Analysis -Involves analyzing, interpreting, and drawing valid conclusions about the data. -Pulling together of all the materials relevant to the study to apply them to a generalized or theoretical framework. -Statistical procedures are applied to summarize quantitative information in a meaningful way -Usually done using data analysis software
Qualitative research
Data gathered through narrative description, typically is obtained under less structured conditions Measurement is based on open ended questions, interviews, observations Purpose of this research may be to simply describe the state of conditions, explore associations, formulate theory, or generate hypotheses.
What is Step 2 of the research process?
Design the study -Plan the methods of subject selection, testing, and measurement so that all procedures are clearly stated -Carefully define all measurements and interventions so that the methods for data analysis are clear
Empirical Data
Documenting objective data through observation Findings are grounded in reality rather than bias Researcher must attempt to control factors that are indirectly related to the variables in question
How outcomes can be measured
Economic indicators -Cost effectiveness -Cost-benefit ratio Function and health status Determined by questionnaires -QOL -HRQOL -Physical psychological and social function
What are the characteristics of a good theory?
Economical (efficient, relevant info) Important (to those who will use it) Accept that theory can change
Clinical research must be ______ and ______.
Empirical and critical Results must be observable, documented, and examined for their validity Can be done in many ways and in many settings.
Evidence-Based Practice
Fundamental principle of quality care where choices made have been confirmed by sound, and decisions are based on the best evidence currently available. Sometimes info is not available and decisions are made based on best logical, educated guess.
What is Step 1 of the research process?
Identify the problem -Review existing literature and formulate a specific research question that provides an opportunity for scientific testing -Define the type of individual to whom the results will be generalized -Be able to provide a rationale for the study - a justification of the need to investigate the problem and a theoretical framework for interpreting results.
A written proposal and informed consent must be submitted to _____ for approval?
Institutional Review Board (IRB)
Nonexperimental research
Investigations that are more descriptive or exploratory in nature that do not exhibit direct control over studied variables "OBSERVATIONAL RESEARCH"
Quantitative research
Involves measurement of outcomes using numerical data under standardized conditions Advantage: The ability to summarize scales and to subject data to statistical analysis
Limitations of the Scientific Method
It is not perfect Especially when applied to human behavior or performance Some variables cannot be controlled (psychosocial and physiological) Researchers must be aware of extraneous influences
What is Step 3 of the research process?
Methods Researcher implements the plans designed in steps 1 and 2. Data collection is typically the most time consuming part of the research process. After data are collected and recorded, the researcher must reduce and collate the information into a useful form for analysis.
Consent elements
Must be voluntary Special consideration must be given to those who are vulnerable Subjects must be free to withdraw at any time
When did the first formal guidelines defining ethical human research emerge?
Nuremberg Code of 1949
Case Studies or Case Series
Observing one or several patients, to document unusual conditions or the effect of innovative interventions.
Clinical research is often what type of research?
Often, clinical research is a hybrid between the two types of research Clinical application along with gaining new knowledge
Temporal propositions
Orders concepts in time and states a sequence of events Ex. Transtheoretical model explain behavior change as a process along a continuum of motivation readiness to change
What does PICO stand for?
Patient/population Intervention Comparison Outcome
Systematic Reviews
Present comprehensive analysis of literature on a particular topic, typically an intervention, diagnostic test, or prognostic factors
What prinicples are cosnidered standard throughout the U.S.?
Principles guiding biomedical research and the rules and regulations declared by the 1974 National Research Act ensure protection of human subjects in research
Meta Analysis
Process of statistically combining the findings from several studies to obtain a summary analysis
Inductive reasoning
Reflects the reverse type of logic -Develop generalizations from specific observations -Begins with experience and results in conclusions or generalizations that are probably true. -Gave birth to the scientific approach to problem solving -Often acts as the basis for common sense Example of Inductive Reasoning -Every quiz has been easy. -Therefore, the test will be easy -The teacher used PP in the last few classes. Therefore the teacher will use PP tomorrow
What is the most important thing to remember about research?
THERE IS NEVER AN END TO RESEARCH, ALWAYS NEW QUESTIONS
Elements of informed consent
The informed consent process •Information elements: disclosure of information and the subject's comprehension of that information •Consent elements: ensure voluntary nature of participation and the subject's competence to consent •Authorization to use data in a manner specified in the protocol •Must provide purpose of the study in writing •Allows subjects to decide whether they agree with the importance of the research. •Participation requirements - the researcher provides, in writing, a fair explanation of the procedures and how they will be applied. •If subjects cannot read the informed consent document, it should be read to them. •Children should be informed to whatever extent is reasonable for their age. •Explanation of why they have been selected to participate in terms of inclusion criteria for the study, such as clinical condition or age. •If the subjects are patients, they should understand the distinction between experimental procedures and those to serve personal needs.
Translational research
The process of applying knowledge from basic biology and clinical trials to techniques and tools that address critical medical needs Unlike applied sciences, this type of research is designed to improve health outcomes "Bedside to bench, back to bedside"
Outcomes research
The study of success of interventions in clinical practice Focus is on the end results of patient care in terms of disability and survival
What are the four sources of knowledge?
Tradition Authority Trial and Error Logical reasoning
Hierarchical propositions
Vertical relationship, establishing ordered levels of concepts Ex. Maslow's theory of relationship of human needs to motivation (pyramid)
Scientific Paradigms
Ways of looking at the world that define problems that can be addressed with legitimate evidence that contribute to solutions
What are the two assumptions of the scientific method?
We assume that nature is orderly and regular and that events are consistent and predictable Second we assume that events or conditions are not random or accidental have one or more causes that can be discovered
Nuremberg Code
•Developed along with the Nuremberg trials of Nazi physicians •Nuremberg Code emphasized that every individual should voluntarily consent to participate as a research subject. •Consent is given only after subject has sufficient knowledge of the purposes, procedures, inconveniences, and potential hazards of the experiment. •Nuremberg Code also addresses the competence of the investigator, stating that research "should be conducted only by scientifically qualified persons".
Risks of participation
•Informed consent must include a description of foreseeable risks or discomforts to which the patient will be subjected •Could be physical, psychological, or social harm or discomfort •The researcher should detail the steps that will be taken to protect against any risks and the treatments that are available for potential side effects. •Fatigue due to exercise •Driving a car once the testing is over •Smoking or eating before testing
Benefits of participation
•Participation may result in a beneficial reduction of symptoms •Benefits cannot be guaranteed •Studies that are geared more toward theory testing may provide no direct benefits.
Guiding principles to research
•Personal autonomy - the capacity of individuals to make decisions affecting their lives and to act on those decisions •Autonomous action - carried out with understanding and without controlling influence •If an individual is unable to understand adequately (children or those with cognitive impairment) researcher must ensure an authorized guardian gives consent
Protection of human rights in research
•The primary professional purpose in conducting clinical research is to document the effectiveness and efficiency of treatment intervention. •Patients are typically participants in research activities. •Commitment to the protection of their rights and dignity must be inherent in the design and conduct of all research projects.
