Intro to Evidence Based Practice (8/30b) Flashcards Preview

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1

Evidence Based Medicine (EBM)

“The integration of best research evidence with clinical expertise and patient values”

2

6S Model - Tiers bottom to top (6S Model)

Single studies
Synopses of studies
Syntheses
Synopses of syntheses
Summaries
Systems

3

Examples of 6S Tiers (6S Model)

Single studies - original article published in journal

Synopses of studies - evidence based abstraction journal

Syntheses - systematic reviews (EX: cochrane library)

Synopses of syntheses - evidence based abstraction journals (EX: DARE, health-evidence.ca)

Summaries - clinical practice guidelines; evidence based textbooks

Systems - computerized decision support systems

4

5 Single Study Designs (6S Model)

RCT
Cohort studies
Case control studies
Cross sectional studies
Case reports/studies

5

Randomized Control Trials (RCTs) (6S Model)

Experimental – level 2

Participants are randomly assigned, experimental or control group

6

Cohort study (6S Model)

Observational – level 3

Prospective-longitudinal, group of participants with similar condition followed over time (may be compared to a similar group without the condition)

7

Case control (6S Model)

Observational – level 4

Retrospective, a comparison group is used

8

Cross sectional studies (6S Model)

Observational – level 4

Population based, participants selected based on inclusion/exclusion criteria, investigator follows the study to assess exposure and outcomes at the same time

9

Case studies (6S Model)

Descriptive – level 4

Single group followed

10

Use ___ ___ to investigate diagnosis, prognosis, intervention (6S Model)

individual studies

11

Best individual study designs to use when possible (6S Model)

cross-sectional studies, longitudinal studies, and experimental studies (RCT)

12

Systematic Review (6S Model)

a review of existing studies that includes

A systematic/comprehensive/transparent search strategy, clear eligibility criteria and methodology, evaluation of individual study quality, ordered way to deal with lots of evidence, can also be very long

Results can be summarized via Forest plot

13

Meta-Analysis (6S Model)

a statistical approach that pools data from multiple studies to estimate the overall“effect” of an intervention

Commonly associated with a systematic review, but not always

The effect is the magnitude of the differences found in the study, believed to be due to intervention

14

Summaries (6S Model)

A peer-reviewed document written by a panel of experts that makes recommendations for treatment

Based on a systematic search & review of available evidence
Include ratings of the quality of the evidence and the strength of the recommendation

Level of evidence of individual articles used in CPG: Level I (high quality) through V

Grade of the evidence = overall strength of the evidence: “A” Strong evidence

Can be hundreds of pages long

15

Examples of places to find evidence

—PT Now (APTA)

—RehabMeasures

—StrokeEngine

—PubMed

—Cochrane Database of Systematic reviews

—PEDRO (PT specific)

—Clinical Key

—NIH Toolbox

16

Evidence Based Practice Steps (EBP Steps)

Ask
Acquire
Appraise
Apply
Adjust/Analyze

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Ask (EBP Steps)

Answerable clinical question formulated

Background questions - help understand the nature of the problem

Foreground questions - treatment, PICO questions

Can ask questions about Intervention, Diagnosis, Prognosis, Outcomes

18

PICO Questions (EBP Steps)

P - Patient
I - Intervention
C - Comparison
O - Outcome

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Acquire (EBP Steps)

Systematic literature review

EX: Google scholar (broad, terminology) VS PubMed (refined, advanced)

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Appraise (EBP Steps)

Research evidence is critically analyzed

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Apply (EBP Steps)

Research is integrated with expertise and patient circumstances

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Adjust/Analyze (EBP Steps)

Steps evaluated

23

Estimate error with Standard Error of Measurement (SEM) with 95% confidence interval (CI)

What range would I expect for the measurement 95% of the time?

Calculated value (from SD and reliability)

Expressed as 17.5° (14.5°, 20.5°)

24

Minimal Detectable Change (MDC)

the minimum amount of change in a patient's score that ensures the change isn't the result of measurement error

Used to decide if change is beyond error

Calculated from SEM, calculated for a specific Pt type/group

25

Minimal Clinically Important Difference (MCID)

a published value of change in an instrument that indicates the minimum amount of change required for your patient to feel a difference in the variable you are measuring

The smallest change that might be considered important to a clinician

At least MDC

Defined for a “population” or patient group

26

Examples of resources on measurement tools

Rehab Measures

Center for Rehabilitation Outcomes Research (CROR) at Rehab Institute of Chicago

27

What individual study to use for diagnosis

cross-sectional study

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What individual study to use for prognosis

cohort study

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What individual study to use for intervention

randomized control trial