EBP & Non-Parametric
Which situation MOST commonly indicates the need for a non-parametric statistical test?
A. Large sample with normal distribution
B. Continuous data with equal variances
C. Ordinal data with non-normal distribution
D. Ratio-level data with normal distribution
C. Ordinal data with non-normal distribution
Rationale
Non-parametric tests are typically used when data violate assumptions of parametric testing, particularly when data are ordinal or not normally distributed
Which component of the PICO framework identifies the desired result of an intervention?
A. Patient
B. Intervention
C. Comparison
D. Outcome
D. Outcome
Rationale
The Outcome specifies what the clinician hopes to accomplish, such as pain reduction, improved function, or increased ROM.
Which statistic answers the question, "Among patients who truly have the disease, how many test positive?"
A. Specificity
B. Positive Predictive Value
C. Sensitivity
D. Negative Predictive Value
C. Sensitivity
Rationale
Sensitivity measures the proportion of individuals with the disease who test positive.
_________ is an epidemiologic measure that provides a "snapshot" of existing cases within a population at a single point in time and ________ measure specifically evaluates the occurrence of new cases over a period of follow-up
A. Incidence and Prevalence
B. Odds and Injury rate
C. Prevalence and Incidence
D. Injury rate and Odds
C. Prevalence and Incidence
Rationale
Prevalence measures the proportion of a population that currently has a condition at a specific point in time. It is considered a cross-sectional "snapshot" measure.
Incidence measures the frequency of new cases developing among individuals initially at risk during a defined follow-up period
What is the primary purpose of a prognostic prediction model?
A. Determine disease causation
B. Evaluate treatment effectiveness
C. Predict future outcomes
D. Establish prevalence
C. Predict future outcomes
Rationale
Prognostic models are designed to estimate the probability of future outcomes and identify individuals at higher or lower risk. Their purpose is prediction, not causation.
Which statement BEST explains why systematic reviews are often considered stronger evidence than individual studies?
A. They only include expert opinion.
B. They are always faster to conduct.
C. They review and synthesize findings from multiple relevant studies.
D. They eliminate all forms of bias.
C. They review and synthesize findings from multiple relevant studies.
Rationale
Systematic reviews comprehensively evaluate and synthesize evidence across many studies, providing more reliable conclusions than a single investigation alone.
A PT is evaluating a case report describing dramatic improvement in one patient following a novel intervention. What is the MOST important limitation?
A. The intervention cannot be described.
B. Results may not generalize to other patients.
C. The patient cannot be assessed.
D. Outcome measures cannot be used.
B. Results may not generalize to other patients.
Rationale
Case reports provide valuable clinical insight but have limited generalizability because findings come from one individual.
Which analysis includes all participants in the groups to which they were originally assigned, even if they drop out?
A. Per-protocol analysis
B. Completer analysis
C. Intention-to-treat analysis
D. Post-hoc analysis
C. Intention-to-treat analysis
Rationale
Intention-to-treat (ITT) analysis preserves the benefits of randomization by analyzing participants according to original group assignment.
A study reports that 25% of collegiate swimmers currently have shoulder pain during preseason screening. Which conclusion is MOST appropriate?
A. The risk of developing shoulder pain during the season is 25%.
B. Twenty-five percent of swimmers developed shoulder pain during preseason.
C. Twenty-five percent of swimmers had shoulder pain at the time they were assessed.
D. Shoulder pain occurs in 25% of all swimmers annually.
C. Twenty-five percent of swimmers had shoulder pain at the time they were assessed.
Rationale
The phrase"currently have shoulder pain" refers to a snapshot of existing cases at a single point in time, which describes prevalence, not incidence.
Which study design is MOST commonly used in prognostic research?
A. Cross-sectional study
B. Case report
C. Prospective cohort study
D. Case-control study
C. Prospective cohort study
Rationale
Prognostic studies typically follow outcome-free participants over time to determine who develops the outcome.
A physical therapist is treating a 42-year-old recreational tennis player who is 8 weeks post–rotator cuff repair. The patient asks whether adding blood flow restriction (BFR) training to the rehabilitation program will improve strength recovery compared to traditional resistance exercise alone.
Which of the following is the best example of a foreground question that would guide evidence-based decision making for this patient?
A. What is the anatomy and function of the rotator cuff?
B. What are the common causes of rotator cuff tears?
C. In adults recovering from rotator cuff repair, does blood flow restriction training compared with traditional resistance exercise improve shoulder strength and functional outcomes?
D. What is the prevalence of rotator cuff tears among recreational tennis players?
C. In adults recovering from rotator cuff repair, does blood flow restriction training compared with traditional resistance exercise improve shoulder strength and functional outcomes?
Rationale
A foreground question is a focused, patient-oriented clinical question designed to support decisions about diagnosis, prognosis, intervention, or outcomes in a specific patient or population. It is typically structured using the PICO framework (Patient, Intervention, Comparison, Outcome)
A researcher includes several questions containing double negatives and multiple ideas within a single item. What is the MOST likely consequence?
A. Increased validity
B. Improved reliability
C. Misinterpretation by respondents
D. Faster completion time
C. Misinterpretation by respondents
Rationale
Questionnaire items should contain only one idea and be interpreted consistently by all respondents. Ambiguous wording reduces validity.
A positive likelihood ratio (LR+) of 12 indicates:
A. No change in disease probability
B. Small increase in likelihood
C. Moderate increase in likelihood
D. Large increase in likelihood
D. Large increase in likelihood
Rationale
An LR+ >10 generally produces a large increase in the likelihood that the diagnosis is present.
A study demonstrates statistically significant improvement after intervention. The average change exceeds MDC but does not exceed MCID. What is the BEST overall interpretation?
A. Recovery is significantly and clinically meaningful
B. The change is significant and definitely important to the patient
C. The change is significant and likely real but may not be clinically meaningful
D. The change is significant and but not likely real and may not be clinically meaningful
C. The change is significant and likely real but may not be clinically meaningful
Rationale
Statistical significance indicates the result is unlikely due to chance, MDC suggests the change is real, but failure to exceed MCID means the improvement may not be meaningful from the patient's perspective.
A clinician identifies:
What EBP step remains?
A. Develop a new treatment protocol
B. Perform a meta-analysis
C. Evaluate personal performance and outcomes
D. Conduct a randomized controlled trial
C. Evaluate personal performance and outcomes
Rationale
The final step of the EBP process is self-evaluation:
A physical therapist wants to determine whether aquatic therapy improves walking endurance compared with land-based exercise in adults with knee osteoarthritis. Which study design would provide the strongest evidence for causal inference?
A. Case report
B. Cross-sectional study
C. Cohort study
D. Randomized controlled trial (RCT)
D. Randomized controlled trial (RCT)
Rationale
RCTs are considered the strongest individual study design for determining treatment effects because randomization helps minimize selection bias and confounding while improving internal validity.
Which finding would MOST strongly support treatment effectiveness in a single-subject design?
A. Stable baseline and clear trend change following intervention
B. Variable baseline and variable treatment response
C. Missing follow-up data
D. One post-treatment observation only
A. Stable baseline and clear trend change following intervention
Rationale
Evidence of treatment effect is strongest when a stable baseline is followed by a meaningful change in level or trend after intervention.
A clinician is reviewing a trial with:
However, the treatment group received substantially more therapist attention than the control group. What is the MOST significant concern?
A. Attrition bias
B. Baseline imbalance
C. Unequal treatment of groups
D. Statistical power
C. Unequal treatment of groups
Rationale
Unblinded therapists may unintentionally provide additional encouragement, attention, or care that influences outcomes independent of the treatment being studied
A baseball coach is deciding whether to implement an arm-care program. Research reports an NNT of 13. Which interpretation is MOST appropriate?
A. All 13 athletes will avoid injury.
B. One additional injury is expected after treating 13 athletes.
C. Treating approximately 13 athletes prevents one additional injury.
D. Thirteen athletes should be excluded from participation.
C. Treating approximately 13 athletes prevents one additional injury.
Rationale
An NNT of 13 indicates that about 13 athletes would need to participate in the program for one additional injury to be prevented.
An investigator identifies study risks but provides no plan to minimize them. Which Belmont principle is MOST directly compromised?
A. Justice
B. Respect for Persons
C. Beneficence
D. Autonomy
C. Beneficence
Rationale
Beneficence requires both identification and minimization of risks while maximizing potential benefits.
A PT compares functional outcome scores across four independent treatment groups using ordinal data. Which test is MOST appropriate?
A. Friedman Test
B. Kruskal-Wallis Test
C. Mann-Whitney U Test
D. Chi-Square Test
B. Kruskal-Wallis Test
Rationale
The Kruskal-Wallis test is the non-parametric equivalent of a one-way ANOVA and is used when comparing three or more independent groups.
A study's discussion section concludes that a new intervention prevents disability, reduces healthcare costs, decreases mortality, and should become the standard of care. However, the study only measured short-term pain outcomes. What is the MOST significant concern?
A. The study lacks a control group
B. The authors are drawing conclusions beyond the scope of their data
C. The sample size is too large
D. The introduction is too short
B. The authors are drawing conclusions beyond the scope of their data
Rationale
The discussion should remain consistent with the collected data. Conclusions extending far beyond measured outcomes represent over-interpretation.
A physical therapist evaluates a patient with suspected pulmonary embolism. Based on the patient's history, risk factors, and examination findings, the therapist estimates a pre-test probability of 60%.
The patient then undergoes a diagnostic test that is negative. The test has a negative likelihood ratio (LR−) of 0.008.
Without using a nomogram, what is the MOST appropriate estimate of the patient's post-test probability of pulmonary embolism?
A. Approximately 1.5%
B. Approximately 30%
C. Approximately 60% (no meaningful change)
D. Approximately 80%
A. Approximately 1.5%
Rationale
An LR− of 0.01 is extremely powerful for ruling out a diagnosis. A negative test result dramatically decreases the probability that the condition is present.
A therapist is selecting an outcome measure for a multicultural patient population. Which consideration is MOST relevant?
A. Publication year
B. Cultural and ethnic diversity of the instrument
C. Therapist preference
D. Statistical software compatibility
B. Cultural and ethnic diversity of the instrument
Rationale
One of the 13 questions when selecting a measure specifically addresses cultural and ethnic diversity considerations.
A prediction model for future ACL injury was developed using collegiate soccer players. The researchers then tested the same model in a completely different group of athletes from several universities and found similar performance.
Which concept is BEST demonstrated?
A. Calibration
B. Clinical utility
C. External validation
D. Discrimination
C. External validation
Rationale
External validation occurs when a prediction model is evaluated in a completely independent population. It provides the strongest evidence that the model is generalizable to other patients.