CPG & systematic reviews
Define clinical practice guidelines
Summary of recommendations about patient management
Describe the differences between RCTs and non-randomized trials.
RCTs randomize individuals to treatment groups
Describe the best design to answer diagnostic accuracy questions
Cross-sectional studies (nonexperimental/observational)
Identify the research design that retrospectively compares two groups, one with the disorder and 1 without the disorder.
Case-control
Double points
Explain how the authors know when they should stop collecting data in qualitative study designs.
When no new themes emerge (data saturation)
Clinical practice guidelines and systematic reviews are at the top levels of evidence because_____
They are pre-appraised evidence (it saves our reading time)
Double points
Describe why the randomization of subjects enhances the quality of intervention studies.
Subject characteristics are more likely to be distributed evenly among the groups
Identify the "I" in this question: “What is the diagnostic accuracy of the OSTRC-P questionnaire in diagnosis patellar tendinopathy in a youth female basketball player, compared to MRI?"
Diagnostic accuracy of OSTRC-Accuracy
P: a basketball player
O: patellar tendinopathy
Prospective cohort
Because it increases the risk of "spin" (overenthusiastic and often misleading presentation of the results).
Other possible responses:
In systematic reviews including experimental designs, the midline of the forest plot reported using mean difference represents______
Zero (no difference between groups)
In trials in which outcomes are measured at several points, a key outcome must have been measured in more than ____% of subjects at one of those points in time.
85%
Double points
If the patient has a negative test result on a highly sensitive test, this test can help the physical therapist to______
Rule out the condition
Additional info: because of the low rates of false negative
Identify what step of a clinical prediction rule is considered a level of evidence 1.
Impact analysis
Identify whether this research objective is a background or foreground question. "A physical therapist is considering a continuing education course about Pilates but wants to know if it is effective for use with older adults with hip pain."
A foreground question about Pilates
Define meta-analysis
A meta-analysis is a statistical method that summarizes the results of more than one study.
Provide two examples of quasi-experimental designs
Non-randomized controlled trial (at least 2 groups - no randomization) and case series (one group)
An index test with 70% sensitivity means that____
The test is able to correctly identify 70% of individuals with the disease
Explain why derivation (level of evidence 4) is not enough to implement a clinical prediction rule in clinical practice
Because CPRs need to be validated and then tested (impact analysis) to minimize bias.
Identify the type of bias in this sentence:
"A physical therapist believes all individuals with rheumatoid arthritis benefit from aquatic PT based on his previous patients whose symptoms improved."
Confirmation bias
Authors of a hypothetical meta-analysis about the accuracy of a diagnostic test to detect tarsal tunnel syndrome display their findings in a forest plot. Describe what the midline of the plot represents.
A likelihood ratio that equals 1
In a hypothetical RCT, the authors found a difference between groups of 2 points on a 0-10 scale (p=0.03). Consider a hypothetical minimum clinically important difference (MCID) of 3 points. How would you interpret these results?
The results were statistically significant, but not clinically important
A hypothetical study about a diagnostic test reports the following results: LR+ = 3.12, 95% C.I. = 1.13, 8.25. Describe how you would interpret the results based on confidence interval.
The confidence interval indicates the true value for LR+ is statistically significant
Double points
Authors of a hypothetical study predicting dislocation of femoral prostheses in frail elders following total hip arthroplasty report that cognitive decline, a diagnosis of sarcopenia, and lack of physical assistance are statistically significant risk factors. Explain what you expect to see in the results (ORs interpretation)
The odds ratios for these prognostic factors are greater than one
Investigators want to know if a new clinical examination technique is as accurate as an x-ray. Explain what form of measurement validity are they trying to establish.
Criterion validity (gold standard)