question

4 pillars of EBP

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1. Clients goals, values and circumstances 2. Research evidence 3. Information from the practice context 4. Clinical experience

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5 steps in the process of EBP

answer

1. Convert info into a clinical question 2. Find evidence to answer the clinical question 3. Critically appraise the evidence 4. Integrate the evidence 5. evaluate the effectiveness of steps 1-4

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3 main aspects of evidence

answer

1. Validity 2. Impact 3. Applicability

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Pull information

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Answers the immediate clinical question with the best available e.g. clinical supervisor

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Push information

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Develops professional knowledge for possible use in the future e.g. workshops

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Types of questions

answer

1. Aetiology 2. Prognosis 3. Diagnosis 4. Intervention 5. Patients experiences and concerns

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4 elements of PICO

answer

Population, Intervention, Comparison and Outcomes

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Inductive research

answer

Investigating emerging and present phenomena to understand what is happening and why, from here we formulate the hypothesis

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Deductive research

answer

Allows us to test the hypothesis to understand relationships and causality in our world

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Randomised control trial

answer

Experimental study design where participants are randomly allocated to two or more groups that receive different interventions.

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RCT advantages

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1. Suitable design to use if you want to trial all possible interventions 2. Controls against order effects on learning/satisfaction

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RCT factors influencing findings

answer

1. Differences between groups at baseline 2. Changes in health during intervention 3. Measurement error 4. Research bias 5. Non-compliance with the intervention 6. Drop-outs

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Cohort

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Observational longitudinal study, where one group of participants are followed over time

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Case-Control

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Observational study involving 2 groups, cases have already developed the disease and are matches with other participants (controls) who are similar but have not developed the disease

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Cross-sectional

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Sample a population at a particular point in time and measure them to see who has the outcome of interest

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Quasi-experimental

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Experimental design that has no randomisation of participants to their interventions/control groups. Allocations is based on convenience groupings and can introduce sampling bias

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Pre-post

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Experimental study design where measurements of the outcome of interest are taken at 2 points, before the intervention and after. Participants act as their own controls

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Single subject design

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Experimental study design, where an individuals response to an intervention is measured over time. Measurements taken before, during, after and at follow-up

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Correlation

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A descriptive study design where the researchers look for associations between 2 or more variables that are being measured

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Case series

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A descriptive report on a series of clients (cases) who have an outcome of interest or have received the intervention being studied. There is no control group.

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Level 1 level of evidence

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Systematic review of RCT

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level 2 level of evidence

answer

Randomised controlled trials

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Level 3 level of evidence

answer

Quasi-experimental, pre-post, cohort, case control

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Level 4 level of evidence

answer

Correlation studies of multiple sites

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Level 5 level of evidence

answer

Correlation, descriptive, qualitative studies and experts opinion

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Nominal data

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Name the categories e.g. gender

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Ordinal data

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Categories are ranked in order e.g. likert scale

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Interval data

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Numeral data that can hold any value e.g. temperature

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Ratio data

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Values can be compared as multiples of one another. There is a true 0 that has meaning e.g. I can go twice as fast as you

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Parametric data

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- Normally distributed - t-score - Reported using a mean and standard deviation - Continuous data (interval and ratio)

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Non-parametric data

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- Not normally distributes - z-score - Data is reported using median and interquartile range - Positively/negatively skewed - Categorical data (nominal and ordinal)

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Intervention-to-treat (ITT)

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Conservative approach - Data are analysed to original random allocation to intervention or control (the way the participants were intended to be treated)

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Hypothesis

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An educated guess that predicts outcomes of a study within a certain population

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Inductive Hypothesis

answer

Based on trends or patterns seen in clinical settings

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Deductive hypothesis

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Based on a theoretical premise and predicts what may occur

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Null hypothesis

answer

No difference, we cannot accept a null hypothesis only reject or do not reject

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Alternate hypothesis

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Predicts that any observed difference between the means of 2 groups is not due to chance

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Testing a hypothesis

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Efficacy and effectiveness

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Type 1 error

answer

- Saying there is a difference when there really isn't - We reject the null hypothesis when it is in fact true - We have said a real difference exists but the differences are due to chance - Denoted by the alpha.

question

Type 2 error

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- Saying there is no difference when there really is - We do not reject the null hypothesis when it is in fact false - We have said there is no real difference but the differences are real and are not due to chance - Denoted by the beta

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Statistical power

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- When determining the chance of making a type 2 error - Denoted by 1-B

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Statistical power is concerned with 4 factors

answer

1. Level of significance 2. Sample size 3. Sample variance 4. Effect size

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Variance of the data

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- Power increases as variance reduces - When variability within a group is large, differences between groups will be less obvious - Variance can be reduced when sample size is increased

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Effect size

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Measure of the degree to which the null hypothesis if false. It tells us how big the difference between 2 groups is. - 0 = little effect of intervention - 1 = large effect of intervention

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Sample size

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The larger the sample the greater the statistical power

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Factors influencing sample size

answer

- Finding and recruiting eligible participants can be challenging - Eligible participants might not consent - Clinicians may forget to enrol eligible participants - Dropouts - Allow for attrition

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Independent (unpaired) t-test

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- Parametric test - Comparison between 2 independent data sets

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Paired t-test

answer

- Parametric test - Used in repeated measures to improve control over extraneous variables - two related scores e.g. data from time 1 and time 2

question

Analysis of Variance (ANOVA)

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- Parametric test - When we have 3 or more samples to test the null hypothesis of no differences

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One-way ANOVA

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- Parametric test - When there is only one independent variable

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Repeated Measures of analysis of variance (RANOVA)

answer

- Parametric test - Comparing one group that is exposed to different interventions (3 or more related scores)

question

Mann-Whitney U Test

answer

- Non-parametric test - To determine differences in the mean scores between 2 sets of data that came from independent groups

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Wilcoxin Signed-ranks test

answer

- Non parametric test - Comparing 2 related scores

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Kruskal-Wallis analysis of variance by ranks

answer

- Non parametric test - Comparing 3 independent groups

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Friedman two-way analysis of variance by ranks

answer

- Non-parametric test - Comparing 3 related scores

question

Chi-square statistic

answer

- Parametric test - Nominal data (whats your preference) - Compares expected frequencies and observed frequencies - E.g. cats vs dogs

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Internal Validity

answer

Reflects the degree to which a conclusion about causal relationship between variables in a study can be properly demonstrated

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Threats to internal validity

answer

- History - Confounding - Maturation - Natural progression - Attrition - Testing effects - Instrumentation effects - Regression to the mean - Selection bias - Experimenter bias

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External validity

answer

The extent to which the results of a study can be generalised to other situations, to other people and to other time periods

question

Threats to external validity

answer

- Sample is small - Sample has characteristics that are not representative to the wider population - Excluding participants who are not compliant with the intervention - Study is conducted in a geographical or social environment that is specific - Whether results can be generalised to different periods of time in the past/future

question

Univariate

answer

data collected on a single variable and then characterised with descriptive studies

question

Types of descriptive research

answer

1. Cross-sectional 2. Case study 3. Cohort 4. Case-control (retrospective) 5. Correlation

question

Cohort advantages

answer

- Able to determine the incidence of the outcome of interest - Can establish a time sequence

question

Cohort disadvantages

answer

- Not useful for studying disorders that are rare - Prone to attrition (people drop out over time)

question

Case-control advantages

answer

- Don't have to wait years to find out what will happen to find a cause-effect relationship - Can look at exposure/non-exposure to treatment or risk factors

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Case-control disadvantages

answer

- The 2 groups may not be well matched - Reliant on people's self-reporting of their history - Bias in the way that questions are asked - Reliant on archival medical records, which may be lost of incomplete

question

Correlation Coefficients

answer

Used to quantitatively describe the strength and direction of the relationship between 2 variables (r)

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Spurious relationship

answer

2 or more events are independent of each other but they happen at the same time by coincidence or because of an unseen third variables

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Pearson correlation

answer

- Tests associations between 2 variables - Used for parametric data - normally distributes - Continuous/ratio data - 0 = no relationship - 0.75+ = strong to excellent

question

3 aspects to consider when reporting associations between variables

answer

1. What is the direction of the relationship? 2. What is the strength of the relationship? 3. Is the relationship significant?

question

Spearmans Rho (Sr)

answer

- Non-parametric data - Examines the difference between the 2 sets of rankings for each participants - Scores are on an ordinal scale

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Prevalence

answer

Is a measure of how much a health condition exists in a population at a point in time

question

Incidence

answer

Is a measure of the rate of new cases of the health condition in a specified time period

question

Probability

answer

The chance of an event happening

question

Absolute risk

answer

Refers to the incidence or natural frequency of the disease in the population

question

Absolute Risk Reduction (ARR)

answer

Indicates the actual difference in risk between those who have received an intervention and those who have not = Control event rate (CER) - Experimental event rate (EER)

question

Number needed to treat

answer

Identifies how many patients would need to be treated before a benefit can be seen. It describes the effectiveness of an intervention in terms of patient numbers

question

Relative Risk

answer

The likelihood that someone who has been exposed to a risk factor will develop the disease compared to someone who has not been exposed

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Relative Risk Reduction (RRR)

answer

We consider a decrease in risk/increase in benefit that is associated with an intervention = (CER-EER) / (CER*100)

question

Cohen's D

answer

- Magnitude of difference between 2 compared groups - What was the effect of the intervention - Parametric test - Continuous/ratio data - 0 = hardly any difference - 1+ = very large difference between 2 data sets

question

Systematic Review

answer

A rigorous process of searching, appraising and summarising evidence. Addresses the effectiveness of an intervention and looks at the accuracy of diagnostic tools.

question

Characteristics of a Systematic Review

answer

- Clear aims and relevant criteria - Transparent and reproducible methods - Rigorous search designed to locate all eligible studies - An assessment of validity of the findings - Systematic presentation and synthesis of the included studies

question

Systematic review process

answer

- State the study object - Develop the protocol - Develop a search strategy - Conduct the search - Retrieve relevant papers - Screen and select papers that meet criteria - Evaluate methodological quality of studies - Critical appraisal - Analyse, synthesise and report findings

question

Inclusion/exclusion criteria based on

answer

1. Types of studies (level of evidence) 2. Partipants 3. interventions 4. Outcomes

question

Measurement error

answer

- Random error, systematic error - Calculated by: true score = observed test score - (systematic error + random error)

question

Random error

answer

- Environment (temperature/background noise) - Client (feeling sick) - Therapist (recorded wrong test score)

question

Systematic error

answer

- Outcome measure (unreliable or non-standardised) - Therapist (doesn't follow clinical guidelines)

question

Ways to test validity

answer

1. Ask the experts (face) 2. Cover all aspects (Content) 3. Compare to an external standard (criterion) 4. Compare to an idea (construct)

question

Face validity

answer

The extent to which a test appears to measure what it is supposed to measure

question

Content validity

answer

The relevance of a test to the construct that it says it measures

question

Criterion-related validity

answer

How its results compare with the results from another relevant measure (concurrent and predicted)

question

Construct validity

answer

Refers to how valid a test or assessment is in terms of the validity of the construct (the underlying theory or model) that the test says it is measuring

question

Convergent validity

answer

Get the same answer to what you expect

question

Discriminant validity

answer

Get a different answer to what you expect

question

Reliability

answer

A measure that gives us the same result over and over again in the absence of any real change (repeatability or consistency)

question

Inter-rater reliability

answer

Used to assess the degree to which different raters give consistent estimates of the same population - Nominal = Cohens Kappa

question

Test-retest reliability

answer

Used to assess the consistency of a measure from one time to another - Non-parametric ordinal = spearmans rank - parametric ratio = person correlation

question

Internal consistency reliability

answer

Used to assess the consistency of results across items within a test and the total score - Ordinal = Cronbach's alpha

question

Standard error of measurement (SEM)

answer

Gives an indication of the dispersion of the measurement errors when you are trying to estimate a clients true scores from their observed assessment scores

question

Linearity

answer

How easy it is to change the score in different parts of the scale

question

Clinical utility

answer

How easily can the outcome measure be used in clinical practice? (cost, training, time taken, equipment used)

question

Raw score

answer

The score obtained from a specific testing procedure

question

Standard score

answer

Developed so that the score can be used to understand performance of people from different groups or across sub-tests

question

Derived score

answer

A raw score that has been converted to a second scale (confidence intervals, percentile scores)

question

Percentiles

answer

Derived score that indicates how many people score above and below the percentile score

question

Confidence interval

answer

A way of calculating measurement error, tells you how confident you can be that the true score is within a given range

question

Qualitative research

answer

Allows the researcher to understand the perspectives of the people they engage with: this facilitates a client-centred approach to professional practice

question

Characteristics of qualitative research

answer

- Inductive - Occurs in naturalistic settings - Uses purposive and convenience sampling - Data consists of descriptions that are analysed using both qualitative and non-qualitative means - Sources of data include: texts, fields and action processes

question

Sampling for qualitative research

answer

- Include participants who have knowledge in the area being measured - Purposive and convenience sampling - No requirement for a particular size - Saturation point

question

Data gathering strategies for qualitative research

answer

1. Participation in the setting 2. Observation 3. In-depth interviews 4. Analysis of documents and objects

question

Phenomenology

answer

Aims to describe experiences from the perspective of people who have the experience (e.g. people who have cancer). Only those who have lived experience are fully knowledgable

question

Ethnography

answer

Aims to understand the underlying patterns of behaviour and meaning in culture

question

Steps of ethnography

answer

1. Gain access to culture of interest 2. Collect data (observation/interview) 3. Record data in log book, diary or audio 4. Analysis of data from description to explanation to reveal meanings and generate a theory 5. Impressions are verified with the informants and reported once findings are determined as accurate

question

Grounded theory

answer

Purpose is to construct a theory from qualitative data and the theory emerges from the experiences of the people interviewed. Sets of categories emerge that are used to make a generalisation

question

EBP is

answer

- A process of looking for understanding - Associated with research - A potential threat to the OT's practice

question

Participation Action Research (PAR)

answer

Generation and ownership of knowledge is associate with power and influence. People have capacity to work towards the solution of their own problems

question

PAR elements

answer

- Joint ownership of the research - Collaborative conduct of the research - Immersion of the subjects being studied in every stage of research

question

PAR processes

answer

- Collective investigation of problems and issues - Collective data gathering and analysis - Collective action and evaluation of outcomes

question

Concerns with PAR

answer

- Tokenism - Time frames - Cost - Ownership of knowledge

question

Q Methodology

answer

A research method used to understand peoples subjectivity. To explore and generate a better understanding of people's perspectives and beliefs

question

Steps in conducting Q Methodology

answer

1. Developing the Q-sort pack - develop statements 2. Administering the Q-sort - sort the statements 3. Factor analysing the data - find factors that summarise the pattern 4. Interpreting factors - interpret the main factors that have emerged

question

Q Methodology Advantages

answer

- Allows people to express their viewpoints - Rare missing data - Can use with different populations - Require small sample of participants

question

Q Methodology Disadvantages

answer

- Time consuming in administration - Comprehensive instructions - Not designed to show how many people have a particular view - May not always represent broader population

question

Steps in data management

answer

- Tape record the conducted interview - Transcribe the recorded interviews - Write up observations - Transcribe the spoken words - Write comments and explanations of what is going on

question

Analysing the data

answer

1. Free-form margin notes 2. Conceptual labels 3. Index codes with operational definitions 4. Audit trail

question

Credibility

answer

- Trustworthiness of data - Related to the true picture of the phenomenon - Triangulation, member checks and time sampling

question

Transferability

answer

- Trustworthiness of data - Cn the findings be transferred to other situations or can the participants be compared to the population of interest? - Purposive sampling

question

Dependability

answer

- Trustworthiness of data - Consistency between the data and findings - Audit trail, code-recode strategy, triangulation, peer examination

question

Confirmability

answer

- Trustworthiness of data - Have steps been taken to limit the bias in the research? - Triangulation, reflexivity (journalling), peer review

question

Triangulation

answer

The aim is to enhance validity by using more than one method, researcher, data set and theories

question

Journalling

answer

To document assumptions, beliefs, personal feelings related to the study, the participants or the data. This reflexivity separates the researchers subjective opinion from the data analysis

question

Member checks

answer

Data is gathered, recorded, transcribes and analysed and transcripts are given to participants to ensure accuracy

question

Coding strategies

answer

Essentially looking for certain words, phrases, patterns of behaviour or ways of thinking

question

Types of naturalistic enquiry

answer

- Phenomenology - Ethnography - Grounded theory - Action research (PAR)

question

Human research

answer

- Taking part in surveys, interviews and focus groups - Undergoing psychological, physiological or medical testing - Being observed by researchers - Access to their information

question

Beneficence

answer

Minimise risk to the greatest extent possible and maximise the potential for benefits to be gained from the research outcomes

question

Respect for human beings

answer

- Justice - Access to treatment - Storage, access and disposal of personal information

question

Informed consent must state

answer

1. Purpose of the study 2. What participation involves 3. The benefits and risks of the study 4. Voluntary participation 5. Withdrawal 6. confidentiality of information

question

Vulnerable participants

answer

- Pregnant women - Children, young people - People in dependent/unequal relationships - People unable to give consent (Seeking medical care) - People with cognitive/intellectual disability or mental illness - Aboriginal or Torres Strait Islanders

question

Ethics in publishing research

answer

- Informed consent - Approval from an independent ethics committee - Disclose conflict of interest - The role of editorial boards for journals

question

Evidence Based Practice

answer

1. Having a clinical question to answer 2. Seeking sources of credible information 3. Accessing the information 4. Critically reading the information 5. Evaluating the usefulness of the info 6. Trialling it in your practice 7. Evaluating the effect of the info

question

Barriers to implementing evidence

answer

1. Attitudinal barriers (people who are resistant to change) 2. Knowledge and skills/confidence barriers 3. Social influences (expectations of clients)

question

Strategies to overcome barriers of evidence

answer

- Educational materials - Educational meetings - Educational outreach visits - Reminders - Audit (summary of clinical performance over time) and feedback

question

Sensitivity

answer

is a technique used to determine how different values of an independent variable impact a particular dependent variable under a given set of assumptions.

question

Objectivity

answer

Assumes that a truth or independent reality exist outside of any investigation or observation.

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