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PICO & Evidence Lvls

PICO & Levels of Evidence Information

Systematic Reviews of Randomized Control Test (Study) Has internal controls, comparing many studies
Individual Randomized Control Test (Study) Has internal controls, one study
SR & Individual RCT’s Cohort Study Has bigger group; more generalized. May apply to your pt.
Outcome Study Has a lot of people with specific outcome. Control people, measurement
SR of Case Control Compares many studies of general information
Individual Case Study (clinical) Gives value to the individual but not to majority population
Case Series More control but not a lot
Expert Opinion Value but limitations
Inclusion criteria Anything the pt had that allowed them to be included in the group
Exclusion criteria Anything someone in the inclusion group has that excludes them from the study
Subject reimbursement Payment from participating in the study
Signing waivers Pt signs so they are aware they are in a trial
Blinding Can’t know any details, no Tx ,recording, or recipient bias
Recorder reliability (Repeating measures) giving testers practice and training before the study
Research approval From powers that be
Randomization Different levels of dividing the group up so that it is random
Statistically sound study Must have 30 or more people in it
Intention to treat (ITT) Report the reason that any person dropped out of the trail (Proof that it wasn’t the treatment that caused the person to drop out or die before the trial ended)
Confounding variables (CV) Factors that could make the study better or worse; Can’t control everything
Name some confounding variables Ex. Hip replacement, Atrophy, Time of Day ** very important for stretching**, Current or past activities, Diet/meds, Arthritis, Socioeconomics, Male/female, Ages, Co-morbidities; steoporosis, diabetes, Diseases, Cooperation of patient, Family influences
Foreground Question (4 components): P – Patient (everything) problem (everything) population I – Intervention (what was studied) C – Comparison (treatment or placebo) O – Outcome (SPECIFIC!!!) Return to work
PICO Example: P- 55ylo, female, hemo stroke I- Retro Gait C- Standard rehab vs standard rehab + retro gait O- Increase gait skills; decrease assistance and decrease assisted device in 3 weeks
Places to look for Journal info: ProQuest & medline – web sites; CINAHL – Journal directory; Cochran Database – only SR (compare pt with MANY studies); APTA – has all available for free if you are a member
External Validity The truth of information gathered matches the patient you are treating (actual clinical practice)
Internal Controls Things that make a study more valid; -If confounding variables are too great, we can use the study with conditions (monitor more often) - if not doing treatment, come up with what treatment you will do instead - how effects outcome
Evidence Based Practice (EBP) Clinical expertise w/patient's values & best research available. Patient always decides what the best option for them is once given the choices.
List the levels of evidence: 1. SR of Randomized Control Test (Study); 2. Individual Randomized Control Test (Study); 3. SR & Individual RCT’s Cohort Study; 4. Outcome Study 5. SR of Case Control; 6. Individual Case Study (clinical); 7. Case Series; 8. Expert Opinion
List the internal controls: 1. Inclusion criteria; 2. Exclusion criteria; 3. Subject reimbursement; 4. Blinding; 5. Research approval; 6. Randomization
What is another name for Foreground Question (4 components)? PICO
Ideally, these people should always be” blinded” 1. Patients 2. Treating Clinicians 3. Data Collectors 4. Data Analysts
1. Patients 2. Treating Clinicians 3. Data Collectors 4. Data Analysts Should be blinded in all SR & RCT's? Yes, but **Not usually possible in PT**
True or False - If ITT is not done it can cast doubt on the study True, if ITT is not done it can cast doubt on the study
How do you translate the evidence into practice? 1. Generate evidence from research 2. Synthesize evidence 3. Develop evidence based clinical policies 4. Apply the policies
For EBP, what your given: patient circumstances, patient value, and the evidence...whats your best option? Where they overlap is the best option (1. Patient circumstance 2. Patient values 3. Evidence)
Evidence Based Practice (EBP) Integration of clinical expertise w/ the pt values & the best available research evidence to ensure optimal outcomes
Goal of EBP Improve clinical performance through critical evaluation of the current evidence
In randomization, name some extraneous variables Patient, age, race, gender, symptom duration, condition severity, comorbidities, intellectual status, motivation, & treatment expectations.
How can you avoid bias from the investigators in allocating to groups? Do in this order: informed consent, enroll in trial, sealed envelope from locked file cabinet to reveal group assignment
True or False - It may still be possible to use the patient data set using an ITT approach True, It may still be possible to use the patient data set using an ITT approach
Validity of Systematic Reviews We must distinguish SR’s from unsystematic “literature reviews” where the authors survey published literature w/o explicit search or selection criteria
4 key validity issues of SR -Address PICO,explicit/sufficiently narrow in scope -Search for relevant studies should be detailed, exhaustive & fully revealed -Use/report explicit criteria for assessing methodologic quality -Adequate reliability btwn 2 or more assessors should be told
What does PICO stand for? Patient, Intervention, Comparison, and Outcome
Background questions are developed to? Enhance knowledge relative to a specific disorder
Reliability (intra- and inter- tester) The extent to which an experiment, test or measuring procedure yields the same results on repeated trials
What is the difference between intra- and inter- tester Intra - one person doing testing, 7%. Inter - two people doing testing, 15%.
Difference between internal & external validity Internal validity - Benefit of the Tester & External validity - can NOT control
Identify 3 considerations of the patient and research in order to make clinical application judgement 1. Patient circumstance 2. Patient values 3. Evidence
Created by: srussel