PICO & Levels of Evidence Information
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| Systematic Reviews of Randomized Control Test (Study) | Has internal controls, comparing many studies
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| Individual Randomized Control Test (Study) | Has internal controls, one study
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| SR & Individual RCT’s Cohort Study | Has bigger group; more generalized. May apply to your pt.
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| Outcome Study | Has a lot of people with specific outcome. Control people, measurement
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| SR of Case Control | Compares many studies of general information
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| Individual Case Study (clinical) | Gives value to the individual but not to majority population
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| Case Series | More control but not a lot
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| Expert Opinion | Value but limitations
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| Inclusion criteria | Anything the pt had that allowed them to be included in the group
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| Exclusion criteria | Anything someone in the inclusion group has that excludes them from the study
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| Subject reimbursement | Payment from participating in the study
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| Signing waivers | Pt signs so they are aware they are in a trial
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| Blinding | Can’t know any details, no Tx ,recording, or recipient bias
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| Recorder reliability | (Repeating measures) giving testers practice and training before the study
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| Research approval | From powers that be
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| Randomization | Different levels of dividing the group up so that it is random
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| Statistically sound study | Must have 30 or more people in it
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| 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)
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| Confounding variables (CV) | Factors that could make the study better or worse; Can’t control everything
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| 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
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| 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
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| 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
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| 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
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| External Validity | The truth of information gathered matches the patient you are treating (actual clinical practice)
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| 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
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| 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.
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| 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
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| List the internal controls: | 1. Inclusion criteria; 2. Exclusion criteria; 3. Subject reimbursement; 4. Blinding; 5. Research approval; 6. Randomization
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| What is another name for Foreground Question (4 components)? | PICO
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| Ideally, these people should always be” blinded” | 1. Patients
2. Treating Clinicians
3. Data Collectors
4. Data Analysts
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| 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**
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| 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
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| 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
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| 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)
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| Evidence Based Practice (EBP) | Integration of clinical expertise w/ the pt values & the best available research evidence to ensure optimal outcomes
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| Goal of EBP | Improve clinical performance through critical evaluation of the current evidence
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| In randomization, name some extraneous variables | Patient, age, race, gender, symptom duration, condition severity, comorbidities, intellectual status, motivation, & treatment expectations.
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| 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
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| 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
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| 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
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| 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
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| What does PICO stand for? | Patient, Intervention, Comparison, and Outcome
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| Background questions are developed to? | Enhance knowledge relative to a specific disorder
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| Reliability (intra- and inter- tester) | The extent to which an experiment, test or measuring procedure yields the same results on repeated trials
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| What is the difference between intra- and inter- tester | Intra - one person doing testing, 7%. Inter - two people doing testing, 15%.
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| Difference between internal & external validity | Internal validity - Benefit of the Tester & External validity - can NOT control
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| Identify 3 considerations of the patient and research in order to make clinical application judgement | 1. Patient circumstance
2. Patient values
3. Evidence
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