637 Evidence-Based Practice Exam Questions and Complete Solutions

637 Evidence-Based Practice Exam Questions and Complete Solutions Steps of Evidence-Based Practice - Ans: 1. Posing a clinical question 2. Searching for evidence 3. Appraising literature 4. Making a decision 5. Assessing the effectiveness of the intervention (or test/assessment) and one's proficiency of the EBP process Clinical question is referred to as: - Ans: P.I.C.O. P.I.C.O. stands for: - Ans: P = target population I = intervention C = comparison to another group or intervention O = desired outcome of intervention Gold standard for research about therapy effectiveness - Ans: Randomized Controlled Trials _________ research is not always seen as significant in the EBP realm as compared to ________ research. - Ans: QL; QN Questions to ask when appraising the literature - Ans: 1. What are the results? 2. Are the results valid? 3. How will these results help me work with my client? Questions to ask when making a decision (on whether and how you can apply your obtained information) - Ans: Were the study participants similar to my client? Is the intervention realistic? Were the outcomes in line with our treatment goal? Does the strength of evidence warrant clinical use? Questions to ask when assessing the effectiveness (after implementing the intervention) - Ans: Did the intervention result in positive outcomes? Did the benefits outweigh the harm? Were the clients satisfied? Were you, as the OT, satisfied? Is this intervention superior to usual care or no intervention? _________ - to examine and analyze the available research to decide what findings are valid and clinically useful - Ans: Evaluating the Evidence When evaluating the evidence, we are focused on detecting _____ and differentiating between ____ & _____ quality studies. - Ans: bias; higher & lower Are different study designs needed for different types of clinical questions? - Ans: Yes _________ research is essential to support our practice - Ans: QN Six questions to ask yourself when appraising QL research - Ans: 1. Was the sample used in the study appropriate to its research question? 2. Was the data collected appropriately? 3. Was the data analyzed appropriately? 4. Can I transfer the results of this study to my own setting? 5. Does this study adequately address potential ethical issues, including reflexivity? 6. Is what the researchers did clear? Examples of QL study designs....... - Ans: Case study Ethnography Phenomenology Grounded theory QL Study Design: An in-depth study of a bounded system such as a process, activity, event, program, or interaction - Ans: Case Study QL Study Design: To study a particular culture or group of people to identify their daily life patterns, meanings, and beliefs - Ans: Ethnography QL Study Design: To understand the lived experience, interpret it, and provide information that can be shared with and used by others - Ans: Phenomenology QL Study Design: Used when generating or verifying theoretical concepts - Ans: Grounded Theory The main focus of evidence-based practice: - Ans: QN Evidence _____________ can define how accurate a diagnostic test is or how big a treatment effect is expected; based on a sample of people who are used to represent the population (not purposeful sampling) - Ans: QN evidence ________ is the single most powerful tool for discounting the effects of factors that could potentially bias study findings - Ans: Randomization What are the 3 basic approaches to appraisal of QN research? - Ans: 1. Instruments that assess the methodological quality of studies 2. Instruments that assess the quality of the reporting of clinical studies 3. Tools/Processes for assessing the risk of bias ____ is the only experimental design that can ascertain effectiveness; hallmark of EBP; considered the level 1 evidence of treatment effectiveness. - Ans: Randomized Control Trial 3 situations that can be labeled as level 1: - Ans: 1A. consists of systematic review of a number of RCTs 1B. an individual RCT 1C. unusual circumstance - absence of randomization, but large impact occurs Study Levels: Highest _________; enhancing our confidence that if we select an intervention, we will achieve similar outcomes used in the study - Ans: internal validity; Level 1 Study Levels: Loose randomization, less protection against biases - Ans: Level 2 Study Levels: A systematic review of cohort studies that are similar in _____ and ____ of the effects obtained - Ans: direction and size; Level 2A Study Levels: A single high-quality cohort study with greater than __ follow-up patients - Ans: 80%; Level 2B Study Levels: A systematic review of case control studies that _____ with each other - Ans: agree; Level 3A Study Levels: Single, individual case-control study - Ans: Level 3B Study Levels: Evidence for treatment effectiveness occurs when studies are case-controlled - Ans: Level 3 Study Levels: Consists of case series - evaluates the clinical outcomes of a single group of patients - Ans: Level 4 Study Levels: expert opinion without explicit critical appraisal - in rehab can be viewed in high regard - Ans: Level 5 ______ is the optimal design for questions about interventions including prevention, treatment, and rehabiliation - Ans: Randomized controlled trails Building evidence into practice - Once a clinical problem/issue is identified, the therapist can carry out these 6 steps: - Ans: 1. Write a clinical question 2. Search for the evidence related to the question 3. Evaluate/Critically appraise evidence to determine the evidence that best informs the clinical question 4. Speak with the client and decide whether to act upon the evidence 5. Evaluate the outcomes of the action 6. Save the information you have required for future reference Some forms of evidence may never have level 1 evidence....? - Ans: True 5 Major Types of CATs - Ans: 1. Diagnosis/Screening 2. Prognosis 3. Evaluating risk and harm in a case-control study 4. Evaluating risk and harm in a cohort study 5. Intervention studies - treatment, prevention, & screening Important elements of CAT - Ans: - Date of completion (shelf life) - The question (if utilizing all aspects of PICO it will likely yield usable results) - The clinical bottom line (where you summarize your findings & report your critical eval and clinical judgement on how those results can be used) - The evidence (the CAT is your lifeline) Intervention Role of ___: Responsible for the development, documentation, and implementation of intervention - Ans: OT Intervention Role of ___: Intervention plan is documented as appropriate - Ans: OT Intervention Role of ___: Collaborates with client to develop and implement the intervention plan - Ans: OT Intervention Role of ___: Uses professional and clinical reasoning to select appropriate interventions - Ans: OT Intervention Role of ___: Able to select appropriate interventions - Ans: OTA Intervention Role of ___: Modify the intervention plan as appropriate - Ans: OTA Intervention Role of ___: Able to modify intervention plan by exchanging info with and providing documentation to OT - Ans: OTA Intervention Role of ___: Documents OT services as appropriate - Ans: OTA Types of OT Intervention: selected for specific clients and designed to meet therapeutic goals and address the underlying needs of the mind, body, and spirit to the client - Ans: Occupations and Activities Types of OT Intervention: dressing with use of adaptive equipment, applying for a job, purchasing groceries, and making a meal - Ans: Occupations Types of OT Intervention: practice fasteners to dressing, practicing a tub transfer - Ans: Activities Types of OT Intervention: These prepare the client for occupational performance, used as part of a treatment session in preparatory for or concurrently with occupations and activities. - Ans: Preparatory Methods & Tasks Types of OT Intervention: modalities, splints, assistive technology, environmental modifications, wheeled mobility - Ans: Preparatory Methods Types of OT Intervention: used to target specific skills, may not hold meaning to client - folding towels from linen cart to increase ROM - Ans: Preparatory Tasks Imparting of knowledge and information about occupation, health, well-being, and participation that enables the client to acquire helpful behaviors, habits, and routines that may or may not require application at the time of the intervention session - Ans: Education Facilitation of the acquisition of concrete skills for meeting specific goals in a real-life applied situation - Ans: Training Efforts promoting occupational justice and empowering clients to seek and obtain resources to fully participate in daily life occupations - Ans: Advocacy Ex: serving on a policy board, educating public on disability awareness - Ans: Advocacy Ex: accommodations in educational setting, using ergonomically designed keyboards in the workplace - Ans: Self-advocacy Use of distinct knowledge and leadership techniques to facilitate learning and skills acquisition across the lifespan through the dynamics of group and social interaction. - Ans: Group Interventions Service Delivery: _____ services include settings such as hospitals, schools, and homes, whereas ____ service would include consultation - Ans: direct; indirect What are the steps to the basic intervention process? - Ans: Intervention Plan Intervention Implementation Intervention Review Intervention process: Consider - Client goals, beliefs, values and health Performance skills/patterns, contexts, client factors, & activity demands Setting including payment methods Theory and FOR Approach with the client Interaction with family and caregivers (amount of involvement) EBP Knowledge of development of disease - Ans: Intervention Plan Intervention process: Put the plan into action Outcomes Documentation Therapeutic use of self Consultation Education Re-assessing - Ans: Intervention Implementation Intervention process: Determine if outcomes are met Assess effectiveness of the treatment - Ans: Intervention Review Intervention process: -Develop plan that includes object & measurable goals with a time frame, OT intervention approach based on theory and evidence, & mechanisms for service delivery - Consider D/C needs and plan - Select outcome measures - Make referrals and recommendations as appropriate - Ans: Intervention plan Intervention process: - Carry out intervention - Monitor client's response and reassess - Ans: Intervention Implementation Intervention process: -Re-evaluate plan to see if reaching targeted outcomes - Modify plan - Determine if D/C or refer away - Ans: Intervention Review - Allows OT to address learning capacity - Get one-on-one, undivided attention - Privacy - Allows OT to have more control over environment/context - Allows OT to consider behaviors of client - Can quickly alter activity or occupation (grading) - Ans: Individual Intervention Considerations - Development of interpersonal skills - Receive feedback from those with similar experiences - Peer role models - Socialization - Learn from other people - Places own condition into perspective - Development of expected behaviors - Ans: Group Intervention Considerations ___________ is utilized to categorize interventions to determine if the occupational therapy plan is directed toward engaging the client in occupations to support participation - Ans: Intervention Continuum Four categories of intervention: - Ans: 1. Adjunctive 2. Enabling 3. Purposeful 4. Occupation-based Type of Intervention (4): -First phase of intervention continuum -Typically used to prepare client for participation in a purposeful or occupation-based intervention -Use with goals of preparing client for participation in his/her occupations - Ans: Adjunctive Type of Intervention (4): massage, contrast baths, orthotic devices, education, issuing or viewing AE, sensory integration techniques - Ans: Adjunctive Type of Intervention (4): -Used in a treatment session that would appear to simulate an activity and are not directly purposeful, but incorporate use and integration of performance skills -Focus on the performance of select skills and are typically exercise-oriented - Ans: Enabling Type of Intervention (4): upper extremity exercise, dressing board, cognitive worksheets, practicing operation of AE, theraputty, graded pinch exercises - Ans: Enabling Type of Intervention (4): -Predetermined goals and an obvious beginning and end -Separates us from other healthcare professionals -Focus on improvement of areas of occupation -Do not necessarily reflect the client's priority occupations nor the client's typical performance contexts - Ans: Purposeful Type of Intervention (4): practicing dressing with facility clothes, crafts, scooter board obstacle course, role-playing - Ans: Purposeful Type of Intervention (4): -Perceived by client as desirable, matching his/her personal goals, and occurring in its appropriate context -Can be a challenge for experienced OTs - Ans: Occupation-based Type of Intervention (4): laundering own clothes, purchasing desired items from store, telephoning a friend - Ans: Occupation-based Distinguishing between purposeful and occupation-based occupations will depend upon the _____ of the client and the _____ _____! - Ans: specifics; clinical situation It is necessary to provide interventions in a set sequence based on the continuum - T or F - Ans: False! The same intervention may be categorized differently on the continuum for different clients - T or F - Ans: True! Occupation-based intervention is not limited to basic ADLs - T or F - Ans: True! Adjunctive or enabling interventions may be beneficial in the _______ of performance skill impairments - Ans: Remediation ________ allows us to keep track of patient progress/response from intervention plans - Ans: Documentation As a result of reassessment, intervention _______ changes may be necessary - Ans: plan _________ responsible for the monitoring and reassessment of client intervention plans and making sure they are ________ - Ans: Both OT and OTA; goal-oriented Consultation Process Steps: - Ans: 1. Identify the need for consultation 2. Locate a group, program, organization, or community that can provide the service. 3. Determine if a consultation or referral needs to occur 4. A plan is created 5. Continual reassessment of plan 6. Discharge Discharge planning begins at _______ and continues throughout the intervention process as the client's ____ change. - Ans: evaluation; needs