Evidence-based Practice Exam Questions and Complete Answers

Evidence-based Practice Exam Questions and Complete Solutions What is Evidence Based Practice? - Ans: EBP is the process by which a clinician is encouraged to utilize and integrate high quality quantitative and qualitative research, clinical experience, and patient values into the provision of clinical service. What is evidence based rehabilitation? - Ans: EBR is an adaptation of the concepts of EBP to rehabilitation practice and necessitates specific skills that allow clinicians to use evidence within the complex decision-making required for rehabilitation practice The three things that help become a good evidence based practitioner. - Ans: Current best evidence Treatment environment Client's values and circumstances Meta analysis, randomized controlled, systematic reviews - Ans: Level 1 Not randomized: Cohort Studies - Ans: Level 2 Not having a control group. Case control studies - Ans: Level 3 Experimental single case studies, with at least marginal manipulation of the independent variable.(Case series) - Ans: Level 4 Case review, opinion paper, expert review. - Ans: Level 5 Limitations of EBP - Ans: Shortage of scientific evidence in area of OT practice. Difficulty in applying evidence to specific problems w/ 1 client. Work Barriers Personal Barriers Three steps of organizing evidence around central clinical tasks: - Ans: 1. Getting to know the client- background & diagnosis. 2. Choosing an effective treatment approach. 3. Estimating the probable outcomes Evidence based practitioners integrate research evidence into practice through a systematic 4-step process: - Ans: Step 1: Write an answerable clinical question Step 2: Gather current published evidence Step 3: Appraise the evidence Step 4: Use the evidence to guide practice for individual clients by communicating the results to patients What are the 2 types of answerable questions? - Ans: 1. Background question 2. Foreground question What are the 4 aspects to "best evidence"? - Ans: 1. Relevance 2. Trustworthiness 3. Generalizability 4. Clinical importance Determining the degree of fit between the practitioners clinical needs and the methods research study - Ans: Relevance Determining the degree of fit between the researcher's purpose and the methods of the study - Ans: Trustworthiness Research is completed on a sample of people assumed to be representative of the whole population - Ans: Generalizability When you emerge yourself into a culture - Ans: Ethnography Understanding someones lived experience - Ans: Phenomenological Outcome based something that goes straight into action - Ans: Action research. CAT Stands for and is? - Ans: Critically appraised topic- look at a bunch of different papers and analyze and synthesize them for the PICO question CAP - Ans: Critically appraised paper- this appraises one paper for it's ability to answer the PICO. list the 3 def. that EBP is - Ans: is approach to decision-making that uses the best evidence available in conjunction with client choices to decide on an option; a process that begins with clinical questions, approaches of evidence, application of evidence considering the clients wishes and needs and finishes with an evaluation of clinical outcomes; requires that decision about health care are based the best available current, valid and relevant evidence. What is knowledge - Ans: a collection of ideas and facts about a topic What is evidence - Ans: information that makes a conclusion of a set of facts more apparent Process of EBP - Ans: Step 1 Posing a clinical question. Step 2: Searching for the Evidence Step 3: Appaising the Literature Step 4: Making a decision Step 5: Assessing the effectiveness of an intervention and One's Proficiency with EBP process. Postpositivism - Ans: scientific method, believes that absolute truth of knowledge was determined by empirical science Postpositivism underpins what research design - Ans: quantitative design Constructivism - Ans: that knowledge is more complex than that which can simply be reduced to facts. What other term is associated with the constrructivism worldview - Ans: interpretativism What worldview underpins mixed method research - Ans: constructivism Pragmatism - Ans: that knowledge is derived from the analysis of actions, situations, and consequences rather than the sole examination of conditions What worldview underpins mixed methods research - Ans: Pragmatism Transformative - Ans: seeks to create knowledge beyond imposed structural laws and theories, It seeks to understand how politics and social oppression What worldview underpins mixed method and qualitative research designs - Ans: transformative what approach to research involves true experiments: applied behavior analysis or single subject experiements - Ans: Quantitative What approach to research involves the procedures of grounded theory, ethnography, phenomenology, narrative research and even case studies - Ans: Qualitative What approach to research involves combining or integrating quantitative and qualitative research and data into a single research study, or open ended data - Ans: mixed methods In regard to the philosophical worldviews which underpin research design, if the intent of the research is to understand the lived-experience of being paraplegia, which worldview supports this design? - Ans: Constructivist worldview four important concepts of evidence based rehabilitation - Ans: awareness, judgement, consultation creativity Why are there misunderstandings with EBP - Ans: because of the way in which it breaks with traditional practice, How should EBP be seen - Ans: as a powerful tool not burden True or False - Ans: EBP maintains a fine balance between clinical expertise and external clinical evidence Nature of EBP in rehabilitation - Ans: allows clinicians to use evidence within the complex decision making required for rehabilitation True or False - Ans: EBP cannot support a strongly client-centered approach to rehabilitation False EBP is based on an ongoing and self-directed learning model - Ans: True or False What serves as a generative function in the evolution of information for practice - Ans: evidence based knowledge the 3 individual professional responsiblity - Ans: itating knowledge development as insights emerge in daily practice, 2. evaluating effectiveness 3. willingness to use information to abandon ineffective methods or erroneous ideas1 What are the three vantage points for evidence-based knowledge - Ans: begin with preservice educational preparation and continue through the expert phase of professional career path 2. develop and share information with each other within thier own disciplines 3. professionals develop and share information across disciplines to inform others Phases of Professional Development - Ans: preservice experiences, Novice professional period, experienced professional peroid, expert professional period What phase of professional development becomes aware of own beliefs and learns initial strategies for questioning beliefs - Ans: preservice experiences What phase of professional development begins to generate ideas, determine effective and ineffective methods for practice, and test knowledge and beliefs - Ans: novice professional period What phase of professional development establishes methods for evaluating effectiveness, hypothesizes successful therapeutic techniques and shares with colleagues - Ans: experienced professional period What phase of professional development participates in formal methods of collecting data, and evaluating interventions, share knowledge more globally and critiques the work of others - Ans: expert professional peroid What period of professional development occurs in the first 5 years - Ans: novice period what period of professional development occurs in the second decade - Ans: experienced What professional development occurs after 2 decades of practice - Ans: expert What are the three challenges associates with developing evidence for practice - Ans: cing generalizable evidence. 2. disseminating evidence in an accessible and relevant format 3. implementing evidence into practice Barriers to accessing evidence may include lack of time, lack of access to resources, lack of desire to enhance current knowledge and skills - Ans: true or False Becoming a evidence based practice rides on what three things - Ans: balance of knowledge, skills and attitudes that begin to develop in formal education and refine in the clinical practice True or False - Ans: EBP educational interventions for students and practitioners should be grounded in learning theories and be informed by current research in knowledge translation A well built clinical question contains what 4 elements - Ans: P(client, population), I(Intervention, C(comparison) 0 (Outcome) 3 types of scholary publications - Ans: books, non-peer reviewed journals and professional magazines, peer reviewed journals a paper that is submitted that may or may not be reviewed by editorial staff of a publication - Ans: non peer reviewed journal or magazines True or False - Ans: Good questions are relevant, direct, clear and focused. different sources of evidence - Ans: books, non-peer reviewed articles, journals,; peer reviewed journals all effective literature searches should be: - Ans: systematic, explicit, reproducible. provides the highest internal validity due to randomizations: therefore little bias or confounding variables - Ans: systematic reviews of random control trails what level of evidence says that randomization is lost however little bias is present because subjects are identified prior to outcome - Ans: systematic reviews of cohort studies What level of evidence says bias can be present, subjects are pre-selected and therefore internal threat can be evident - Ans: Systematic reviews of case Cohort studies What level of evidence is comparison between groups is lost at this level outcomes are particular to a single group - Ans: case series and case control studies What level of evidence is it common for the opinion of experts to be held in high regard - Ans: expert opinion without explicit critical appraisal Systematic reviews of cohort studies provides the highest level of internal validity of all the levels of evidence due to randomization. - Ans: True or False three approached to research - Ans: Qualitative, Quantitative, Mixed methods What is a means for exploring and understanding the meaning individuals or groups ascribe to a social and human problem - Ans: Qualitative research What is a means for testing objective theories by examining the relationship among variables. - Ans: Quantitative research what is an approach to inquiry that combines or associates both qualitative and quantitative forms - Ans: Mixed method research What worldview can be described as determination, reductionism, empirical observation and measurements, and theory verification - Ans: postpositivism What worldview can be described as understanding, multiple participant meaning, social and historical construction, and theory generation - Ans: Constructivism What worldview can be described as political, empowerment issue-oriented, collaborative, and change-oriented - Ans: Advocacy-Participatory What worldview can be described as consequences of actions, problem-centered, Pluralistic, and real-world practice oriented. - Ans: Pragmatism What research uses experimental designs, non-experimental designs such as surveys - Ans: Quantitiative What type of research using narrative , phenomenology, etnographies, grounded theory studies, and case studies - Ans: Quallitative What type of research uses Sequential, Concurrent, and transformative - Ans: Mixed methods Provides a quantitative or numeric description of trends attitudes or opinions of a population by studying a sample of that population - Ans: Survey research Experimental research - Ans: seeks to determine if a specific treatment influences an outcome Ethnography - Ans: a strategy of inquiry in which the researcher studies an intact cultural group in a natural setting over a prolonged period by collecting, primarily, observational and interview data Grounded theory - Ans: strategy of inquiry in which the researcher derives a general, abstract theory of a process, action, or interaction grounded in the view of participants. Phenomenological research - Ans: is a strategy of inquiry in which the researcher explores in depth a program, event, activity, process or one or more individuals. Narrative research - Ans: is a strategy of inquiry in which the researcher studies the lives of individuals and asks one or more individuals to provide stores about their lives, Sequential mixed methods - Ans: those in which the researcher seeks to elaborate on or expand on the finding of one method and another method transformative mixed methods - Ans: are those in which the researcher uses a theoretical lens as on overarching perspective within a design that contains both quantitative and qualitative data A review article provides information to one or two of the following - Ans: population, intervention or outcome measures What is the problem with literature review - Ans: designs, populations, interventions or outcomes are not the same across studies Narrative review - Ans: A review of similar topic articles to a meaningful conclusion. Systematic Review - Ans: inclusion and analysis methods are specified. Meta-Anaylasis - Ans: Systematic reviews concluding with an overall effectiveness staticis Meta-Synthesis - Ans: A systematic review of Qualitative studies Narrative review articles are based on what types of studies - Ans: mixed methods, qualitative, quantitative Systematic review articles are based on what types of studies - Ans: Qualitative, can be mixed methods and quantitative Meta-analysis review articles are based on what types of studies - Ans: Quantitative Meta-Synthesis review articles are based on what types of studies - Ans: Qualitative How do qualitative researchers answer the research questions - Ans: Participant observation, interviews, document reveiws, focus groups In order to write a critical review what questions need to be answered - Ans: was the purpose or research stated clearly, was relevant backgound literature reviewed, what was the study design Some design types - Ans: phenomenolgy-understands phenomenon of a lived experience.Ethnography- tells the whole story of a groups daily life to identify the cultural meanings, beliefs, and social patterns of the group. Grounded theory- focus is on searching to identify the core social processes within a given social situation, Par-Type of Qualitative research In a Quantitative review What design types are used - Ans: Randomized=set of clients are identified and then randomly allocated to two or more different treatment groups.; Cohort design=group of people exposed to same situation. Single case design=involves one client or number of clients, basic feature is evaluation of clients for outcomes, before baseline and after. Before and After design= Clients studied before trail and then after trail, Case Control Design-participants with outcome of interest, participants without outcome of interest, both are studied, results are comparison between the two. main disadvantage to RCT - Ans: expense involved, it is not ethical to have control groups. wise approach for self assessment - Ans: wonder, investigate, speculate, evaluate Types of innate egocentric thinking - Ans: innate wishful thinking, innate selfishness, innate self validation An "autonomous person" is someone who: - Ans: A.Has reached the legal age to provide informed consent in the State. B.Is willing to accept certain risks if the research will benefit others in the future. C.Understands the risks and benefits of his or her participation and is able to make a voluntary decision if adequate information is provided. D.Meets all eligibility criteria for a study and asks the investigator if she or he may participate answer C. A study proposing to involve pregnant adolescents who are detained in a juvenile detention center would only be allowed if: - Ans: A.The requirements for Subpart B, Additional Protections for Pregnant Women, Human Fetuses and Neonates Involved in Research are met, because Subpart B takes precedence over Subpart D. B> The requirements of Subparts A, B, C, and D are met. C Such research would never be allowed because it involves an extremely vulnerable population. D. The research is noninvasive and the adolescent detention periods are temporary and will end at about the same time the study is completed. answer B. Identify the most influential event that led to the HHS Policy for Protection of Human Research Subjects - Ans: Nuremberg trials Syphilis Study at Tuskegee Jewish Chronic Disease Hospital Study Willowbrook Study Answer is Syphilis Study at Tuskegee What are the three ethical principles that constitute the basis for the HHS Human Subjects Regulations (45 CFR 46)? - Ans: Honesty, Trust, Respect Informed consent, IRB review, Research Integrity Respect for Persons, Beneficence, Justice Protections for Pregnant Women, Prisoners, Children Answer Is Respect for Persons, Beneficence, Justice Which entity has regulatory authority for the protection of human subjects for PHS-funded research? - Ans: OHRP NIH Institutions that receive Federal funds HHS Answer is OHRP An institutionally designated authority, other than the investigator, should determine that proposed studies are exempt from regulatory requirement - Ans: True False Answer is True One of the requirements of informed consent is that subjects must be told whether they are eligible to receive compensation if they are injured as a result of their participation in the research - Ans: True or False Answer is True Communities may grant emergency waivers of informed consent for research involving pregnant women in the community who are in active labor and call Emergency Medical Services - Ans: True or False Answer is False The regulations strongly suggest but do not require that the informed consent process be delivered in a language that is understandable to the subject - Ans: True or False Answer is False Research involving prisoners requires both specific IRB membership and approval by OHRP to signify that the proposed research falls within the permissible research categories. - Ans: True or False Answer is True After informed consent for a research study is given, a research participant must complete the study. - Ans: True or False answer is False Why might an individual have diminished autonomy - Ans: They are a neonate. They are incarcerated or involuntarily confined. They are unconscious. All of the above. Answer is all of the above. Therapeutic misconception is the tendency for investigators to overemphasize the benefits of research to society while incorrectly minimizing the risks to a particular patient - Ans: True or False Answer is False Because the expedited IRB review process is generally used for certain types of minimal risk research, it is less stringent than review by the full IRB - Ans: True or False Answer is False Risks to research participants must be completely eliminated for the study to be considered ethical. - Ans: True or False Answer is False There must be equipoise in order to justify conducting a clinical trial. - Ans: True or False Answer is True What is an appropriate method for maintaining confidentiality of private information obtained from human subjects - Ans: Keeping data in a password-protected database Storing images in a secured cabinet Coding data or specimens and keeping the key to the code in a separate, locked drawer All of the above are ways to maintain confidentiality Answer is all of the above It is ethical to use deceptive methods in research when the scientific goals of the project can be achieved by non-deceptive method - Ans: True or False Answer is False NIH has specific policies addressing: - Ans: Inclusion of children in research Inclusion of women and minorities in research Treatment for research subjects in HIV/AIDS antiretroviral studies following completing of trials in developing countries All of the above Answer is all the above Social justice and individual justice are different and distinct, yet compatible, concepts - Ans: True or False Answer is True Children must be included in all NIH-supported human subjects research unless: - Ans: A.The researcher is not a pediatrician B.Past experience has shown it is time-consuming and expensive to recruit children C. There are scientific and ethical reasons to exclude them D. The researcher does not possess the pediatric equipment necessary to involve children in the proposed research Answer is C.