Evidence-based Inquiry Week 1-3 Exam Questions and Complete Solutions

Evidence-based Inquiry Week 1-3 Exam Questions and Complete Solutions EBP - Ans: "Evidence-based practice (EBP) is the process of integrating the best available research evidence, practitioner experience, and client values into practice decisions" Evidence-Based Practice - Ans: practitioner experience external evidence client's situation/values It is clear from this definition that evidence- based practice relies on practitioners' clinical expertise when applying research evidence to practice. Sackett et al. (1996) state that neither clinical expertise nor the best available external evidence alone are enough for evidence-based practice; external clinical evidence can inform but can never replace individual clinical expertise. Clinical expertise is what determines whether the external evidence applies to the individual patient (i.e., whether and how it matches the client's clinical state, predicaments, and preferences). Thus, evidence-based practice is a multifaceted endeavor comprising three components 1. The external scientific evidence 2. The practitioner's experience 3. Client/family situation and values Each source of evidence provides information for clinical decision-making. The best decisions occur when all three sources are considered. Why is EBP Important? - Ans: uMore effective treatments uBetter cooperation from patients uEasier to defend services to insurance companies uKeeps your skills current Benefits of EBP Implementation - Ans: uImproved patient outcomes uReduced healthcare costs uHigher levels of health practitioner engagement, teamwork, and job satisfaction Process of Evidence-based Practice - Ans: 1.Formulate a question based on a clinical problem. 2.Identify the relevant evidence. 3.Evaluate the evidence. 4.Implement useful findings. 5.Evaluate the outcomes. Formulate the question: The first step in evidence-based practice involves identification of a clinical problem and formulation of a question to narrow the focus. Once the problem has been identified, a question is formulated. The formulation of a specific evidence-based question is important because it provides the parameters for the next step of searching the literature. Identify the relevant evidence: After the question has been formulated, the next step is to find relevant evidence to help answer it. Evidence can include information from the research literature, practice knowledge, and client experience and values. Searching the literature for evidence takes skill and practice on the part of practitioners and students. Evaluate the evidence: Once evidence is found, evidence-based practitioners must critically appraise that evidence. The design of study, size of the sample, outcome measures used, and many other factors all play a role in determining the strength of a particular study and the validity of its conclusions. In addition, practitioners need to evaluate the applicability of a particular study to their practice situation and client life circumstances. Implement useful findings: Clinical decision-making may focus on an intervention or assessment approach, use evidence to better understand a diagnosis or an individual's experience, and/or predict an outcome. Once the evidence has been collected, screened, and presented to the client, the practitioner and client use a collaborative approach and, through shared decision- making, apply the gathered evidence to practice. Evaluate the outcomes: When a practitioner evaluates the outcomes of implemen Writing An Evidence-Based Research Question - Ans: You'll use different types of questions based on the type information that you are seeking •Efficacy of an intervention •Usefulness of an assessment •Description of a condition •Prediction of an outcome •Lived experience of a client Efficacy of Intervention- PICO Question - Ans: Intended to help therapists make clinical decisions about implementing an intervention. Writing an efficacy question- PICO: uP= Population/participants (among_school-age children) uI= Intervention/exposure (does_assistive technology in the classroom setting) uC= comparison or control condition (versus_traditional reading strategies) uO= outcome (affect_improve reading skills) Levels of Evidence (Efficacy) - Ans: uNO UNIVERSALLY ACCEPTED HIERARCHY •Level 1: Systematic Review •Level 2: Randomized Controlled Trial •Level 3: Non-randomized Controlled Trial •Level 4: One Group Trial w/ pretest & posttest •Level 5: Case Report & Expert Opinion Levels I & II of Evidence - Ans: uLevel I: Systematic Reviews uSystematic Review: A literature review containing a synopsis of peer-reviewed publications focusing on a specific health problem or question assembled uAppraises, analyzes and synthesizes the results of studies uMeta-analysis- A subcategory of systematic reviews, which presents a quantitative summary of findings from all the assembled studies on a given topic uLevel II: Randomized Controlled Trial (RCT) uRCT= Must have at least 2 groups (experimental and a control/comparison) uParticipants must be randomly assigned to the conditions. uAn interventions must be applied to the experimental group. Level 2: Randomized Control Trials Randomized trial: Subjects are assigned to one of two or more blinded condition groups through random assignment Controlled exposure to the independent variable Level III Evidence - Ans: uLevel III: Nonrandomized Controlled Trials uSimilar to RCT but the assignment to groups is not random. uOften completed as one setting receiving an intervention vs another setting not receiving an intervention. Level IV Evidence - Ans: uLevel IV: One Group Trial with pretest & posttest uPre-test is administered, the intervention is applied, then the posttest is administered. uTypically have no control group. uThe individuals serve as their own control using pretest/posttest. uHard to know if the intervention actually CAUSED something. uCould have gotten better "just because". Level V Evidence - Ans: uLevel V: Case Reports & Expert Opinions uStudy that examines the effects of an intervention on a single individual over time with no control uBased on a single case study or expert opinion. uDo not use statistical analysis to draw conclusions. Question: Usefulness of an Assessment - Ans: uLooking for research and information regarding the psychometric methods of an assessment tool. uPsychometric Methods- primary focus is to examine the reliability and validity of assessments uReliability: consistency of a measure including the dependability of scores, agreement of scoring for different testers, and stability of scoring across different forms of a measure uValidity: ability of a measure to assess what it intends to measure uSensitivity: proportion of individuals who are accurately identified as possessing the condition of interest. uSpecificity: proportion of individuals who are correctly identified as not having the condition. Reliability- consistency & accuracy of measurement Validity- the ability to measure what the assessment wants to measure Sensitivity- true positive- the accurate identification of people who DO possess the condition Specificity- true negative- the accurate identification of people who do NOT have a condition Question: Description of a Condition - Ans: uDo not provide manipulation of variables uPrevalence & Incidence Studies uPrevalence: Proportion of individuals within a population who have a particular condition. uIncidence: Risk of developing a condition within a period of time. uCan describe groups that already exist uObservational methods and survey methods can be used to answer descriptive questions. Question: Prediction of an Outcome - Ans: uPredictive studies use similar methods to descriptive studies: observational or survey data. uData is collected as cross-sectional research (single point in time) or as longitudinal research (over a period of time). uPredictive studies find associations but do not imply causation. uSample size is an important consideration when assessing the quality of predictive studies uA larger sample size will be more representative of the population Question: Client's Lived Experience - Ans: uQuestions about the lived experience of a client are answered using qualitative methods. Barriers & Solutions to EBP-barriers - Ans: uDifficulty finding time to search for evidence, then appraise and implement it. uLack of access to journal articles that are needed to carry out EBP. uLack of training about EBP and how to carry it out. uLimited quantity of evidence in specific practice areas. uInsufficient quality of evidence. uResearch does not provide certainty since findings cannot be applied to individual patients. uClinical research does not tell of client's experiences. Solutions to Barriers - Ans: Solution 1: Support from Managers uProduce guidelines for how to develop evidence-based clinical guidelines. uUse information systems that integrate evidence and guidelines with patient care. uDevelop facilities and incentives to encourage effective care and better disease management systems. uImprove programs for practitioners. Solutions to Barriers Cont. - Ans: Solution 2: Make EBP a Priority uSeek out continuing education opportunities. uMake use of EBP resources uParticipate in research evaluating interventions within your discipline. uParticipate in or establish a journal club. uSeek out or contribute to evidence based clinical practice guidelines. Solutions to Barriers Cont. - Ans: Solution 3: All Stakeholders Needed uClinicians and Researchers must work together—create linkages. uResearch professionals need to demand/emphasize the timely transfer of theoretical knowledge into practice. uResearch studies should be carried out in the field to begin with to ensure relevancy of studies. examples of different types of evidence-based clinical questions - Ans: type of question: efficacy of an interv usefulness of an assessment description of a condition prediction of an outcome lived experience of a client efficacy of an interv-common designs/research methods - Ans: randomized controlled trials nonrandomized controlled trials pretest/posttest w/o control group examples - Ans: in indiv w/head and neck cancer, what is the efficacy of swallowing exercises vs. usual care for preventing swallowing problems during chemotherapy? in infants, what is the efficacy of swaddling (vs. no swaddling) for dec crying? for w/c users, what is the best cushion to prevent pressure sores? usefulness of an assessment-common designs/research methods - Ans: psychometric methods reliability studies validity studies sensitivity/specificity studies usefulness of an assessment examples - Ans: what is the best assessment for msrg improvement in ADL function? how reliable is goniometry for indiv w/severe burns? what methods inc validity of health-related qol assessment? description of a condition - Ans: Incidence and prevalence studies Group comparisons Surveys & Interviews description of a condition ex. - Ans: what motor problems are assoc w/CP? what are gender diff in sexual satisfaction issues for indiv w/SCI? prediction of an outcome - Ans: Correlational, regression, and cohort studies prediction of an outcome ex. - Ans: what predictors are assoc w/successful return to employment for indiv w/back injuries? what childhood conditions are r/t stuttering in kids? lived experience of a client - Ans: Qualitative studies, ethnography, phenomenology, and narratives lived experience of a client ex. - Ans: what is impact of MS on parenting? how do athletes deal w/career-ending injuries? week 2: Finding and Reading the evidence-finding evidence - Ans: Process of EBP Review: 1.Convert information needs into focused clinical questions 2.Identify the best evidence 3.Critically appraise the evidence for validity and clinical usefulness 4.Use the results, clinical expertise and patient input (goals, concerns) and apply the results in clinical practice 5.Evaluating performance of the evidence in clinical application formulate ?-search/ID evidence*-appraise evidence-apply results-evaluate perf of evidence Strategies for Identifying the Best Evidence - Ans: •Define your question •Select appropriate information sources •Choose the best databases or printed sources. •Apply search strategy using subject terms, keywords, and/or index entries •Select relevant articles from literature search Define Your Question - Ans: You'll use different types of questions based on the type information that you are seeking Efficacy of an intervention Usefulness of an assessment Description of a condition Prediction of an outcome Lived experience of a client Select Appropriate Information Sources - Ans: spotting fake news-consider source, read beyond, check author, is it a joke? check date, check your biases, ask experts, supporting sources? databases vs. search engines - Ans: Databases can be helpful because they are a smaller, targeted pool of information. They can often get you to the type of information you need faster, if you know what type of information you need. If you choose the right database for your topic, it can narrow down your search to relevant results as databases can be focused on a particular discipline(s) or type of content. Search engines can help you when you don't know what you're looking for yet or when you're doing exploratory background research on a topic. Perhaps you're not sure if you should be looking for scholarly articles or web resources, or you're having trouble understanding some of the more advanced articles that you're finding in databases. Choose the best Database(s) - Ans: ◦PubMed: ◦Most comprehensive database ◦Can use MESH terminology ◦PubMed Central has full text ◦Cochrane Library ◦Good for efficacy and diagnostic type questions ◦Messiah University's PRIMO ◦Includes all databases Messiah has access to in one easy place ◦Includes CINAHL ◦"Find sources citing this" ◦"Find sources cited in this" ◦Permalink Benefits of MESH: One of the biggest advantages to using MeSH terms is that all MeSH terms are pre-defined and have synonyms included. MeSH is effective for searching for meaning, rather than only looking for where words appear in the text of the abstract. With MeSH terms, you will not have to think about word variations, word endings, plural or singular forms, or synonyms. You can use MeSH features to refine your searches with subheadings and chose, if you like, to select specific MeSH terms to be tagged as the major focus of references retrieved. choose best databases (cont.) - Ans: ◦PEDro ◦Contains trials, reviews, and practice guidelines ◦Otseeker ◦OT specific database that contains abstracts of systematic reviews, RCTs, and other resources relevant to OT intervention ◦Provides rating on some journals ◦ Search AJOT, British Journal of OT, and Canadian Journal of OT through AOTA Applying Search Strategy - Ans: ◦Start with key words from your research question ◦Filter the search through the following: ◦Date ◦Source type (peer reviewed article, book, journal, etc.) ◦MESH terms ◦Search field ◦Relevance ◦Use Boolean operations ◦AND- narrows search ◦OR- expands search ◦NOT- narrows search ◦Use Truncation searching ◦Use an asterisk at the end of the common root ◦Ex: psychology, psychological, psychologist ◦Use: Psycholog* ◦Use phrase searching ◦Use quotation marks to keep phrases together ◦Ex: "climate change" would produce different results than Climate AND change ◦Use parentheses if using Boolean operations or phrase searching ◦("hand washing" OR handwashing) AND (nurses OR physicians) ◦Look up the citations used in relevant articles and search for those Determining the Credibility of Evidence - Ans: ◦Primary vs. Secondary source ◦Is it peer reviewed? ◦intensive review by at least two other professionals who are considered peers of the authors in a given field of study ◦Is there a research funding bias? ◦Can lead to conflict of interest if it's linked to the product under study ◦Is there a publication bias? ◦Tendency for journals to only publish "positive" results Reading the Evidence-Reading a Research Article - Ans: title page-abstract-intro-method-results-discussion-references-appendices (if applicable)-tables and/or figures Title Page - Ans: A page that, at a minimum, contains the article title, authors' names, and institutional affiliations. •Institutional affiliation—The location and nature of the institution or institutions in which the research was developed, supported, and/or executed •Corresponding author—The author who has agreed to receive and respond to any correspondence regarding the article •Keywords Abstract - Ans: A concise summary that serves as a topical legend or reference point and presents key aspects of a study. It should include: Background information about the topic of the study Objectives of the study Research questions or hypotheses to be examined Description of the participants and the methodological approach Description of the results and conclusions Abstract- What to Look For - Ans: •The methodological approach and the results will be concisely described, which contributes to knowing whether the article is worth further reading •Reading the abstract to determine if the article is relevant to needs Introduction - Ans: ◦An article section that provides background evidence justifying the relevance and need for a given study (where you put all sources, aka background/lit review) ◦Statement of impact—A statement that references data that point to the importance of the topic under study ◦Problem (big purpose where research is lacking, Purpose & Significance (how it will solve bigger problem) Introduction: Problem, Purpose & Significance - Ans: •Problem Statement: Larger issue that others have tried to do something about, or where information is lacking •Purpose: What one hopes to accomplish as a result of the contribution to the larger problem •Significance: Importance of the study and what it will do to solve the larger problem Introduction- What to Look For - Ans: •Might find a hypothesis or objectives of the given study in this section •Is the research question stated? Relevant? •Should be framed within the scope of relevant literature related to the given focus of the study Methods - Ans: Describes (in detail) the approach that was used to answer a particular practice question or to solve a practice problem •Ethical approvals (IRB approval) •The professional bodies that approved conduct of the research and how participants provided consent for the study •Design •A description of the type of study and the way in which a research question or problem was examined •Participants •A description of the social and demographic characteristics of the sample, as well as the criteria by which the individuals were selected or excluded from participation •Procedures •A description of the sequence of actions taken to conduct the study, from beginning to end •Analysis •A description of how the data was analyzed1. Write a question examining the usefulness of an assessment How reliable and valid are the evaluation in Ayres Sensory Integration (EASI) vestibular and proprioceptive tests? 2. Find an article that examines the usefulness of an assessment Methods- What to Look For - Ans: info on study design allows for better understanding of methodological rigor. consider sample, data collection, data analysis the sample allows reader to see if study is relevant to their population of interest measures used will allow reader to know if comparisons from data may be made to his or her population Results - Ans: An article section that contains the statistical findings or qualitative summarization resulting from the data analyses that were conducted It should not include an interpretation of or reflection on any of those findings This is like the O part of the SOAP note Results- What to Look For - Ans: •This section will provide a reader with a concise summary of the specific study data •The research questions or hypotheses should be restated in this section •Measures and statistical evidence should be directly tied to each question or hypothesis with a degree of significance. Does the data justify the conclusion? Discussion - Ans: An article section that provides an overview of study aims and findings Compares/contrasts results with findings from related studies Provides reflection on questions, controversies, and issues raised in the introduction Indicates implications for practice Includes a limitations section This is like the A part of the SOAP note Discussion- What to Look For - Ans: •Quickly access the limitations of the study and therefore have knowledge of its overall applicability •Future directions of research should be identified References - Ans: A list of references that correspond to the literature cited within the paper Should be formatted in the same style as the paper (e.g., APA formatting) References- What to Look For - Ans: •Allow an experienced reader to recognize the credibility of the sources •Provides the reader with a list of related literature Recommended Order of Reading - Ans: ◦Title/Key Word/Date ◦Abstract ◦Introduction ◦ References ◦Figures & Tables ◦Skim Discussion ◦Review Abstract & Introduction ◦Methods ◦Deeply Read Results ◦Deeply Read Discussion ◦Deeply Read Conclusions ◦Re-Read Abstract Efficacy of an Intervention-1. Write a PICO question (Efficacy of an intervention) - Ans: In individuals with treatment resistant Schizophrenia, is the occupational goal intervention method more effective than craft activities in improving executive dysfunction? 2. Find an article that examines efficacy of an intervention - Ans: 3. Find each level of evidence for an efficacy type question - Ans: I Systematic Review of Randomized Controlled Trials II Randomized Controlled Trial III Nonrandomized Controlled Trial IV One Group Trial with pretest & posttest V Case Reports or Expert Opinion Usefulness of an assessment - Ans: 1. Write a question examining the usefulness of an assessment How reliable and valid are the evaluation in Ayres Sensory Integration (EASI) vestibular and proprioceptive tests? 2. Find an article that examines the usefulness of an assessment Description of a condition: - Ans: 1. Write a question examining a description of a condition What is the incidence of traffic violations and crash incidence over a 1 year period for drivers with visual field impairment? 2. Find an article that examines the description of a condition Prediction of an outcome: - Ans: 1. Write a question examining a prediction of an outcome What factors are associated with successful postsecondary transition for people with disabilities receiving OT? 2. Find an article that examines a prediction of an outcome Lived Experience: - Ans: 1. Write a question examining the lived experience of a client How do people with disabilities experience hotel stays? 2. Find an article that examines the lived experience of a client ppt notes-week 1 - Ans: EBP notes: and client preferences-slide 7 research/client preference-as beginning OT your experience-as you grow as an OT focus today is efficiency, getting people out sooner with more efficient tx, b/c so many on medicare now (it used to be you would do longer tx/length of tx would be based on amount of reimbursement-slide 9 slide 12: identify relevant evidence-experience, coworkers, research articles (but may not be accurate or valid treatments in articles) slide 14: ex-does ACLS really measure if person is safe to go home (is it valid/reliable?) lived experience of a client-qualitative data slide 16: PICO - Ans: (C is optional like with COAST goals S is optional)-only used for efficacy of intervention questions pico ?: Among stroke clients, does mirror therapy decrease phantom limb pain/improve fine motor skills in the affected arm, compared to traditional interventions without mirror use? when researching evidence, may want to start w/systematic reviews/level 5 evidence-narrative review/expert opinion (b/c these all are already evaluated/analyzed for us) writing a question examining usefulness of an assessment: how reliable and valid are the EASI vestibular and proprioceptive tests? levels 1/2-best evidence, usually in lab, not real-world slide 26-validity-does tug predict fall risk? sensitivity-can tug say those people are a fall risk specificity-can tug say someone isn't a fall risk. describe a condition-slide 29- - Ans: not doing intervention (incidence/prevalence) slide 32-prediction of an outcome-associations slide 35-lived experience of a client-interview parents of children w/MS, qualitative data slide 35-qualitative/quantitative-both equally as good, just look at totally different things -continuing ed that's cheapest* medbridge continuing ed 12 hrs continuing ed/yr required as an OT ppt notes-week 2 (and APA notes) - Ans: week 2: EBP notes lived experience-qualitative research slide 5 google-search engine, general info, can't search in databases-specific info, researches lot of content-slide 7 *can only cite if whole article is available-if cite have to rd whole thing not just abstract. attach full pdfs for her. pubmed central-full articles pubmed-only some articles OT seeker-to get validity/statistical score stick to primary sources*, needs to be peer reviewed-just bc in journal doesn't mean peer reviewed. see if journal is peer reviewed! don't say "so and so" as cited by "so and so"-use primary/1st source! wk 3: types of research: process of EBP - Ans: 1.Convert information needs into focused clinical questions 2.Identify the best evidence 3.Critically appraise the evidence for validity and clinical usefulness 4.Use the results, clinical expertise and patient input (goals, concerns) and apply the results in clinical practice 5.Evaluating performance of the evidence in clinical application •Formulate the Question •Search the Evidence •Appraise the Evidence •Apply the Results •Evaluate the Performance of the Evidence Depending on what question I have - Ans: depends on what type of research I'm going to use Overview: Research Definitions & Classifications - Ans: 1.Major methodological approach •Qualitative •Quantitative 2.Research Designs (many) •Experimental •Randomized Controlled Trial •Nonrandomized Controlled Trial (Quasi-exp) •Pretest/posttest (Pre-experiment) •Non-experimental •Group Comparison (Observational) •Incidence/Prevalence (Observational) •Correlation (Observational) •Predictive (Observational) •Qualitative 3. Research Collection Time •Cross sectional •Longitudinal 4. Aim, or purpose, of the research •Basic •Applied 1. Methodological Approaches-Qualitative Research - Ans: •Defined as a process of inquiry that builds a complex and holistic picture of a particular phenomenon of interest by using a natural setting (lived experience questions, description of a condition questions, in writing or verbal; trustworthiness, study of people different from investigator-philosophy, sociology, anthropology, social reality is dynamic, contextual, governed by local meanings, to understand social life and describe how people construct social meaning, authentically represent viewpoints of indiv studied, ex.-direct quotes from people, textual, "thick" descriptions in lang. of participants, identifies meaning, patterns, and connections among data; describes experience/social scene) •Involves analysis of words, pictures, videos, or objects in the context in which they occur •The goal is to understand social issues from multiple perspectives to have a comprehensive understanding of a particular event, person, or group •Assumptions: •Reality is socially constructed and there are multiple realities •Research is context bound and based on inductive forms of logic that emerge as a study progresses The purpose of research is to find theories that help explain a particular phenomenon Quantitative Research - Ans: •Defined as a process of inquiry examining an identified problem that is based on testing a theory measured by numbers and analyzed with statistical techniques, deductive logic (vs. qualitative-inductive; description of condition-either quant or qual; efficacy, the usefulness of an assessment, prediction of outcome). •Involves analysis of numerical data •The goal is to examine instances of aspects of phenomena to determine if predictive generalizations of a theory hold true or to test causal hypotheses. •Assumptions: •Reality can be studied objectively •Theories and hypotheses are tested in a cause- effect order with research based on primarily deductive forms of logic •The purpose of research is to develop generalizations that contribute to theory and allow the researcher to predict, explain, and understand a phenomenon Quantitative vs. Qualitative Research - Ans: Quantitative Research (quantity) is numerically collected data. Research designs in which events can be quantified so that the final data are numerical (for example, an experiment). The theory states relationships in mathematical terms. Qualitative research (quality) involves data that is descriptive and results in opinions. Research designs that use descriptive data such as written descriptions of people, including opinions and attitudes, and of events and environments. Key Similarities Between Quantitative & Qualitative Research Methods - Ans: •They both follow the steps in the process of research •The format for reporting the research problem is the same •Both have data collection steps •Both require adherence to ethical standards (IRB approval) Quantitative Research Cont. - Ans: •Hypothesis: A structured statement of anticipated outcomes or results •Quantitative Research is centered on *testing a hypothesis* (physical/life sci, objective reality contains stable, preexisting patterns/order that can be discovered, maintain objectivity-bias not involved, to discover natural laws that enable prediction or control of events, describes variables and their rel and tests hypotheses in order to test theory) •Results of a study only support a hypothesis; it is never proven. •Nondirectional hypothesis: exploratory, researcher does not have a prior notion regarding the results. •Directional hypothesis: the researcher has an assumption or belief in an outcome. A directional hypothesis indicates that the researcher has an assumption or belief in a particular out- come. A nondirectional hypothesis is exploratory, suggesting that the researcher does not have a prior notion about what the study results may be, but may assume that a difference or relationship exists. For example, in a correlational study a researcher may set out to examine the relationship between being bilingual and particular cognitive abilities such as memory, problem-solving, cognitive flexibility, and divided attention. The researcher may have a directional hypothesis that bilingualism is associated with greater cognitive flexibility and divided attention. In contrast, the researcher may go into the study expecting a relationship, but not speculating about the particular associations (nondirectional hypothesis) Quantitative Research- Type 1 & Type 2 Errors - Ans: (these are only for quantitative) •Type I: occurs when the hypothesis is accepted yet the hypothesis is actually false. (false positive, say to man, "You're pregnant," and they're not) •Type II: occurs when the hypothesis is rejected yet the hypothesis is true. (false negative-say to pregnant lady, "you're not pregnant.") Quantitative Research - When to accept or reject the hypothesis? - Ans: •Probability value (P-value) obtained from statistical analysis is the calculated likelihood of making a Type I error. •Type I Error= hypothesis is accepted yet the hypothesis is actually false. This error might have occurred by chance. (ex.-LSVT-Big-> freezing episode-like feet stuck in caramel (parkinson's), LSVT-Big helps with dec freezing episodes). type 1 is we say it helps but it actually doesn't help. type 2-LSVT-Big doesn't help for 5 random people, but it actually does I just didn't test enough people to find it out. •If P is less than .05, the hypothesis is accepted. •It means that there is less than a 5% chance that the hypothesis is incorrect from a statistical point of view, or put another way, there is a 95% chance the hypothesis is correct •Type II Error- hypothesis is rejected but it is actually true. (don't have to do with p values, p values go with type 1, type 2 mostly just sample size) •Can occur due to small sample size If I were to do this thing 100 times - Ans: how many of those attempts would the outcome match my hypothesis? 95/100 or greater, it's said to be statistically significant. Is what I'm seeing simply due to random chance or due to the independent variable. A strong hypothesis is one that is clear and test- able. When the researcher has an expected outcome, the study can be better designed to collect data that will test the hypothesis. A researcher who goes into a study blind may be described as going on a "fishing expedition"; he or she is likely to find something, but that something may be difficult to explain. In addition, findings gathered from a "shotgun approach,"—one in which the researcher hunts for interesting findings among the data—are more likely to represent a chance result that is difficult to replicate. In a hypothesis-driven study, statistical analysis is used to determine whether or not the hypothesis is supported. However, not everything can be quantified, and numbers tend to obscure the uniqueness and individuality of the participants. A drawback of quantitative research is the loss of the individual when data are combined in means, standard deviations, and other statistics. A researcher typically decides to accept or reject the hypothesis based on the p value obtained from the statistical analysis. If p is less than or equal to 0.05, the hypothesis is accepted. A p value that is less than 0.05 means that there is less than a 5% chance that the hypothesis is incorrect (from a statistical point of view). When p is greater than 0.05, the hypothesis is rejected. 2. Research Designs - Ans: •Experimental: •Examines cause & effect relationships •Good for efficacy studies •Examples: •RCT (true experiment) •NRCT (quasi-experiment) •Pre-test/post-test without a control (pre-experimental) •Non-experimental •cannot determine causal relationships. •Can describe people with a particular diagnosis, identify the incidence of a condition, identify a relationship, or predict an outcome. • Common approaches: surveys, observations, reviewing existing medical records. •Examples: •Group comparison •Incidence/prevalence •Correlational studies •Predictive studies A research design is - Ans: the fundamental strategy or plan for how a study is structured Experimental design—A systematic design in which subjects are assigned to one of two or more condition groups (and thereby have controlled exposure to the independent variable) Quasi-experimental design—A design in which subjects have controlled exposure to an independent variable; however, they are not randomized to a condition group (they either remain in a single group or are assigned to a group according to other criteria) Experimental Research: - Ans: 3 types of experimental research: 1. RCT (true experiment)- A systematic design in which subjects are assigned to one of two or more condition groups (and thereby have controlled exposure to the independent variable) through random assignment 2. Non-RCT (quasi-experiment)- A design in which subjects have controlled exposure to an independent variable; however, they are not randomized to a condition group (are assigned to a group according to other criteria) 3. Pre/post (pre-experiment)- .A design in which there is only one group, nothing is manipulated (i.e., all participants receive the same intervention), and there is no random assignment. Therefore, it stands to reason that this design is much less powerful than a design with a control Experimental- Variables - Ans: •Independent Variable- variable that is manipulated or compared in a study (intervention) •When more than 1 independent variable is being tests, it's called a factorial design •Dependent Variable- outcome variable; observed and intended to measure the result of the manipulation •Control Variable- remains constant/controlled because it could affect outcome of the study •Ex: age of participants •The more controlled variables you have, the more confident you can be that the independent variable is what actually impacted the dependent variable •Extraneous Variables- all other variables which are not the independent variable but could affect the results of the study Participants of the study - Ans: are systematically divided into multiple condition groups. Control group: group of subjects is assigned as a basis for comparison who do not have exposure to the independent variable Experimental group(s): group in which subjects do have a level of exposure to the independent variable to determine the effect on the study's dependent variable(s) Example: independent variable: music Dependent variable: weight lifting ability Extraneous variable: underlying fitness condition Control variable: age, time of day, temperature of room Experimental- Independent vs. Dependent Variable - Ans: IV-amt of direct sun plant receives DV-plant health Experimental- Extraneous Variables - Ans: IV-caffeine-influences DV-# of words recalled, other variables-time of day, tea/coffee, noise True Experimental and Quasi-Experimental Studies - Ans: Participants of the study are systematically divided into multiple condition groups. •Control group: group of subjects is assigned as a basis for comparison who do not have exposure to the independent variable •Experimental group(s): group in which subjects do have a level of exposure to the independent variable to determine the effect on the study's dependent variable(s) Blinding - Ans: Some studies may further employ blinding to reduce the risk of confounding variables. (a type of extraneous variable-don't ntk) •Blinding: Either the investigator or the research subject are not aware/informed of the manipulated variable of study •Double-blind study: Neither the investigator nor the research subject are aware/informed of the manipulated variable of study True Experimental and Quasi-Experimental Studies - Ans: Some studies may further employ placebo control groups to reduce the risk of extraneous variables. •Placebo/placebo control groups: An experimental condition in which a proxy (which has no effect on the dependent variable) is administered instead of the independent variable •Attempts to rule out Expectancy Effects •Expectancy effects: The confounding impact that is caused by the psychological knowledge that a subject is receiving a treatment Example: Caffeine- independent variable How well they do on test- dependent variable Placebo- non-caffeinated drink True Experimental vs. Quasi-Experimental Studies - Ans: RANDOM ASSIGNMENT •Random assignment: Neither the subjects nor the researchers choose the group to which subjects are assigned •Assignment is performed by random allocation •Quasi-experimental has NO random assignment (aka non-experimental research) 2. Non-Experimental Research - Ans: •Cannot determine cause and effect •Can study *relationships* using correlational studies used to determine if a relationship exists between two constructs and how strong that relationship is Not all research questions are causal in nature; nonexperimental research can answer descriptive and relationship questions. Many different methods can be used to collect data and information in nonexperimental research. Common approaches include surveys, observation of behavior, standardized measures, and existing data from medical records Nonexperimental Research - Ans: Group Comparison: comparison studies may be conducted to answer descriptive questions when comparing existing groups. For example, in health-care research, researchers are often interested in the differences between people with and without a particular condition. When making these comparisons, it is not possible to arbitrarily or randomly assign individuals to groups. For example, when compar- ing people with and without schizophrenia, the researcher will recruit individuals with schizophrenia and compare the schizophrenia group with a similar group of individ- uals without schizophrenia. The research may elucidate how these groups differ in terms of particular cognitive abilities, employment rates, and quality of life. In ad- dition, there is no manipulation. For this reason these studies are observational studies. In an observational study, the naturally occurring circumstances are studied, as opposed to assigning individuals to an intervention or research condition. Incidence & prevalence- Incidence is the frequency of new occurrences of a condition during a specific time period. Incidence is cal- culated as the number of new cases during a time pe- riod, divided by the total population at risk. The focus on "new" cases is a distinguishing characteristic of incidence studies. Prevalence refers to the number of individuals in a population who have a specific condition at a given point in time, regardless of onset. Prevalence is a measure of how widespread a condition is, whereas incidence pro- vides an estimation of the risk of developing the condi- tion. Prevalence is calculated as the number of cases at a given time point, divided by the total population at risk. Correlation: seek to determine whether a relationship exists between two constructs and, if so, assess the strength of that relationship. For example, r Example of Third Variable Problem with correlational studies - Ans: •Third Variable Problem: presents an alternative explanation for relationship or can influence the relationship 3. Research Collection Time - Ans: •Cross-Sectional •Data collected at a single point in time •Longitudinal •Data collected over at least two time points and typically covers an extended period of time, such as several years or decades Cross-sectional studies use nonexperimental methods; they are observational in nature, meaning that the researcher does not manipulate a situation (e.g., provide an intervention). Descriptive and correlational studies frequently use cross-sectional research. Longitudinal research is in- tended to examine the effect of time (such as development, aging, or recovery) on some phenomenon (such as cognition, independent living, or language). Most longitudinal studies examine naturalistic changes, making them observational. However, occasionally intervention studies examine the impact of an intervention over an extended time period. Although there is no time frame criterion for determining whether a study is longitudinal, a simple pretest-posttest intervention study is not considered longitudinal. Therefore, most intervention studies are neither cross-sectional nor longitudinal. Cross-sectional studies often compare different groups of individuals at the same point in time, whereas longitudinal studies compare the same people over several time points. (qual: non-experimental, cross or long; quant: exper or non experimental, can be cross or longitudinal 4. Aim or Purpose of the Research - Ans: 4. Research Purposes •Basic •Generates new knowledge without direct concern for its applicability or practical significance •Applied •Directly informs practice. Studies that determine efficacy of programs Generally speaking, basic research is used to investigate fundamental questions that are directed at better understanding individual con- cepts. Using brain imaging techniques to determine the purposes of different brain regions, identifying environ- mental conditions that contribute to a stress reaction, and examining the role of proteins in antibody responses are examples of research on the basic end of the continuum. Applied research, in contrast, has direct application to health-care practices. Studies that determine the efficacy of a fall prevention program, describe the prevalence of foot drop in multiple sclerosis, and ascertain the strength of the relationship between diet and ADHD symptoms would be considered examples of research on the applied end of the continuum. review in-class assignments for practice for exam - Ans: Research Designs for Efficacy, Descriptive and Predictive Studies - Ans: Research Design is based on type of question being asked •Efficacy •Descriptive •Predictive •Lived Experience (will cover later) •Usefulness of Assessment (will cover later) Research Designs for Efficacy - Ans: Review-Types of Experimental Studies •Experimental design—A systematic design in which subjects are assigned to one of two or more condition groups (and thereby have controlled exposure to the independent variable) through random assignment-RCT •Quasi-experimental design—A design in which subjects have controlled exposure to an independent variable; however, they are not randomized to a condition group (they either remain in a single group or are assigned to a group according to other criteria)-nRCT •Pre-experimental design- A research design in which a single group is compared before and after an intervention (pre-test/post-test without a control) Experimental- Variables - Ans: •Independent Variable- variable that is manipulated or compared in a study (intervention) •When more than 1 independent variable is being tested, it's called a factorial design •Dependent Variable- outcome variable; observed and intended to measure the result of the manipulation •Control Variable- remains constant/controlled because it could affect outcome of the study •Ex: age of participants •The more controlled variables you have, the more confident you can be that the independent variable is what actually impacted the dependent variable •Extraneous Variables- all other variables which are not the independent variable but could affect the results of the study Participants of the study are systematically divided into multiple condition groups. Control group: group of subjects is assigned as a basis for comparison who do not have exposure to the independent variable Experimental group(s): group in which subjects do have a level of exposure to the independent variable to determine the effect on the study's dependent variable(s) Some studies may further employ blinding to reduce the risk of confounding variables. Blinding: Either the investigator or the research subject are not aware/informed of the manipulated variable of study Double-blind study: Neither the investigator nor the research subject are aware/informed of the manipulated variable of study New Content - Ans: Efficacy Studies- Between Group Comparison vs. Within Group Comparison Between-Group Comparisons- identify the difference between two or more groups. ◦ Usually, the difference between intervention group and control group ◦ Within- Group Comparisons- make a comparison inside the same group, most often a comparison of the scores before and after an intervention (pre-post test); not comparing intervention vs. control Example: Intervention Group: weight bearing on affect arm s/p stroke Dependent variable: functional use of arm Control group: normal therapy Between group: test functional use of arm before and after therapy comparing pre-test of intervention and control and comparing post-test of intervention and control (comparing intervention vs. Control) Within group: test functional use of arm before and after therapy for intervention group and for control group (not comparing intervention vs. Control) Efficacy Studies- Interaction Effect - Ans: Interaction Effect: the pattern of differences of the dependent variable for at least 2 independent variables. (like a cross-comparing interv to control group w/before and after, cross within and btw group, you DO want an interaction! says one thing works better than another in after group) ◦Often, one variable is a within group variable of time (pre-post) and the other variable is the between-group variable of intervention vs. Control • Combines the between and within group comparison ◦Determining whether there as a difference in the way that one group performed from pretest to post test compared with the other group's performance from pre-test to post test. ◦When the intervention group improves more than the control group from pre-test to post-test, the intervention was more effective than the control group treatment in causing a positive change in the outcome •When there is a difference in how 2 groups respond, an interaction has occurred (GOOD) •If that difference is large enough, the interaction effect is statistically significant Research Designs for Efficacy Questions - Ans: 1. RCT ◦A systematic design in which subjects are assigned to one of two or more condition groups (and thereby have controlled exposure to the independent variable) through random assignment ◦The control group may get no treatment, standard treatment, or an alternative form of treatment ◦Can compare two or more specific interventions to identify the preferred approach ◦Can compare a standard approach plus a new approach with just standard intervention ◦Level 2 Evidence Research Designs for Efficacy Questions - Ans: 2. Crossover Design oAll participants receive the intervention/exposure but in a different order. oParticipants are randomized, then: oOne group starts with the treatment and then receives the control. oOne group starts with the control and then receives the treatment. (ex-first group gets regular OT, other gets interv; then switch-everyone gets interv 1st or 2nd, one group starts w/control gets tx and one ends w/control, to end ethically-so all get tx as OT, everyone gets tx but allows for control group) oMost useful for an intervention in which permanent change is not expected- don't want second condition to be affected. oConsidered the same level of evidence as an RCT (level 2) Patients admitted - Ans: to a hospital's long-term care ward were randomly allocated to Groups A or B, and a crossover trial was performed. As intervention, 16 weekly Metacognitive training sessions were performed for 4 months as part of standard occupational therapy, and the participants' cognitive functioning, psychiatric symptoms, overall functioning, and cognitive bias were assessed at baseline, 4 months later, and 8 months later. A crossover trial was performed, with the participants being allocated to two groups (A and B) via stratified randomization that took their sex and age into consideration. In the first half of the follow-up period, Group A had MCT added to their occupational therapy (OT) sessions, while Group B received the usual OT only. In the latter half of the follow-up period, MCT was added to Group B's OT sessions, while Group A received the usual OT only. Because the carryover effects of MCTs were anticipated from the outset, no washout period was established in this crossover design. The start of the follow-up was based on the baseline assessment of outcome indicators. Assessment 2 was implemented in both groups four months after Group A had completed their MCT, and Assessment 3 was implemented in both groups eight months after Group B had completed their MCT Research Designs for Efficacy Questions - Ans: 3. Non-randomized Controlled Trial (Quasi-experimental) oParticipants do not have an equal chance of being assigned to a condition. oInstead of random assignment, allocation to groups can occur by asking for volunteers for the intervention first and matching individuals to a control group. oOften this approach is used for pragmatic or ethical reasons, with one setting receiving an intervention and another setting being the control or standardized treatment group. oWhen the settings are randomly assigned to group, the study design may be called a cluster randomized controlled trial (not an RCT as participants don't have an equal chance of being assigned to study conditions, ex pick schools at random to get flexible seating, group selection is randomized but indiv partic are not, b/c kids are already in school/group). oLevel 3 Evidence Research Designs for Efficacy Questions - Ans: 4. Pre-Experimental Design ◦Pre-Post Test without a control ◦May use this design initially before investing time & money into an RCT ◦Goal is to show a cause-and-effect relationships but lacks a control group to conclude that a relationship exists ◦Level 4 Evidence Research Designs for Efficacy - Ans: 5. Factorial Design o Can be randomized or non-randomized oIncludes more than 1 independent variable oTypically, one independent variable is the intervention condition and the other one is included to determine in the intervention had different effects on that additional variable oEx: 1. intervention 2. health condition oA memory intervention can be compared with a control condition for healthy other adults, older adults with Alzheimer's disease, and older adults with Parkinson's disease (memory interv w/multiple groups-diff types of variables, healthy-control, AD vs. PD-other variable) A quasi-experimental - Ans: 2 (ASD/not ASD) X 3 (music condition: no music, light classical, and self-selected) factorial design was used in the present study. There were two groups, one with individuals with ASD (n=16) and the other with neurotypical individuals who do not have a diagnosis indicating neurological impairment or delay (n=16). Each group participated in three driving scenarios on a driving simulator. For each driving scenario, there was a different music condition (manipulated independent variable) that either consisted of 1) no background music, 2) light classical background music, or 3) self-selected background music. The music conditions were counterbalanced to control for any order effect. The order of driving scenarios remained the same for all participants so that any learning that occurred was the same. The dependent variable of driving performance was measured by a quantitative score of a standardized observational tool for driving. Research Designs for Efficacy - Ans: 6. Single Subject Studies oA research design in which data is collected from a single subject (can do 500 ppl but everyone compared to themselves, vs case study-just one person) oSubject serves as its own control through its response to the experimental variable oStudies do not average participant scores oNOT A CASE STUDY oNote- there can be many participants, but they aren't compared to each other oCan be any level of evidence based the design ◦ (can do pre/post, can gather data at different points) •There are two major strategies that allow the subject to represent both the control and experimental condition: oGathering baseline data over a time when the experimental condition is absent and then gathering data over a time when the experimental condition is present oGathering data during alternating periods in which the experimental condition is present or withdrawn Studies do not average participant scores Each subject is analyzed for any significant differences. Single-subject research is a within participant design (each participant is their own control) A different notation is used (ABA) (A- first phase measurement, B- Intervention, A-Second Phase Measurement) Multiple baseline designs can strengthen the cause/effect relationship. ABAB Design or ABABAB design. Non-experimental Research Designs for Efficacy - Ans: 1. Retrospective intervention studies oResearcher looks back at something that already happened and uses existing records to collect data oDescribed as "observational" not experimental oSometimes called retrospective cohort studies as they utilize and compare existing groups (cohorts) of individuals oDisadvantage- conditions cannot be controlled (b/c getting data from before) Sample Size & Intervention Research - Ans: •A larger sample size reduces the risk of a Type 2 errors (when the research finds no difference between groups, but a difference DOES exist) •A larger sample size is more likely to reflect the true population •A larger sample size makes the study more reliable PEDRO Scale to Evaluate the Evidence - Ans: evaluates if efficacy studies are good, are 11 pieces, did they explain eligibility criteria, were subj randomly allocated to groups? was it blinded? similar groups at baseline? blinding of all subj, blinding of OT doing interv? was there msmt of at least 1 key outcome, etc., levels of evidence aren't only thing that make a study good) Research Designs for Descriptive Studies - Ans: •Descriptive Studies- explain health conditions and provide information about the incidence and prevalence of certain conditions within a diagnostic group. •Non-experimental Descriptive Research- Incidence & Prevalence Studies - Ans: 1. Epidemiology- study of health conditions in populations, often aimed at identifying the incidence and prevalence of specific conditions. oIncidence- frequency of new occurrences of a condition during a specific time period (day, month, year). Incidence is calculated as the number of new cases during a time period, divided by the total population at risk. oIncidence= number of new cases during a time period/total population at risk (new stuff, vs. prevalence-do you have it) oPrevalence- refers to the number of individuals in a population who have a specific condition at a given point in time, regardless of onset. oPrevalence= number of cases at a given point/total population at risk Incidence conveys information about the risk of contracting the disease, whereas prevalence indicates how widespread the disease is. Example of Incidence - Ans: Huang et al (2014) set out to study children in Taiwan who underwent brain surgery after a traumatic brain injury between to determine the incidence of dysphagia (difficulty swallowing) in this population. Incidence= # of new cases during a time period/total population at risk x 100 Total population at risk: Population of kids in Taiwan who underwent brain surgery after brain injury between = 6290 # of new cases: 775 children of those children had severe dysphagia during . Incidence of dysphagia for children post-TBI after brain surgery= 775/6290 x 100 = 12.3% Example of Prevalence - Ans: Lingam et al (2009) used data of children from a longitudinal study and collected data on the sample to identify children with developmental coordination disorder. Prevalence- # of cases at a given point/total population at risk x 100 # of cases at a given point: 119 Total population sample: 6900 119/6990 x 100 = 1.7% Descriptive Research: Group Comparison Studies - Ans: 2. Group Comparison Study: Cross-sectional designs that compare two or more groups at one point in time, sometimes referred to as ex post facto comparisons. (not exp, not doing interv, look at diff btw groups, can compare indiv w/and w/o disabilities, lack randomization, can be confounding variables, can't say 100% certain for this, look at if groups diff, sig of diff) oGoal = to describe difference between groups oNot experimental- difference is based on pre-existing condition oStudies usually compare individuals with and without a disability on various items such as mobility and assistance required etc. oProblems: lack of randomization & potential difference due to confounding variables Descriptive Research- Survey Research - Ans: 3. Survey Research: Common approach to gathering descriptive information about health conditions. oTypically cross-sectional in nature (collected at one point in time) oCan be used online, face to face, mail in etc. oResponse Rate: % of individuals who returned the questionnaire (rate can be hard if given it online) oThere is no universally accepted response rate but 60% is a frequent response rate required for publication in a journal. oResponse Bias: measurement error that creates inaccuracy in the survey results. In the case of few responses to a survey the responders may be different from nonresponders. Non responders may not want to share sensitive information or are less motivated to participate. Research Design for Predictive Studies - Ans: Predictive Studies-•Predictive Studies using Correlational Methods •Predictive Studies using Group Comparison Methods Simple Correlational Studies - Ans: •Examine the relationship between variables and offer an approach for making a prognosis or predicting an outcome. •Correlation is presented as an r value, which can be described as the effect size. •Cohen (1992) provided a rule of thumb for interpreting the strength of r within the applied sciences. .10= weak effect/relationship, .30= moderate effect/relationship, .50= large effect/relationship Correlation - Ans: Correlation is Positive when the values increase together, and Correlation is Negative when one value decreases as the other increases Dependent Responding Y-axis Manipulated Independent X-axisX- horizontal Y- vertical Example - Ans: Correlation Example 1: In a sample of 86 clients who were discharged from an inpatient rehab facility, independence in bathing is strongly positively correlated with community reintegration within 3 months post-discharge (r = .72, p<.05) ◦Meaning: those who have higher independence in bathing are also engaged in more community reintegration Correlation Example 2: In a sample of 150 clients who were discharged from an inpatient rehab facility, independence in bathing is strongly negatively correlated with fatigue within 3 months post-discharge (r= -.72, p < .05) ◦Meaning: those who have higher independence in bathing are LESS fatigued Complex Correlational Studies - Ans: oLooks at multiple predictors for a single outcome. (looks at how all variables pair together, and how all correlate together) oA common use for this statistical procedure is to identify risk factors as a predictors of a certain condition. oShown as R2, ntk strong, weak, med correlation numbers for test!) oNeeds larger sample sizes (often in the hundreds) oThese studies examine the total amount of variance accounted for by multiple predictors together AND the relative importance of each individual variable as a predictor Predictive Studies using Group Comparison Methods - Ans: •Case-control design: observational, retrospective, cross-sectional study (one time? usually look at one healthy group and then one unhealthy group, ex-RF is RA, does it inc risk of fx?) that can be used to answer prognostic research questions concerning which risk factors predict a condition. Individuals who already have a condition are one group and matched with individuals without the condition. (ex-look at past medical notes) •Case-Control design Example: Brennan et al (2014) examined RA as a risk factor for fractures in women 35+ •1.9% of individuals with RA had suffered a fracture, compared with 1.2% without RA, 2 kinds-case control, cohort studies-on test, 2 kinds of predictive studies Predictive Studies using Group Comparison Methods - Ans: •Cohort studies: observational but participants are followed over time (longitudinal), compared to case control which is cross-sectional. case control-only retro, cohort-retro or prospective. Hypothesized risk factor is identified and individuals are studied with and without the risk factor. •Can be prospective or retrospective •Example of a prospective cohort study- Xiao et al (2013) examined lack of sleep as a risk factor for developing obesity by following individuals who were not obese at the onset. (Group of ppl have something and you follow them) •Example of a retrospective cohort study- Schneider et al (2014) retrospectively examined a database of individuals with mod to severe TBI and found that educational attainment predicted disability recovery. More of the individuals who had