EBCP TQ Final Exam

What type of question is: " in adult patients with low back pain is chiropractic more effective than medical care to relieve pain?"

Foreground question

What type of study is higher on the hierarchy of evidence so we give it more weight?

Randomized controlled trial (RCT)

What is the relationship between studies that are higher on the pyramid of hierarchy of evidence and the risk of bias in a study?

Inversely proportional

Which study type is the best to answer this question: does daily exercise reduce the risk of heart disease?

Cohort study

Which study is a summary of all the research on a specific topic that combines the statistics of the individual studies?

Meta - analysis

Which study would hold more weight?

- Randomized controlled trial with a sample size of 25

- Cohort study with a sample size of 100

- Randomized controlled trial with a sample size of 100

Randomized controlled trial with a sample size of 100

What type of study is a report of the presentation, treatment, and outcome of a patient that has educational value.

Case report

Which logical fallacy does the following statement exemplify: if a chiropractors advertise that they are good at helping patients with low back pain, then we will never get to treat anything

else.

Slippery Slope

Which fallacy is attacking the character of the person rather than the argument/idea?

Ad hominem

Which fallacy involves switching the argument away from dealing with the original problem and focuses on a different issue?

Red herring

Why is randomization important in RCTs?

To equalize the unknown prognostic factors between groups

Where can you usually find out if the groups in the RCT were equal at baseline?

In table 1 of the results

Which statement indicates that follow up was complete in a RCT?

- 60 patients were enrolled and 48 finished the study

- 1 patient dropped out of the study because he moved away and his data was still included

- The trial was not stopped early

- The patients had an average of 10 points of improvement

- 1 patient dropped out of the study because he moved away and his data was still included

A valid RCT is one in which

- The study was done correctly

- The study had positive results

- The results of the study were precise

- The study was not stopped early

- The study was done correctly

What does it mean if a study was stopped early

You should NOT trust the results and should not use the treatment

To answer the question: "Were the groups similar at baseline with respect to prognostic factor?"

You can be confident they are similar because they all have the same complaint to get into the

study T/F?

False

How can you tell if the results of the study are precise or not?

By assessing the width of the confidence interval

Choose the correct interpretation of age = 63 (1.7). [mean (SD)]

- Average age of study participants is young with wide variability

- Average age of study participants is old with wide variability

- Average age of study participants is old with narrow variability

- Average age of participants is young with narrow variability

Average age of study participants is old with narrow variability

Choose the correct interpretation of p=0.07. the result is:

- Statistically significant because there is less than 5% chance the result is due to

random error

- Not statistically significant because there is greater than 5% chance the result is due to random error

Not statistically significant because there is greater than 5% chance the result is due to random error

Interpret: ROM change = +10 o (-5,95). [mean (95% ci)]

ROM is increased but CI is very wide and crosses 0.

Choose the correct interpretation of : mean (95% ci) VAS pain change was -4.5 (-3,7)

- The average pain decreased by 4.5 cm on the VAS but the result is not statistically significant

- On average, pain decreased by 4.5 cm on VAS and the result is statistically significant

The average pain decreased by 4.5 cm on the VAS but the result is not statistically significant

Which of the following is a way to describe something about central tendency (for) a group of

data?

Mean, Median, Average

Which of the following is a way to describe how wide your data is spread out?

- Standard deviation

- Range

- Mean

- Median

- 1&2

- 3&4

1 & 2 (Standard Deviation & Range)

Patients in a study were recruited from a medical center where they were being treated for terminal cancer. Are the results of that study applicable to patients in the average chiropractic practice? Y/N?

No

You want to study whether or not a cleaning chemical causes/increases risk of cancer. What type of study should you do?

Observational Study

What is defined as: the probability of a negative test in someone who doesn't have the disease?

Specificity

What is defined as: the probability of a positive test in someone who has the disease?

Sensitivity

What is defined as: the probability that a patient with a positive test result really does have the disease?

Positive Predictive Value

What is defined as: the probability that a patient with a negative test result really doesn't have the disease.

Negative Predictive Value

Choose the correct interpretation for: PPV= 74%

- There is a 74% chance that someone with the disease will have a positive test

- With a positive test there is 74% chance of the patient having the disease

- The patient is 74% more likely to have the disease than not.

With a positive test there is 74% chance of the patient having the disease

What type of study involves putting together a group of people and following them forward in time to see what diseases develop and what exposures may be responsible?

Cohort study

What type of study involves assembling a group of people with a disease and matching them to similar people without the disease?

Case control study

Which statement indicates the follow up was complete in a RCT?

- The study went for the full 12 weeks

- Data was collected at the beginning and again at 8 weeks

- Data was collected from all 158 patients except the 2 dropouts who moved away

Data was collected from all 158 patients except the 2 dropouts who moved away

What is "intention to treat analysis" in a RCT?

All patient data is analyzed in the group of patients were assigned to

What type of study attempts to summarize all clinical trials about a topic utilizing rigorous methods for selection and appraisal of articles to be included?

Systemic Review

Publication bias is bias in the healthcare literature

Because trials with negative results often don't get published

What does the size of the squares in a forest plot represent?

The relative size (weighting) of the effect of the study

Use the above nomogram to answer the next 2 questions.

Your pretest probability is 50 %, your LR is 20, estimate your post-test probability?

- 5%- 25% - 95% - 100%

Your pretest probability is 60 %, your LR is 15, estimate your post-test probability? - 5%- 25% - 60% - 95% - 100%

95% for both

Data that follows a bell-shaped curve is called:

Normal

T/F: Researcher need to know if their data is normally distributed or not, so they choose the correct statistical test.

True

Testing between group differences in improvement in patients in a RCT would require a statistical test that is for:

Unpaired groups

Testing within group differences in improvement in patients in a RCT would require a statistical test that is for:

Paired groups

Which test is best for describing a group of data where one data point is significantly larger than the rest?

Median

Interpret this: the between group VAS difference was 22 (t= 1.34, p<0.001; 95% CI=18 to 26)

The t test showed that the difference between groups was real

Clinically significant means:

The difference was enough to be important to patients

Statistically significant means:

The statistical test showed a real difference between the groups

T/F: It is possible for a difference between groups to be statistically significant but not clinically significant?

True

What type of information is blood pressure?

DOE

What type of information is the number of degrees of lumbar spine range of motion?

DOE

What type of information is a measure of a patient's ability to get dressed in the morning?

POEM

What type of information is the level of electrical activity of the muscles of the lumbar spine?

DOE

Regression testing (simple linear, multiple linear, non-parametric linear) is used for what?

To find out if one (or more) variable (s) can predict another

The Mann-Whitney test indicates that improvement with medical care (mdn=5) was greater than improvement with placebo (mdn=1), U= 67.5, p=0.034, r= .38.

The between group difference is real

Where is a good place to find current, up-to-date, clinical guidelines?

Guidelines.gov

The CRAAP test acronym is:

Currency

Relevance

Accuracy

Authority

Purpose

What is described by the C in "CRAAP"?

The timeliness of the information and whether the site is maintained

What is described by the R in "CRAAP"?

The importance of the information for your needs

What is described by the P in "CRAAP"?

The reason the information exists

What does the phrase "intent to treat" analysis tell you?

The data was analyzed in the groups the patients were assigned to.

Which statement indicates that follow up in a RCT was completed?

- Three patients dropped out of the study because they moved out of state. Their last data point were carried forward for the analysis

- The trial was not stopped early for benefit, it was carried out for the planned 52 weeks.

- 100 patients were randomly assigned to two treatment groups with 50 in each group. Data were collected on 48 patients in the active treatment group and 45 patients in the placebo group.

- 200 patients volunteered for the study but 100 were not eligible so they were excluded. The remaining 100 patients were randomly assigned to the study treatment groups.

Three patients dropped out of the study because they moved out of state. Their last data point were carried forward for the analysis

What do the positions of the squares in the forest plot represent

The point estimate for each study in the meta-analysis

What does the width of the diamond on the forest plot represent?

The size of the confidence interval for the combined result of all studies

For critically appraisal of a case-control study which of the following would be an example that "the circumstances and methods for determining exposure was similar for cases and control?"

Cases: survey

Control: questionnaire

Studies have shown:

- That doctors usually rate their patient's improvement lower than the patients do

themselves

- That doctor's rating of patient improvement is very accurate

- That doctors usually rate their patients' improvements much higher than patients do themselves

That doctors usually rate their patients' improvements much higher than patients do themselves

Which of the following is a description of concealed randomization?

- Patients in the treatment groups were blinded as to which treatment they were blinded assigned to receive

- Patients were randomly assigned to either the active treatment group of the placebo randomi

treatment group

- The randomization method was prepared off-site and placed in sealed, sequentially concealment numbered opaque envelopes

- Patient's data were analyzed in the groups to which they were randomized

- Patients in the treatment groups were blinded as to which treatment they were blinded assigned to receive (BLINDED STUDY)

- Patients were randomly assigned to either the active treatment group of the placebo randomi

treatment group (RANDO)

- The randomization method was prepared off-site and placed in sealed, sequentially concealment numbered opaque envelopes (RANDO CONCEALED = CORRECT ANSWER)

- Patient’s data were analyzed in the groups to which they were randomized (INTENT TO TREAT)

How do you know if the treatment groups in a study are equal?

By checking table 1 of the paper for a description of the baseline characteristics

Which statement indicates appropriate blinding was carried out in a RCT?

- The study was a double blinded placebo controlled randomized trial

- Patients, therapists, data collectors, data analysts and all other personnel were

blinded

- The study was a triple blinded randomized controlled trial

- The randomization was prepared off-site by an independent researcher who used a random number table. The assignments were sealed in sequentially numbered, opaque envelopes, and kept in a locked file cabinet.

Patients, therapists, data collectors, data analysts and all other personnel were blinded

You have a 45 year old patient with low back pain and have just read a study about patients with low back pain. Which statement indicates that patients in the study are similar to your patient?

- The patients were adults with low back pain that were seeking treatment at a physical therapy practice in Ohio

- The patients were patients being treated for cancer related back and neck pain

- The patients were volunteers who had just undergone surgery for back pain

- The patients were all 15-20 year-olds with back pain caused by scoliosis

The patients were adults with low back pain that were seeking treatment at a physical therapy practice in Ohio

In the meta- analysis of manipulation for low back pain, the authors reported mean improvement on a 0-10 scale for pain. What would it mean if the diamond on that forest plot crosses zero?

The result for the pooled studies was not statistically significant

In healthcare, examples of DOE are:

Urine bilirubin concentration (a test for liver function)

Nerve conduction velocity is an example of:

DOE

In a RCT comparing exercise to drug therapy, the exercise group can be tested to see if the improvements from the beginning to the end of the study is real or due to random chance using a:

Within group statistical test

Linear regression is used to test:

If one variable can predict another like class attendance predicting grade

Which of the following is an example of an observation study?

- Cohort study

- Randomized controlled trial

- Survey

- Case study

Cohort study

Which of the following is a description of the importance of using POEMs in healthcare?

-POEMs help to entertain the patients in your waiting room

- POEMs mean that researchers are measuring things that are important to patients in their research studies

- POEMs mean that doctors are measuring things like blood glucose level in their patients to make sure the patients are improving.

- POEMs mean that doctors are measuring things like electrical activity in muscles (EMG) to makes sure their patients are getting better.

POEMs mean that researchers are measuring things that are important to patients in their research studies

Number of headaches per week is an example of:

POEM

In a RCT comparing exercise to drug therapy, a statistical test can be used to test if the difference in improvement between the exercise group and the drug therapy group is real or due to random chance. This would be a:

Between group statistical test

Which of the following is a research question that would be more appropriate to answer with a cohort study but not with a randomized controlled trial?

- Is manipulation more effective than exercise to improve neck and back pain

- Does smoking cause lung cancer?

- Is "the patch" more effective than cognitive behavior therapy for successfully quitting smoking?

- Does exposure to cigarette smoke increase the risk of lung cancer?

Does exposure to cigarette smoke increase the risk of lung cancer?

Which of the following is the most important reason to randomize patients in a randomized control trial?

- To ensure that patients don't know which treatment group they are assigned

- To equally distribute the elderly patients and smokers between groups

- To equally distribute the unknown prognostic factors between groups

- To keep data managers fromm knowing which group the patients are assigned

To equally distribute the unknown prognostic factors between groups

T/F: RCTs: when asked the question "are the likely benefits worth the potential harms & cost," consider cost of equipment.

False

System review of manipulation for LBP, search of PubMed using search terms manipulation & LBP. Was it a complete search? Y/N & Why?

No, they would miss a lot of studies from the chiropractic literature

Interpret the forest plot: The results were or were NOT statistically significant

The results were NOT statistically significant

Interpret the forest plot: The results were or were NOT statistically significant

The results were statistically significant