Module 2 & 3

• Sources of Clinical Questions

  • Preliminary Thinking
  • Questioning
  • Discussion
  • Literature search on a general topic
• Preliminary Thinking: Voiced out by the patients
• Questioning

  • arise from research
  • which question will help the clinician to make decision
• Background Question

  • general, answered by textbook
• Foreground Question

  • specific knowledge to inform clinical decision
  • concerns a specific patient, intervention or desired outcome
  • effective ways to communicate
• Components of Clinical Question

  • P: Population, patients, problem
  • I: Intervention, exposure
  • C: Comparison, contrast
  • O: Outcome
  • T: Time
  • S: Setting, study design
• Examples of clinical questions

  • Intervention
  • Etiology
  • Diagnosis
  • Prognosis
  • Meaning
  • Prevention
• Primary Sources: RCTs, pilot studies, survey, case studies & prospective
• Secondary

  • published, systematic reviews, meta-analysis, practice guidelines and standards
• Tertiary

  • summarized information in the form of encyclopedia and textbooks
  • used for base knowledge
  • less critique and peer-reviewed
• Physiologic Studies

  • biological possibilities
  • scientific literatures that can be primary source of evidence
  • rare in rehab science
• biological plausibility: natural science
• Levels of evidence

  • Systematic reviews of RCTs
  • Individualized with narrow confidence of RCTs
  • Systematic reviews of cohort studies
  • Individualized review of cohort studies & low quality RCTs
  • Systematic review of case-controlled studies
  • case-controlled studies
  • case series and poor quality cohort and case control studies
  • Expert Opinion
• Levels of evidence are only used to facilitate a decision not a final basis on clinical knowledge
• Intervention evidences: systematic review of RCTs or RCTs
• Prevention evidences: RCTs, prospective studies
• Diagnosis: RCTs, cohort, observational
• Prognosis: cohort, observational
• Etiology: observational, cohort
• Meaning: qualitative design
• Critically appraised Topics (CATs)

  • short summary focused on clinical question that a clinician has already done
• Clinical Practice Guidelines (CPGs)

  • systematically developed statements to assist practitioner decisions about appropriate health care for specific clinical circumstances
• PubMed: highest index of all allied health professionals

  OTseeker: for OTs

  PEDpro: for PTs
• Steps to search for evidence

  • Build
  • Limit
  • Run
  • Scan
  • Retrieve
• similar terms: use or to increase and broaden topics
• different terms: use and to decrease topics
• quotation mark: very specific
• Yields: the total number of articles from search term
• Hits: Number of articles relevant upon title screening
• Obtained: Total number of articles relevant upon abstract and/or full-text screening
• Retrieved: Number of articles from list of obtained with full text