appreciate • appraise • apply Part 2 Brenda Boucher PT, PhD, CHT, OCS, FAAOMPT
Patient Management Model Diagnosis
Diagnostics Simoneau, GG, Allison SC. Physical therapists as evidence-based diagnosticians. JOSPT. 2010;40(10):603-605.
Examination History Systems review Selected tests & measures Clusters - Syndromes - Categories
Hypotheses Intake form History Patient’s report Rule-in . . . Rule-out Liklihood?
highly unlikely . . . . . . . highly likely pre-test probability
Interpret test results Select best tests
Diagnostic Accuracy • Examination • History • Systems review • Tests & measures Examination
Tests & Measures rule-in . . . rule-out
Reliability |re-ly-a-bi-li-ti| Yielding the same or compatible results in different clinical trials.
Reliabilty Question: “What is my destiny in life?”
Reliabilty Intra-rater reliability Inter-rater reliability
Reliabilty • Intraclass Correlation Coefficient (ICC):usedforcontinuous data and captures both correlation and agreement among raters • Kappa: used for categorical data and takes into account possibility of chance agreement between examiners
Validity Validity: the extent to which an instrument measures that which it is intended to measure.
Validity My emotional state today . . .
References Simoneau, GG, Allison SC. Physical therapists as evidence-based diagnosticians. JOSPT. 2010;40(10):603-605. Portney LG, Watkins MP. Foundations of Clinical Research: Applications to Practice. Upper Saddle River, NJ: Prentice-Hall, 2000. Gyatt G, Rennie D. User’s Guide to Medical Literature: A Manual for Evidence-Based Clinical Practice. Chicago: AMA Press, 2002. Fritz JM, Wainner RW. Examining diagnostic tests: an evidence-based perspective. Physical Therapy. 2001;81(9):1546-1564. Cleland JA, Noteboom JT, Whitman JM, Allison SC. A primer on selected aspects of evidence-based practice relating to questions of treatment, Part 1: asking questions, finding evidence, and determining validity. JOSPT. 2008;38(8):476-484. Noteboom JT, Allison SC, Cleland JA, Whitman JM. . A primer on selected aspects of evidence-based practice relating to questions of treatment, Part 2: interpreting results, application to clinical practice, and self evaluation. JOSPT. 2008;38(8):485-501. Sim J, Wright CC. The kappa statistic in reliability studies: use, interpretation, and sample size requirements. Physical Therapy. 2005;85(3):257-268.