Research Designs for Questions About Outcomes - ANS The end result, not the efficacy or effectiveness of an individual intervention
Has gained relevance in the policy world
Enables effective clinical decisions that relate to context and quality of life
Research Designs for Question...
Research Designs for Questions About Outcomes - ANS The end result, not the efficacy or
effectiveness of an individual intervention
Has gained relevance in the policy world
Enables effective clinical decisions that relate to context and quality of life
Research Designs for Questions About Outcomes: How does it differ from traditional research -
ANS Evaluates a wider range of outcomes
Often focus on results that are meaningful to the patient
Should we rely only on RCTs? - ANS Often trade internal validity for external validity
Research Designs for Questions About Outcomes: Often ______ design - ANS
non-experimental/observational
Researchers do not control the intervention
No randomization
Research Designs for Questions About Outcomes: Because it is non-experimental: - ANS
Careful attention to basic design
Careful delineation of the factors that might influence the outcomes
Often use sophisticated statistical techniques to correct for any biases
Efficacy Vs Effectiveness - ANS Efficacy: effect of treatment under carefully controlled
conditions
Effectiveness: usefulness of treatment to individuals receiving it under typical clinical conditions.
Effectiveness: Non-experimental Design: Messy Process!!!!! - ANS Heterogenous group of
subjects
,Treatment implemented in various ways
DV focuses on broader outcomes of interest to patients
The goal of analysis in outcomes research is to... - ANS isolate the relationship between
outcomes of interest and the treatment provided by controlling for the effects of other relevant
material
Risk Adjustment - ANS Creates a level playing field
Baseline status
Clinical characteristics (comorbidities)
Demographic and psychosocial characteristics
Setting
What research design for this question: To determine whether patient age is associated with
types of physical therapy interventions received for CLBP. - ANS Observational
Correlational Design
Research Designs for Questions About Outcomes: Retrospective (cross sectional or
longitudinal) - ANS Often use secondary databases
-Institutional
-Commercial
-Government
-Medical records
Database Research: Review of Existing Medical Records: advantages and disadvantages -
ANS Advantages:
-Vast information that can be evaluated in context
Disadvantage:
-Time-consuming
-Inconsistent and incomplete information
Database Research: Abstracts of medical records: advantages and disadvantages - ANS
Advantages:
-Face sheet: time-efficient ensuring common data set on all patients of interest
, Disadvantage:
-Errors in coding information
-Less specific information, eg. Eliminating chronically depressed patients
Database Research: Administrative Databases (Information from the federal government
(Medicare), the state government (Medicaid), private insurers): advantages and disadvantages -
ANS Advantages:
-Large number of subjects, representative data, standardized data content, and format
Disadvantage:
-Patients without insurance
-Variation in coding among agencies
-Lack of insurance coverage
Database Research: In-House Databases: advantages and disadvantages - ANS
Advantages:
-High level of use
-Control of the training process
-Design the data collection tools to answer specific questions of interest
Disadvantage:
-Time consuming and expensive venture
Database Research: National Outcome Databases: advantages and disadvantages - ANS
Advantages:
Limited resources to develop in house database
Allows benchmark practice against other similar clinics in database
Large sample size, enhance power, improve generalizability
E.g National Spinal Cord Injury Database
Disadvantage:
-Longitudinal data is lost
Self-report Outcome Measures - ANS Standardized self report
•Surveys
Performance based
•Balance tests
• Person-level end points
•Disability, health status, satisfaction, QoL
•Design: Survey with question
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