Professional Documents
Culture Documents
Introduction to Research
Dr. Ana Maria Rodriguez
Learning Objectives
Understand the role of research in evidence-based practice Identify different types and spheres of rehabilitation research Understand the stages of the health research cycle Identify the components and formulate clinical and research questions related to rehabilitation
Why do research?
Hyppocratic Oath (460-370 BC): I will apply measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.
Evidence-based Practice
Health professionals must use the best practices available not to inflict harm on patients. The integration of the best research evidence with clinical expertise and patients values Our professional responsibility : Research is the means by which we test the beliefs that we are improving patients lives with our interventions.
Evidence
(Davidoff, 1999)
A professional responsibility
It is not good enough to simply report that patients are doing better or are satisfied with our services. Demanded by patients and third-party payers. We must be willing to search, and in many instances, to create the evidence about the values of our practices and modify our practices in response to this evidence.
Research in Rehabilitation
Careful examination and systemic evaluation of the subject at hand. A friendly, welcoming attitude regarding change.
Research:
Challenges the status-quo:
Identifying gaps in knowledge Collective wisdom has not always been carefully reviewed. Novel treatments.
Creative Systematic:
Much of our clinical knowledge is anecdotal.
Bias is about how close you can get to the truth related to design Precision is about how much uncertainty remains - related to sample size
Getting it right
Research is about getting the right answer, not just any answer
Evaluative research
Biological/Physiological Mechanisms
Identified using a series of experiments Highly controlled Small studies in selected samples to reduce extraneous variables Replication is important Outcomes physiological in nature Used to build a theory
Determinants of health
Factors that influence a disease or health state Could be environmental, sociodemographic, psychosocial, etc. Observational studies with larger samples Used to build / test theory
Evaluative Research
Medical Model
Examples of Interventions
Examples of Programs
Stroke Rehabilitation (stroke unit, early supported discharge) Spinal Cord Rehabilitation TBI Work hardening . Etc. Geriatric Day program
Rehabilitation Model
Mechanism
Rehabilitation strategy
Rehabilitation intervention
Rehabilitation program
Implementation
Mechanism
Program Intervention
Strategy
Knowledge Translation
Program Intervention
Strategy
Evaluative Research
Research Cycle
Burden of disease Implementation Mechanisms/ Associations
Efficiency
Effectiveness
Efficacy
The 3 Es
Efficacy does more good than harm when delivered exactly as directed, i.e. under optimal conditions Effectiveness does more good than harm when delivered under usual conditions (e.g. fluctuating patient compliance) Efficiency considers cost and resources
Variable
A property or characteristic that can be measured and that varies across people, places, and time Term used in research methods and statistics Examples ?
Outcome
Research is about answering important and interesting questions Research is not about collecting data Good research questions are about what you WANT TO KNOW Not about WHAT YOU WANT TO DO
In order to get the right answer at the endwe must ask the right question at the beginning
Nancy E. Mayo
PICOT Format
In people with ______________________ (P) Does a new intervention ______________ (I) In Comparison to usual care __ ________ (C) Affect outcome characteristic __________ (O) At Time __________________________ (T)
PECOT Format
In people with ______________________ (P) Does a higher level of an exposure _____ (Exposure level 1) In Comparison to a lower level of exposure (Exposure level 2) Affect outcome characteristic __________ (O) At Time __________________________ (T)
Or ..
In children with AHDH, the objectives of this study were:
To determine the level of quality of life scores To estimate the association of symptom severity with quality of life
Actually 2 separate objectives, as each will have its own statistical analysis and results table
Observational design
e.g. estimating relationships, associations or mechanisms
Observational design
e.g. estimating relationships, associations or mechanisms
Experimental design
e.g. estimating the effect of a treatment or intervention; also called evaluative research