RESEARCH

NPTE Review Class

 CONTENTS
• Roles and Responsibilities
• Research Design
• Problems related to measurement
• Evaluating the Evidence Levels of Evidence
and,
• Grades of Recommendation
• Data Analysis & its Interpretation

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 ROLES AND RESPONSIBILITIES
• Conduct Research in Clinical and Academic
Settings
• Incorporate Research Evidence into Practice
• Evidence-Based Practice (EBP)

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 Conduct Research in Clinical and
Academic Settings
• Research Question
• Submitted for Ethical clearance
• Apply for funding
• Data collection
• Data is analyzed and reported
• Publication

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 Incorporate Research Evidence into
Practice
• Keep yourself updated through publications
(website; journals; conferences)
• Make necessary changes in practice
• MUST have good judgment in using the
evidence

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 Evidence-Based Practice
• Explicit & Judicious use of current best evidence in making decisions
about the care of the patient.
• Based on:
– Systemic review
– Clinical expertise
– Patient’s value
• Four Steps
– Identify the research question/Clinical problem.
– Systematic Literature Review.
– Summarization & analysis of evidence.
– Application in clinical practice.

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 RESEARCH DESIGN
• Methods
• Variables
• Hypothesis
• Sampling
• Data Types
• Instrumentation – Gold Standard
• Informed Consent

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 Methods
• Historical Research
• Casual Comparative Research
• Epidemiology
• Correlation Research
• Experimental Research
• Descriptive Research

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 Historical
• Uses data already existing
• Find out the authenticity of the data
• Evaluates worth of data
• Establish relationship between items based on
analyses & inferences

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 Correlation
• Predicts Relationships
• Can’t establish the cause & extent of
relationship
• It can be:
– Retrospective
– Descriptive
– Predictive

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 Epidemiology
• Study of frequency & distribution of disease in
particular community.
• Conducted for better understanding helath
problems.
• Helps to design policies & future strategies.

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 Experimental
• Define a cause and effect relationship
between variables
– Treatment is manipulated – Independent Variable
– Effect is determined – Dependent Variable
• Example
– True Experimental (Randomly assigned to one group)
– Cohort (quasi experimental; subjects are identified &
followed over a period of time)
– Single Subject (A-B, A-B-A & A-B-A-B design)
– Factorial (number of independent variables utilizes)

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 Descriptive
• Determines existing phenomena
• Typically data is collected by
– Survey
– Interview
– Observations
• Examples
– Case Studies
– Normative Research
– Qualitative Research
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 Variables
• Independent:
– its an activity or factor, we manipulate.
• Dependent:
– the outcome, which is effected by the activity or
factor.
• Just to make it more simple
– We manipulate one variable (IV) and measure the
effect of this on other variable (DV).

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 Hypothesis
• It’s a Statement or an Idea which is to be
tested by conducting the research.
• Experimental/Research Hypothesis:
– It is based on theories/article one has read OR
observation one has made.
– It predict the relationship between the variables
• Null Hypothesis
– It’s a statement which states that no relationship
exists between the variables.

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 DATA
• What ever we measure is called as DATA.
• What all we measure:
– Performance
– Distance walked
– Range of Motion
– Vital Capacity
– Muscle Strength
• It falls under four main categories of Data
Measurement.
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 Nominal Scale
• Lowest level of Measurement.
• Classify score in two or more exclusive
category.
• Simply a naming category, what only gives
name or label to the data.
• Example:
– Number of OA patients visiting Hospital A and
Hospital B.
• Has no implication for degree, order & quality.
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 Ordinal Scale
• Classify the ranks in terms of their common
characteristics.
• Tells us bit more than Nominal.
• Allow us to rank order our data in the dimension we
are interested.
• Example:
– Rank Order of students performance by their
supervisor.
– Evaluating pain on NO, Mild, Moderate, Severe or
Unbearable.
• It will provide relative information not absolute.
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 Interval Scale
• It is like a Ordinal Scale except that it assumes
equal intervals in measurement.
• Classify scores based on predetermined equal
intervals.
• Its possible to identify the difference between
two scores.
– 30% and 60% is half the difference.
– Difference between 40% & 50% is same as of 70%
& 80%.
• Does not have absolute ZERO.
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 Ratio Scale
• Classify scores based on equal intervals and
true zero point exists.
• It measures:
– Distance
– Height
– Muscle Strength
• For purpose of statistical tests Interval & Ratio
are considered as same.
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 Sampling
• Random
– All individual in population has an equal chance to be
chosen for the study.
• Systematic
– Taking individuals at specific interval.
• Stratified
– Taking individuals on some predetermined characteristics.
• Double Blind
– Both the subjects & investigator are not aware of the
group assignments.
• Cluster
– Successive random sampling of a series.

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 Instrumentation
• Gold Standard
• Validity
• Reliability
• ICC

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 Informed Consent
• Information about the nature of study
• Risk involvement
• Benefits
• An Ethical Disclosure
• Voluntary Acceptance
• Right exit with out stating any
reason/obligation.

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 PROBLEMS RELATED TO MEASUREMENT

• Control
• Validity
• Threats to Validity
• Reliability
• Threats to Reliability
• Objectivity
• Subjectivity
• Sensitivity and Specificity
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 Control
• Attempts to remove the influence of any
variable other than the independent variable.
– Control Group
– Experimental Group
– Intervening Variable (not easily observable e.g.
stress)

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 Validity
• The degree to which a test or a tool accurately
measure what it is supposed to.
– Internal Validity:
– External Validity
– Face Validity
– Content Validity
– Concurrent Validity
– Predictive Validity
– Construct Validity
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 Reliability
• Interrater: Degree to which two or more
independent tester can obtain the same result.
• Intrarater: Degree to which one tester can
obtain same rating on multiple trials.
• Test-Retest: Scores on a test are stable over a
period of time.
• Split-half: Degree of agreement when a test
can be spilt in to two equal half.

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 Objectivity & Subjectivity

• Agreement among expert/neutral judges on

what is done
– Sign & Symptom is same regardless of who is
observing.
• Testing a format that may differ depending
upon the person grading the test.
– Judgment varies from one observer from other.

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 Sensitivity and Specificity
• True Positive: Correctly indentified as having
the target population/condition
• True Negative: Correctly indentified as NOT
having the target population/condition
• False Positive: Wrongly indentified as having
the target population/condition
• False Negative: Wrongly indentified as NOT
having the target population/condition
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Evaluating the Evidence Levels of Evidence
& Grades
• Systemic Review: Meta-analysis; quantitative
in nature with inclusion & exclusion criteria.
• Randomized Control Trials: Subjects are
randomly assigned to either of the group.
• Cohort Study: Prospective study with a group
of participation with similar conditions for
defined period & comparison to matched
group.

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• Case Control Study: A retrospective study of
individuals with a similar conditions,
compared with the group that does not have
the condition, to determine factors played
role.
• Case Report: Descriptive & only one individual
is studied
• Homogeneity: Free of variations in directions
& degree between indiviual studies.

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 Data Analysis & its Interpretation
• Descriptive Statistics
• Inferential Statistics

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 Descriptive Statistics
• Summarize & Describe important characteristics of a known
set of population data.
• Used in conjugation with survey methods.
• Conditions cannot be extended beyond the known set of
population data and any similarity to data outside the known
set cannot be assumed.
– Measure of Central Tendency
– Measure of Variations
• Example:
– Type of patient seen over a period one year.
– Measuring the standard of PT students.
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 Inferential Statistics
• It use sample data to make inferences about a
population.
• Example:
• Opinion Polls before general election
• It is often utilizes to determine whether there are
significant differences between groups.
- Parametric
- Non Parametric
- Correlation
- Linear Regression
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 Parametric OR Non Parametric
• Parametric tests are more Powerful and
Sensitive in detecting any effect of
independent variables.
• Example:
– Kitchen Scale OR
– Bathroom Scale

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 Than why Non Parametric …?
• Interval OR Ratio data
• Random selection of subjects.
• Data should be equally distributed.
• Variation in the results from each condition
should be same.

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 Parametric
• T-Test
• ANOVA
• ANCOVA

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 “t” test
– Compare two independent groups created by
random sampling.
– Paired or Unpaired “t” test
– One tailed or Two Tailed “t” test

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 ANOVA
• Analysis of Variance
• Three or more independent treatment group.
• Three or more sets of data from groups.
• One way ANOVA
– Single independent variable
• Multifactorial ANOVA
– Two or more independent variables
• Example
– IQ level of population at three different age group.

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 ANCOVA
• Analysis of Covariance
• Two or more independent groups
• Controlling the effect of intervening the variables i.e.
Covariate
– A source of variation that affects the response variable, but was
not controlled for during study design (often observational
studies).
• Example:
– Patients are being treated for strength with 3 different
treatment approaches.
– We put all the patient for 1 particular approach with out
considering their base line strength.

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 Non Parametric
• Chi Square
– Equal to Unpaired ‘t’ test.
– Only on Nominal data
• Mann-Whitney
– Equal to Unpaired ‘t’ test.
– Only on Ordinal data
• Wilcoxon
– Equal to Paired ‘t’ test
• Friedman Test
– Used one 1 group is tested for 3 or more conditions.
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 Correlation
Used to indentify relative strength between two
variables.
• Spearman's rank correlation Coefficient or
Spearman's rho:
– Correlates Ordinal data
• Pearson product-moment Coefficient
– Correlates Interval or Ratio data
• Interclass Correlation Coefficient
– Correlates reliability coefficient.
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 Linear Regression
• Relationship between two variables.
• Example:
– Blood pressure & reaction to a particular drug is
related.
– Vital capacity of a man/woman who smokes more
than 20 cigarettes a day

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