EVIDENCE BASED PRACTICE

Prof Dr Nazia Mumtaz

PhD
Rehabilitation Sciences
OBJECTIVES
• CAT Definition / Different Types

• Sensitivity, Specificity, Likely hood Ratio (LR) Odd

Ratio(OD).

• Key parameters of critical appraisal

• Steps in CAT process

• CAT for Introduction, Literature Review,

Methodology & Discussion
 CAT DEFINITION

• The Categorization format for quick studies in EBP.

• “Summary of a search & critical appraisal of literature

related to a focused clinical question”(Center for EBEM)

• The critically appraised topic (CAT)- means to

disseminate evidence from research literature to
rehabilitation professionals.

• Provides a quick & succinct information in Scientific

literature.
 CAT DEFINITION
• A CAT is a standardized, one-page summary of
research evidence organized around a clinical
question.

• Includes a clinical bottom line that reflects

synthesis of a research article & clinical
application of results.

• The synthesis includes a critique of internal,

external & statistical validity of research.
DIFFERENT TYPES
• CAT for Diagnosis.

• CAT for Prognosis.

• CAT for evaluating risk & harm in Case-control study.

• CAT for Evaluating risk & harm in Cohort Study.

• CAT for Treatment, Prevention & Screening.

https://nswspeechpathologyebp.com/resources/
 CAT FOR DIAGNOSIS

• Involve simply finding relevant studies that identify

disease symptoms & assessing the diagnostic accuracy
of those symptoms.
• Diagnostic CATs compare new diagnoses with medical
“ Gold Standard" or most highly accurate diagnostic
test that currently exists.

https://guides.library.utoronto.ca/c.php?g=251035&p=1672823
CAT FOR PROGNOSIS

• A CAT for prognosis will assess the ability of a

symptom to forecast probable outcomes.

• The diagnosis CATs attempt to establish whether or

not a person has a condition while prognosis CATs
try to predict the future of a condition for one
person.
 CAT FOR EVALUATING RISK &
HARM IN CASE-CONTROL STUDY
• Risk is the probability that the event will occur.

• A Case-Control study “ which starts with the identification

of persons with a condition of interest & a control group
without the condition"

• The case-Control CAT analyzes information on the

presence of risk factors using a statistical technique called
an odds ratio (OR). MEASURE OF ASSOCIATION
CAT FOR EVALUATING RISK & HARM IN
COHORT STUDY

•Cohort studies are studies in which subsets of

defined population are identified

•This CAT is basically for the evaluation relative risks

in the experimental & control group.
CAT FOR TREATMENT, PREVENTION &
SCREENING

• CATs in this category deals with the strongest type of

available evidence-randomized controlled trials.
• This type of CAT distills information from an article on a
treatment into a final conclusion on the Number Needed
to Treat (NNT).
• NNT- Number of persons needed to treat to prevent one
additional adverse outcome.
 SENSITIVITY

• Sensitivity of a diagnostic test is proportion of people who

actually have the disease or problem in question who
come up with a positive test.

• Probability that the test says a person has the disease

when in fact they do have the disease.
 SENSITIVITY

• Measure-likely for a test to pick up the presence of a

disease.

• In diagnostics, test sensitivity (true +ve rate)

• If 100 patients known to have a disease were tested & 43

test positive, then the test has 43% sensitivity.

• High sensitivity means diagnostic test is reliable & should

be used for screening the disease.
 SPECIFICITY
• Specificity of a test is equal & opposite result- proportion
of people who do not have the disease who come up with
a negative test.

• Specificity as probability that test says a person does not

have the disease when in fact they are disease free.

• If 100 patients with no disease are tested, 96 return a

negative result, then test has 96% specificity.

• High specificity means- test is reliable.

 DIAGNOSTIC TEST
 Four possible OUTCOMES, Whenever a test is done:

1) The patient has the disease, and the test is positive for
the disease.

2) The patient has the disease, and the test says he doesn't.

3) The patient does not have the disease, but the test says
he does.

4) The patient does not have the disease, and the test says
he doesn't.
LIKELIHOOD RATIO (LR) & ODD
RATIO (OR)

• A Likelihood ratio is a simple calculation of the probability

that a client has a certain condition given the results of
clinical tests.

• An OR is simply the odds of a patient in the experimental

group suffering an adverse event relative to the odds of a
patient in the control group suffering the same event.
Two-By-Two table
• For diagnostic Calculation.

Disease present Disease absent

Test Positive
a b

Test negative c d
ASSESSING KEY QUALITY PARAMETERS

• VALIDITY

• RELIABILITY

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5483707/
 VALIDITY

• INTERNAL
• Is the study designed in such a way that I can trust the
findings?

• EXTERNAL
• Is the study designed in such a way that I can
generalize the findings?
 RELIABILITY

• If the study was conducted again, would results be the

same?

• Test retest reliability

 STEPWISE APPROACH TO APPRAISE
LITERATURE

• Basic knowledge of epidemiology & statistics

• All rules may not apply to every design
• Critical appraisal may be positive or constructive
• To assess
• Introduction
• Methods
• Results
• Discussion
Assessing introduction

• Problem stated

• Adequate review of literature

• Study rationale
METHODS

Study design appropriate to objectives

• Prevalence
• Prognosis
• Treatment effect
• Cause
Study sample representative ?

• Source of sample

• Sampling method

• Sample size

• Inclusion and exclusion

• Non respondents
Control group acceptability
• –Definition of controls
• –Source of controls
• –Comparable characteristics
• –Matching and randomization

Quality of measurements
• -Validity
• -Reliability
• -Blindness
• -Quality control
Results:

• –Compliance

• –Dropouts

• –Missing data

Influences addressed

• Confounding factors

• Changes over time

RESULTS
• Selection of variables for inclusion
• Selection and/or number of statistical tests performed
• Amount of distortion reduced by analysis
• Presentation of results

DISCUSSION
• Findings linked to current literature
• Appropriate inferences & explanations
• Limitations listed
• Conclusion provides insight
FINAL JUDGMENT
• Objectives achieved & useful information produced

• The worth of a paper

• Pros & cons of research weighed implicitly

• The limitations

• Differentiation of a paper
REFERENCES
• https://www.cdc.gov/training/SIC_CaseStudy/
Interpreting_Odds_ptversion.pdf
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC556167/
• https://www.researchgate.net/publication/
7636526_Critically_appraised_topics_and_evidence-
based_medicine_journals
• http://www.digitallibrary.edu.pk/
• https://us.corwin.com/sites/default/files/upm-binaries/
19352_Chapter_3.pdf
• https://www.cdc.gov/csels/dsepd/ss1978/lesson3/section5.html
• https://pubmed.ncbi.nlm.nih.gov/12712815/
• https://onlinelibrary.wiley.com/doi/full/10.1111/ijcp.12767
• https://www.researchgate.net/publication/
221889814_Critical_Appraisal_Process_Step-by-Step
• https://www.science.gov/topicpages/c/
critically+appraised+topic.html
ASSIGNMENT-2

• Document to be uploaded on Moellim

• Follow guidelines to be discussed in class

• Student to present SAME document (NO PPT)

• Substantiate title with minimum of 5 References.

• Submission date: 20th July 2024,

Jazak Allah
Khair