In this course the presenter will review principles of evidence-based practice relevant to accuracy and use of clinical diagnostic tests. Course participants will learn a structured approach to forming an answerable clinical question, finding & selecting best available evidence related to the question, determining the validity, strength, & relevance of that evidence, and integrating the evidence with clinical expertise and with patient values & expectations. Critical appraisal evidence of diagnostic test accuracy will be addressed in detail, with emphasis on answering the questions: 1) Are the results valid? 2) What are the results? 3) How can I apply the results to patient care?
Learning Outcomes
- Identify the appropriate structure for a 3-part foreground question related to diagnostic test accuracy and perform an efficient online search for evidence for diagnostic test accuracy using PubMed Clinical Queries.
- Identify key validity threats in published evidence for diagnostic test accuracy. Explain the concept of probabilities and limiting uncertainty when using diagnostic tests.
- Use an EBP calculator to compute sensitivity, specificity, positive and negative likelihood ratios, and 95% confidence intervals for each, given numbers of patients with true positives, false positives, true negatives, and false negatives.
- Apply SpPin and SnNout principles to make clinically relevant interpretations of quantitative results from evidence for diagnostic test accuracy. Use a likelihood ratio nomogram to determine a post-test probability given a pre-test probability (or prevalence), values for positive and negative likelihood ratios, and either a positive or negative test result for a given patient.
- Identify the level of evidence for a study of diagnostic test accuracy using the Oxford taxonomy for levels of evidence and a description of that study.
Agenda
| 0-5 Minutes | The diagnostic process |
| 5-10 Minutes | Foreground questions and searching for evidence |
| 10-35 Minutes | Validity issues with studies of diagnostic test accuracy |
| 35-45 Minutes | The classic 2x2 contingency table |
| 45-55 Minutes | Sensitivity & specificity; SpPins & SnNouts |
| 55-70 Minutes | Likelihood ratios & the LR nomogram |
| 70-80 Minutes | Confidence intervals for indices of diagnostic test accuracy. ROC curves & cut scores |
| 80-90 Minutes | An illustration of multiple tests given in sequence |
| 90-105 Minutes | Clinical prediction rules: clusters of diagnostic tests |
| 105-120 Minutes | Application: Homan’s sign & the Wells rule. Q & A |
Presented By
Stephen C. Allison
PT, PhD
Stephen C. Allison is a physical therapist engaged in teaching, research, and consultation. He holds degrees from Brigham Young University (BS), Baylor University (MPT), the U.S. Army War College (MSS), and The University of Texas at Austin (PhD). He was a faculty member and Director of the U.S. Army-Baylor University Graduate Program in Physical Therapy at Fort Sam Houston, Texas from 1994 - 2001. He has numerous publications in peer-reviewed journals and serves as an Associate Editor for the Journal of Orthopaedic and Sports Physical Therapy. Dr. Allison currently holds faculty appointments at Baylor University and Rocky Mountain University of Health Professions, where he holds the Evidence in Motion Chair in Evidence-Based Practice. Dr. Allison is also working for the US Army Research Institute for Environmental Medicine to develop computational and statistical models to predict injury and physical performance deficits in military training. He is a nationally known speaker and an expert on the integration of research evidence in clinical practice.
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Course participation information
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California
PhysicalTherapy.com is a recognized continuing competency approval agency for the Physical Therapy Board of California. This course is offered for 2.00 hours of continuing competency.
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