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Physical Therapy Capstone

Getting Started

Not all research is created equal. You will want to ensure that your research paper includes the best possible evidence. You must put your collected evidence through a process of assessment before including it in your final work.

  • Watch the video: Primary vs Secondary (5:15) This video from the Netter Library provides information on how to identify primary and secondary sources in medical literature with a focus on original articles and review articles. 
  • Watch the video: Literature Assessment (5:26) This video from the Netter Library provides an overview on how to assess the literature. 
  • Take the interactive tutorial from the library: Resource Evaluation for Physical Therapy - Tutorial

Assessment

Evaluate the quality of evidence in each of the studies. This includes evaluating for risk of bias. Determine if the study relates to your research question. 

Critical Reading

When reading critically, focus on the purpose of your literature review:

  • Think about what you expect from the article or chapter, before reading it
  • Skim the abstract, headings, conclusion, and the first sentence of each paragraph
  • Take notes as you read and start to organize your review around themes and ideas
  • Consider using a table, matrix or concept map to identify how the different sources relate to each other

Analyzing your sources

Consider the following criteria:

  • Relevance - Is the article relevant to your topic?  Is the research methodology comprehensively described?
  • Currency - Is the source up-to-date? Does it consider the latest research on your topic?
  • Reliability - Is the source peer-reviewed? How reputable is the source and what is its impact factor?
  • Authority - Is the author from a reputable institution? Have you seen the author cited in other sources?
  • Provenance - Are the author's arguments supported by evidence (primary material, case studies, narratives, statistics, recent findings)?
  • Persuasiveness - Which of the author's arguments are most/least convincing?
  • Objectivity -  What is the purpose of the article and its intended audience? Is contrary data considered or is certain pertinent information ignored to prove the author's point? Can you detect any bias in the content?
  • Accuracy - Does the data support the conclusions drawn? Is the article properly referenced?
  • Value - Are the author's opinions and conclusions convincing? Does the work ultimately contribute in any significant way to an understanding of the subject?

Therapy Specific Questions

  • Were the patients randomized?
  • Was group allocation concealed?
  • Were patients in the treatment and control groups similar with respect to known prognostic factors?
  • Were important groups (patients, care givers, collectors of outcome data, adjudicators of outcome, and data analysts) aware of group allocation?
  • Outside of experimental intervention, were the groups treated equally?
  • Was follow-up complete?
  • Were patients analyzed in the groups to which they were randomized?

Evidence Pyramid

                                                                                             

      

                                                                                               .             
(Sackett DL, Straus SE, Richardson WS, et al. Evidence-based medicine: how to practice and teach EBM.
2nd ed. Edinburgh: Churchill Livingstone, 2000.)

Common Types of Articles

Article Type Definition Advantages/Disadvantages

Systematic Reviews

Systematic reviews focus on a clinical topic and answer a specific question. An extensive literature search is conducted to identify studies with sound methodology. The studies are reviewed, assessed for quality, and the results summarized according to the predetermined criteria of the review question. Systematic reviews are considered more reliable and accurate than individual studies. They are considered a highly evidence-based resource. However, they tend be very long and can take some time to read.
Meta-Analysis

A meta analysis is done using a method for statistically gathering quantitative studies to develop a single conclusion that has great statistical power 

A meta analysis will provide a conclusion that is statistically stronger than any single study because of its use of increased numbers of subjects, diversity of subjects or accumulated effects and results. However, some authors will have a difficult time identifying appropriate studies since not all studies provide adequate data for inclusion and analysis. A meta analysis also requires advanced statistical techniques. 

Critically Appraised Topics CAT's are a brief evidence based critical appraisal of one or two relevant studies to answer a clinical question. A CAT provides a short and brief review.  However, it is a less rigorous version of a systematic review. It is a single piece of evidence that is summarized and should not be considered a complete representation of the entire body of evidence on a clinical issue.
Randomized Controlled Trials RCT's are clinical trials based on random subject assignment to an experimental or control group. They are considered the gold standard for measuring an intervention's impact across many diverse fields.  Well-designed RCTs are superior to other study designs in estimating an intervention’s true effect. 
Cohort Studies Cohort studies have a control group where a group of people with something in common (a cohort) are followed. This group is compared to another group with similar characteristics/circumstances, with the exception of the factor being investigated. Cohort studies are observational and not as reliable as randomized controlled studies, since the two groups may differ in ways other than in the variable under study.  
Case Reports  Case reports are a collection of reports on the treatment of individual patients or a report on a single patient.  They have little statistical validity because they are individual reports of cases and use no control groups to compare outcomes. 
Expert Opinion  Expert opinion is an authoritative opinion of an expert.  An expert opinion provides anecdotal information from someone with clinical experience which can be valuable; however it is not considered to be evidence-based information.  

More Information for Assessing Literature

Use the following links recommended by the library for more information. 

Book From the Library