PHTY211 Lecture Notes - Lecture 6: Casp, Autotransplantation, Prospective Cohort Study
Appraising a prognostic study
• What is a prognostic study
o Prognosis relates to the probability or risk of an individual developing an outcome
over a specific period of time based on his/her clinical profile
o Information on prognosis is used to
• Inform patients about the course of their disease
• Guide deisio‐akig o treatets
• Select patients for future trials on new treatments
o When, whether or how a condition will improve
• I patiets ith aute lo ak pai, hat is the proaility of eig pai‐free
within 6 weeks?
• In patients with chronic low back pain, what is the probability of back pain
recurrence within 1 year?
• In patients with knee osteoarthritis, what is the prognostic value of body
weight gain/loss in reducing pain and increasing function within 3 years of
diagnosis?
• In patients after stroke, can a prediction model be developed to predict
independent ambulation 6 months after stroke?
• How do we appraise the quality of a prognostic study?
o EBP clinical steps
• Formulate a clinical question from a liets prole
▪ Patient
▪ Outcome
▪ Timeframe
• Search the literature for relevant evidence
▪ What is the evidence?
• Evidence about prognosis can come from several sources
• Clinical observation
• Clinical research
• Prospective and retrospective cohort studies
• Clinical trials
• Systematic reviews
▪ Clinical observation
• Accumulated over course of career
• Some clinicians recognise prognostic factors
• Problems
• Physios do't routiely follo‐up log ter
• If folloed‐up usually o a suset ho ay ot e
representative
• Not enough patients seen to gain accurate impression of
prognosis
▪ Clinical research
• Difficult to find
• Buried inside clinical trials
• No databases dedicated to archiving studies of prognosis in
physiotherapy
• General databases
• MEDLINE, Embase, CINAHL, PsycINFO
• Evaluate or critically appraise the evidence for its validity and utility
▪ Are the results of the study valid? (internal validity)
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Document Summary
Appraising a prognostic study: what is a prognostic study, prognosis relates to the probability or risk of an individual developing an outcome over a specific period of time based on his/her clinical profile. Inform patients about the course of their disease: guide de(cid:272)isio(cid:374) (cid:373)aki(cid:374)g o(cid:374) treat(cid:373)e(cid:374)ts. Select patients for future trials on new treatments: when, whether or how a condition will improve. In patients after stroke, can a prediction model be developed to predict independent ambulation 6 months after stroke: how do we appraise the quality of a prognostic study, ebp clinical steps. Formulate a clinical question from a (cid:272)lie(cid:374)t(cid:859)s pro(cid:271)le(cid:373: patient, outcome, timeframe. Search the literature for relevant evidence: what is the evidence, evidence about prognosis can come from several sources, clinical observation, clinical research, prospective and retrospective cohort studies, clinical trials. Systematic reviews: clinical observation, accumulated over course of career, problems. Some clinicians recognise prognostic factors: physios do(cid:374)"t routi(cid:374)ely follo(cid:449) up lo(cid:374)g ter(cid:373)
