PT 2.2 2014 Student Dossier

PHYSICAL THERAPY ENGLISH 2.
2 2014

STUDENTS DOSSIER

Case reports:
A patient with Cervical Pain 1
Online search for clinical information: Cervical Pain 2
Case Reports: Slices of Real Life 5
Online search for clinical information: Chronic Ankle Sprain 6
Analyzing Language: Expressing Health Science Concepts in English 9
Oral Presentation: Evidence-Based Case Study 10

Professional Journal Reading:
Scanning to recognize article types and research design features 14
Pre-Listening: What is a systematic review? 28
Introduction to Systematic Reviews: Reflexology 29
Behavioral treatment for low back pain 31
Exercise for management cancer-related fatigue 33
Foot Orthosis A Systematic Review 35
Effects of IF current therapy in the management of MS Pain 36
Review of therapeutic Ultrasound 37

Group Project
Group Project steps 38
Selecting a general research project 39
Narrowing the topic 41
Finding general background information 43
Finding related research abstracts 44
Formulating a research question: The PICO method 45
Planning your search: Establishing inclusion criteria 49
Representing your search: Flow chart representations 50
Organizing your data: Data tables and data extraction 52
Methodological Quality 65
Presenting your Group Project 68
Writing a summary of findings 70
Citations 71
Answering Research Questions 74

Grammar Exercises
Connecting Ideas and Phrases 79
Summary chart of linker, transition expressions, etc. 81
Summary of patterns of punctuation 82
Linking Expressions 1 83
Linking Expressions 2 84
Paired conjunctions 85
Citation Practice 87

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Dossier, Physical Therapy English 2.2 2014 page 1
UIC Idiomes jcp 28.2.12b Listening to a clinical description

A Patient with Cervical Pain
Listen to a Physical Therapists description of a patient. Take notes:
The patient:
Current problem:

Past Medical History:

Physical examination:

Treatment:

Outcome:

How will you search for information to clarify this case?
What keywords will you use?
Where will you look for information?

UIC Idiomes Angls jcp 5.3.12 Table to document online search for information

Question What is the prevalence of neck pain?
Terms I used to find my answer neck pain prevalence (pubmed)
My source of information

The prevalence of neck pain in the world population:
a systematic critical review of the literature. Fejer R,
Kyvik KO, Hartvigsen J.Eur Spine J. 2006 Jun;
15(6):834-48. Epub 2005 Jul 6.
http://www.ncbi.nlm.nih.gov/pubmed/15999284
My answer

The 1-year prevalence was estimated in 22 studies.
Based on fairly homogeneous denitions of
NP, the prevalence ranged from 16.7% [8] to 75.1%
for the entire adult population (1770 years), with
a mean of 37.2%
The authors answer

The reported 12-month prevalence of neck pain
varies from 30% to 50%, and lifetime prevalence is
approximately 70%.
The authors source of information

Gross AR, Haines T, Goldsmith CH, et al. Knowledge to
action: a challenge for neck pain treatment. J Orthop
Sports Phys Ther.2009;39:351363

Question

Terms I used to find my answer


My answer

The authors answer


Question



My answer

The authors answer



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My answer

The authors answer


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My answer

The authors answer


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My answer

The authors answer


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My answer

The authors answer


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My answer

The authors answer


UIC/ Idiomes/ Angls
Cincies de la salut mld.516
Objective to practice reading comprehension about case
reports and become familiar with editorial structure

5

10

15

20

25

Case Reports: Slices of Real Life to Complement Evidence
Irene R McEwen

With the growing emphasis on evidence-based practice, are case

reports outdated relics of the
professional literature? Clinicians,

educators, and students increasingly ask this question when

they see that case reports appear near the bottom of the hierarchy

of evidencelisted above
only expert opinion.

It's true that case reports cannot establish cause-and-effect

relationships between interventions
and outcomes. It's also

true that case reports cannot prove reliability or validity

of measurements
and cannot identify prognostic variables. What,

then, do case reports contribute to evidence-
based practice?

Case reports are descriptions of practice. Although most case

reports published in Physical
Therapy describe one or more patients,

case reports can focus on any aspect of physical therapy
that

has not already been described well in the professional literature.

No other type of written
professional communication gives the

replicable, detailed, and credible descriptions of practice

that case reports provide. They describe every step in the physical

therapist patient/client
management process: examination, evaluation,

diagnosis, prognosis, and intervention.
Textbooks do not give

this level of detail, and continuing education case examples

rarely
provide an evidence-based rationale for clinical decisions.

Research reports often describe an
intervention or the use of

a measurement in replicable detail, but they almost never describe

the
entire decision-making process for an individual patientand

that process is the reality that
clinicians and students face

every day. Case reports are real life.

Case reports describe what physical therapists and physical

therapists assistants ideally do. I say
"ideally" because a

good case report exemplifies the definition of evidence-based

practice"the
integration of the best available research

evidence with clinical experience and patient values."

Research evidence is important, but it is not the only component

of evidence-based practice.
Even when research evidence is available,

clinicians need to consider the evidence along with
their own

experiences and their patients' preferences and unique circumstances.

What if research evidence is not available? This happens all

the time, and it is not a barrier to
writing a publishable case

report. Authors just need to give solid rationale for their

decisions
and the necessary details about what they did and

why. Perhaps the case report will stimulate
research that will

provide needed evidence in the future. One of the purposes of

case reports is
to identify relevant variables for researchers

to investigate.

Discussion Questions
1. To what audience is this article addressed?
2. Where would you find this article?
3. What is unique to case reports? What can they do that other research cannot?
4. What are case reports not able to do in the context of an evidence-base Physical Therapy
practice?


Chronic Ankle Sprain
More practice searching online for clinical information: Documenting my search.
Question


My answer

The authors answer


Question



My answer

The authors answer


Question



My answer

The authors answer




Question



My answer

The authors answer


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My answer

The authors answer


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UIC/ Idiomes/ Angls
Cincies de salut
mld.05.03.12
Objective to reflect on how certain concepts are expressed in
English
Analyzing language: expressing health sciences concepts in English

1. Read the sentences below. They refer to certain health sciences concepts that are
widely used in the literature. How do you think the phrases in bold are expressed in
English?

a. En pacientes con un trastorno de ansiedad es frecuente observar embotamiento de la reactividad
general.

b. Estos signos y sntomas no son compatibles con el diagnstico de fibromialgia.

c. La clnico desarroll un proceso holstico de deteccin de sndrome de dolor regional complejo.

d. La incidencia de esguinces de tobillo en la poblacin no deportista es desconocida.

e. Las extremidades superiores son afectadas con mayor frecuencia que las extremidades inferiores.

f. Las mujeres tienen una mayor probabilidad de desarrollar trastornos depresivos.

g. Las vctimas reexperimentan el acontecimiento traumtico.

h. Los factores psicolgicos desempean un papel importante.

i. Representan un 18-30% de todas las fracturas con un pico de incidencia a los 11-12 aos.

j. Se evaluaron los resultados psicolgicos de los sobrevivientes de accidentes automovilsticos.

2. Scan the introduction that your teacher gives you for sentences that express the
phrases in bold. Based on the information you find, write these sentences in English.

3. Categorize the sentences. What aspect of health sciences is each sentence
referring to?

4. Discuss patterns in spelling, grammar and vocabulary that you observe in the English
expressions.


Oral Presentation: Evidence-Based PT Case Study

You will prepare an EBPT case presentation. Based on a case of a patient you treated or
observed during your clinical training, you should think of a clinical question. You will
search online for information IN ENGLISH that answers your clinical question. In the Oral
Presentation you will present the case, the question, how you searched for the answer to the
question, and how to apply this information in the future, if applicable.
The EBPT oral presentation will be done individually and should last NOT MORE THAN
15 minutes. You should turn in a paper copy of your slides on the day of the presentation.
What information do you need to include?
Remember you may need more than one slide for some of these categories.

Physical Therapy English
2.2

EBPT Case Presentation

A patient with.

Name
Date

Patient presentation

Chief complaint

History: Current and
previous problems

Physical
examination/Diagnostic tests

Patient presentation

Treatment

Outcome

A Clinical Question that
arose:

Search for Evidence:

Term(s): What term(s) did I
use?

Source(s): What source(s)
did I consult?

Search results

What was the answer to my
question?

Clinical applications: How
can I apply this information?


U.I.C. / Idiomes / Angls
Cincies de la Salut gn.418ap

Objective: To provide guidelines and tips for oral
presentations.

Guidelines and tips for oral presentations on an Evidence-based Physical
Therapy Case Study:
As you are preparing your presentation keep the following in mind.

Keep the text on the slide to a minimum, just enough to orient your audience to what
you are talking about. Remember the audience needs a reason to listen to you and not
ignore you and read the slides by themselves.

Know more than what you have on the slides, so you can answer questions and
explain.

It is useful to have a printout of your presentation with the pagina de notas. This
way you do not have to keep looking back at the screen to know what is on it.

When you present remember to:
Look at the audience when you speak (all of the audience, not just the teacher).

Stand close enough to the screen so that you can point to what you are talking about.

Speak loud enough for your audience to hear you, including the people in the back.

Notes on oral presentations

Notes for presenters

Good morning/afternoon. My name is________________. I am going to present a patient I
saw in my clinical training.

First / To begin with, this patient is ___________________________ (patients background.
example: a 65-year-old, retired female. She plays golf and cares for grandchildren).

The patient presented with ________________ (chief complaint: symptoms). The patients
past medical history included _____________ (what, when, how?). The patient had
undergone ___________ (previous treatments and diagnostic tests). He/she was diagnosed
with_____________ (diagnosis). On examination, ______________ (signs) were observed.

Is that clear? Do you have any questions so far? (Check comprehension in the audience)

Has anyone seen a similar case? How was it similar / different? (Ask your audience to
participate)

The patient was treated with ____________ (actual treatment).

Is that clear? Do you have any questions so far? (Check comprehension in the audience)

Finally, I would like to explain what the outcome for this patients was ____________ .

During my clinical training with this patient, some important questions arose. Firstly,
__________ (Clinical question #1). And secondly, ___________________. (Clinical question
#2).

The terms that I used in my search for answers were: _____________________ (keywords).
In order to answer my clinical questions I consulted ________________ as my sources of
information. I identified these abstracts:______________________________. The answer
to my questions were the following: ______________________________(explain what you
learned from the abstracts and how to apply this information into your clinical practice).

Now I would be happy to answer questions.

Thank you for your attention.

Vocabulary: present with, undergo, be diagnosed with, on examination, , be observed, be
treated with. Others:

Notes for audience
1. Treat the speakers with respect. Dont converse.
2. Take notes.
3. Ask questions if you want clarification or if you want further information.
4. When the presentation is finished, clap.

UIC / Idiomes / Angls / Cincies de la Salut / mks.139

Evaluation of Oral Presentation

Student: ______________________________ Date of presentation: __________
Partner: _______________________________
Condition: ________________

1. Eye contact with audience
No eye contact Appropriate contact

2. Mode of delivery
Read / Not prepared Did not read / Prepared

3. Use/organization/clarity of PowerPoint slides
Too wordy, language errors Clear, concise, no mistakes

4. Clarification of vocabulary and content
None/Insufficient Appropriate

5. Language use (Grammar & Vocabulary)
Lack of variety and/or accuracy Wide variety and accuracy in
in structure and vocabulary structure and vocabulary

6. Clarity / Pronunciation (of crucial vocabulary)
Difficult to understand/Mispronunciations Easy to understand/Accurate

General comments:

0 10
0 10
0 10
0 10
0 10
UIC / Idiomes / Angls / Cincies de la Salut / Physiotherapy A2 jcp 27b
0 10
Scanning to recognize article types and research design features

Rationale: An important skill is rapid scanning to assess article type and qualitythis
involves looking at Medline titles and abstracts or the first pages of journal
articles for certain key words like review, case report, etc. or trial, randomized,
retrospective, etc. Pages 15 to 27 contain texts from physical therapy journals.

Tasks: 1) Scan each page quickly and check the appropriate box in the columns under
article types (<30 seconds per article).
2) For original research papers, scan again to underline key phrases that show
research features (<2 minutes per article).
3) Check the appropriate boxes under Research design features

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Studies that test hypotheses or answer research questions
according to a stated methodology are written in IMRaD form
(I_____________, M___________, R___________ and
D_______________.)

Which of the articles are IMRaD articles?
Text 1

PHYS THER
Vol. 81, No. 5, May 2001, pp. 1127-1134
Changes in Attitudes and Perceptions About Research in Physical Therapy
Among Professional Physical Therapist Students and New Graduates
Barbara H Connolly, Norwood S Lupinnaci and Andrew J Bush
BH Connolly, PT, EdD, is Professor and Chair, Department of Physical Therapy, College of Allied Health
Sciences, University of Tennessee Health Science Center, 822 Beale St, Memphis, TN 38363 (USA)

Background and Purpose. The physical therapy profession, through

its published educational accreditation
standards and its normative

model of professional education, has addressed the importance

of educating
physical therapist students in the basic principles

and application of research. The purpose of this study was to

conduct a longitudinal study of students relative to (1) their

perception of knowledge with respect to research,
(2) their

perception of what source should be used (evidence-based practice

or traditional protocols) for clinical
decision making, and

(3) their perception of what should be used in a clinical setting

for patient management.
Subjects. Thirty-six students during

the final year of their professional program from a sample of

115 physical
therapist students who requested 2 consecutive

physical therapist classes completed the entire sequence of

pretest and posttest survey administrations. Seventy-nine students

did not complete the entire sequence.
Methods. A 10-item 5-point

Likert-type questionnaire was designed by the authors to probe

the students'
attitudes and perceptions about research, their

level of comfort and confidence in reading and applying research

findings published in the literature, and their personal habits

regarding reading the professional literature. An
expert panel

consisting of internal and external reviewers was used for construction

of the questionnaire. The
questionnaire was completed by the

students immediately preceding their research methods course,

immediately after the completion of that course, and following

the second research course, which included
statistics and development

of a research proposal. The subjects also completed the questionnaire

after 1 year of
physical therapy practice. Friedman's analysis

of variance was used as an omnibus test to detect differences

across time. In addition, a follow-up analysis using the Wilcoxon

signed-rank procedure to examine differences
between baseline

data and data obtained during each follow-up was done for all

items to determine whether a
difference occurred at a time other

than at the final posttest survey administration. Results. The

students
showed differences on 5 of the 10 items on the questionnaire

during the study. Discussion and Conclusion.
These items related

to reading peer-reviewed professional journals, critically reading

professional literature,
relevance and importance of evidence-based

clinical practice, and level of comfort with knowledge in research.

Key Words: Attitudes Educational outcomes Research

1. Summarize the objectives of this study in your own words.

2. How many students began this study? _______ How many completed it? _______
3. How many times did students complete the questionnaire?
4. Infer some questions included in the survey

a) about attitudes and perceptions about research

b) about students

level of comfort and confidence in reading and applying research

findings
published in the literature

c) about students personal habits

regarding reading the professional literature

Text 2

PHYS THER
Vol. 86, No. 7, July 2006, pp. 910-911

Interpreting Systematic Reviews: Sometimes,
More Is Better
Rebecca L Craik, Editor in Chief

Many of us remember when it was common for journals to publish

literature reviews in
which content experts summarized topical

information for the reader. A review of the
literature, however,

does not protect the reader against the bias of the content

expert. In fact,
a literature review provides an opportunity

for experts to support their bias using relevant
literature.

The systematic review, on the other hand, is designed to locate,

appraise, and synthesize
primary studies reliably, using a scientific

method that is intended to decrease bias and
errors.
1
The clinical

problem should be focused and clearly stated, and each component

of
the review should be carefully described: the systematic

strategy used to search for relevant
articles, the method used

to critically appraise the articles before they are included

in the
review, the method used to collect data from the selected

articles, and the methods used to
synthesize those collected

data.
2
The Cochrane Collaboration
3
is one of the best-known

organizations that provide an infrastructure for conducting,

maintaining, and updating
systematic reviews of the effectiveness

of health care interventions. However, because the
systematic

reviews overseen by the Cochrane Collaboration are not comprehensive,

many
journals commonly publish systematic reviews on relevant

topics, rather than literature
reviews.

You may be surprised to find that Physical Therapy has published

2 systematic reviews
examining the effectiveness of physical

therapy interventions for temporomandibular
disorders. In the

May 2006 issue, McNeely, Armijo Olivo, and Magee published "A

Systematic Review of the Effectiveness of Physical Therapy Interventions

for
Temporomandibular Disorders"; in this issue, Medlicott and

Harris publish "A Systematic
Review of the Effectiveness of

Exercise, Manual Therapy, Electrotherapy, Relaxation
Training,

and Biofeedback in the Management of Temporomandibular Disorder."

Medlicott
and Harris contacted me when the May issue was published

and offered to forgo publication
of their article. Although

their gesture was noble, I decided to publish both articles.

1. What is the source of this article?
2. What year was it published?
3. How many authors are there?

Circle True or False

4. True / False According to this article literature reviews provide objective analysis of
information from different studies.
5. True / False All systematic reviews are published by Chocrane Collaboration
6. True / False The Chocrane Collaboration is a well respected source of systematic
reviews.
Text 3

PHYS THER
Vol. 87, No. 5, May 2007, pp. 545-555

Effect of Aerobic Training on Walking Capacity and Maximal
Exercise Tolerance in Patients With Multiple Sclerosis: A
Randomized Crossover Controlled Study
Anais Rampello, Marco Franceschini, Massimo Piepoli, Roberto Antenucci, Gabriella
Lenti, Dario Olivieri and Alfredo Chetta
Background and Purpose Physical deconditioning is involved in the impaired exercise

tolerance of patients with multiple sclerosis (MS), but data

on the effects of aerobic training
(AT) in this population are

scanty. The purpose of this study was to compare the effects

of
an 8-week AT program on exercise capacityin terms

of walking capacity and maximum
exercise tolerance, as well

as its effects on fatigue and health-related quality of lifeas

compared with neurological rehabilitation (NR) in subjects with

MS.

Subjects and Methods
Nineteen subjects (14 female, 5 male; mean age [ SD]=418 years) with mild to moderate

disability secondary to MS participated in a randomized crossover

controlled study. Eleven
subjects (8 female, 3 male; mean age

[ SD]=446 years) completed the study.

Results
After AT, but not NR, the subjects walking distances

and speeds during a self-paced walk
were significantly improved,

as were their maximum work rate, peak oxygen uptake, and
oxygen

pulse during cardiopulmonary exercise tests. The increases in

peak oxygen uptake
and maximum work rate, but not in walking

capacity, were significantly higher after AT, as
compared with

after NR. Additionally, the subjects who were most disabled

tended to benefit
more from AT. There were no differences between

AT and NR in effects on fatigue, and the
results showed that

AT may have partially affected health-related quality of life.

Discussion
and Conclusion The results suggest that AT is more effective than NR in improving

maximum exercise tolerance and walking capacity in people with

mild to moderate disability
secondary to MS.

1. What journal was the article published in? __________________________________
2. How many authors contributed to this article? _______________________________
3. Were the results of this study positive, negative, or inconclusive?________________
4. What was/were the objective outcome measure(s) used?_______________________
______________________________________________________________________
5. What was/were the subjective outcome measure(s) were used? __________________
______________________________________________________________________
6. How many weeks total was the study period? ________________________________
7. What was the control treatment? __________________________________________

TRUE OR FALSE?
8. All the subjects received aerobic training. T / F
9. All the outcome measures showed improvement. T / F
10. NR was more effective than AT. T / F
11. Some subjects responded better to therapy than others. T / F
12. This study would rank high on the evidence ladder. T / F
13. Draw a scheme showing the groups of subjects and the treatments (if any) that they
received. Indicate the number of people involved in each group. Also draw the treatment
and assessment timeline.
Text 4

The American Journal of Sports Medicine 28:S (2000)
2000 American Orthopaedic Society for Sports Medicine

Football Injuries and Physical Symptoms: A
Review of the Literature
Jiri Dvorak, MD
*
and Astrid Junge, PhD
Schulthess Clinic, Zurich, Switzerland

Football is one of the most popular sports worldwide. The frequency

of football injuries is
estimated to be approximately 10 to

35 per 1000 playing hours. The majority of injuries
occur in

the lower extremities, mainly in the knees and ankles; the number

of head injuries is
probably underestimated. The average cost

for medical treatment per football injury is
estimated to be

$150 (U.S. dollars). Considering the number of active football

players
worldwide, the socioeconomic and financial consequences

of injury are of such a proportion
that a prevention program

to reduce the incidence of injuries is urgently required. For

this
reason, an analysis of intrinsic (person-related) and extrinsic

(environment-related) risk
factors was undertaken based on a

review of the current literature. It was concluded that the

epidemiologic information regarding the sports medicine aspects

of football injuries is
inconsistent and far from complete because

of the employment of heterogeneous methods,
various definitions

of injury, and different characteristics of the assessed teams.

The aim of
this study was to analyze the literature on the incidence

of injuries and symptoms in football
players, as well as to

identify risk factors for injury and to demonstrate possibilities

for
injury prevention.

1. What was/were the authors objectives?

2. Were they able to achieve this objective? ______ Why or why not?

3. Based on the abstract, do you think this article is likely to have useful clinical
applications for your practice? _______ Why or why not?

Text 5

Therapeutic Effects of Yoga for Children: A Systematic Review of the Literature.
Review
Pediatric Physical Therapy. 20(1):66-80, Spring 2008.
Galantino, Mary Lou PT, PhD, MSCE; Galbavy, Robyn PT, MPT; Quinn, Lauren DPT

Abstract:
Purpose: We completed a systematic review of the literature on the effect of yoga on quality
of life and physical outcome measures in the pediatric population. We explored various
databases and included case-control and pilot studies, cohort and randomized controlled
trials that examined yoga as an exercise intervention for children.
Summary of Key Points: Using the Sackett levels of evidence, this article reviews the
literature on yoga as a complementary mind-body movement therapy. We address the
research through three practice patterns according to the Guide to Physical Therapist
Practice and provide considerations for the inclusion of yoga into clinical practice.
Statement of Conclusions and Recommendations for Clinical Practice: The evidence shows
physiological benefits of yoga for the pediatric population that may benefit children through
the rehabilitation process, but larger clinical trials, including specific measures of quality of
life are necessary to provide definitive evidence.

1. Were the outcome measures in this study subjective, objective or both? ___________

2. According to the evidence ladder, how would you rank the four types of studies
reviewed in this article.

3. The articles reviewed examined yoga as a substitute for other types of physical therapy.
True / False

4. This review found that yoga had a positive result on some objective outcome measures,
subjective outcome measures or both? ______________________
Text 6

PHYS THER
Vol. 75, No. 12, December 1995, pp. 1075-1081

Pelvic-floor rehabilitation, Part 2: Pelvic-floor reeducation with interferential
currents and exercise in the treatment of genuine stress incontinence in
postpartum women--a cohort study

C Dumoulin, DE Seaborne, C Quirion-DeGirardi, and SJ Sullivan
Hopital Ste-Justine de Montreal, Quebec, Canada.

BACKGROUND AND PURPOSE: This descriptive cohort study investigated a physical therapy
program of pelvic-floor neuromuscular electrostimulation (NMES) combined with exercises, with
the aim of developing a simple, inexpensive, and conservative treatment for postpartum genuine
stress incontinence (GSI). SUBJECTS: Eight female subjects with urodynamically established GSI
persisting more than 3 months after delivery participated in the study. The subjects ranged in age
from 24 to 37 years (X = 32, SD = 4.2). METHODS: This was a descriptive multiple-subject cohort
study. Each subject received a total of nine treatment sessions during 3 consecutive weeks,
consisting of two 15-minute sessions of NMES followed by a 15-minute pelvic-floor muscle exercise
program. Patients also practiced daily pelvic-floor exercises during the 3-week treatment period. The
treatment intervention was measured using three separate variables. Maximum muscle contractions
(pretraining, during training, and post-training) were measured indirectly as pressure, using
perineometry. Urine loss pretraining and posttraining was measured by means of a Pad test. Self-
reported frequency of incontinence was recorded daily throughout the period of the study, using a
diary. Data were analyzed using a one-way repeated-measures analysis of variance (ANOVA), a
Wilcoxon signed-ranks test, and a Friedman two-way ANOVA by ranks. RESULTS: The results
indicated that maximum pressure generated by pelvic-floor contractions was greater and both the
quantity of urine loss and the frequency of incontinence were lower following the implementation of
the physical therapy program. Five subjects became continent, and three others improved. A follow-
up survey 1 year later confirmed the consistency of these results. CONCLUSION AND
DISCUSSION: The results suggest that the proposed physical therapy program may influence
postpartum GSI. Further studies are needed to validate this simple, inexpensive, and conservative
physical therapy protocol. [Dumoulin C, Seaborne DE, Quirion-DeGirardi C, Sullivan SJ. Pelvic-
floor rehabilitation, part 2: pelvic-floor reeducation with interferential currents and exercise in the
treatment of genuine stress incontinence in postpartum women--a cohort study.

1. What was the objective of this study?

2. What was the cohort for this study?

3. All interventions took place at the treatment center? TRUE / FALSE

4. What were the outcome measures?

5. According to the authors what type of study is this?

6. Based on what you have learned about different types of studies, what type of study
would you say this is?

7. What features of this study helped you make this decision.

Text 7

Arthroscopy. 2007 Dec;23(12):1320-1325.e6.

A meta-analysis of the incidence of anterior cruciate ligament tears as a function of
gender, sport, and a knee injury-reduction regimen.

Prodromos CC, Han Y, Rogowski J, Joyce B, Shi K.
Illinois Sports Medicine & Orthopaedic Centers, Glenview, Illinois 60025, USA.

PURPOSE: The literature has shown that anterior cruciate ligament (ACL) tear rates vary by
gender, by sport, and in response to injury-reduction training programs. However, there is no
consensus as to the magnitudes of these tear rates or their variations as a function of these
variables. For example, the female-male ACL tear ratio has been reported to be as high as
9:1. Our purpose was to apply meta-analysis to the entire applicable literature to generate
accurate estimates of the true incidences of ACL tear as a function of gender, sport, and
injury-reduction training. METHODS: A PubMed literature search was done to identify all
studies dealing with ACL tear incidence. Bibliographic cross-referencing was done to
identify additional articles. Meta-analytic principles were applied to generate ACL
incidences as a function of gender, sport, and prior injury-reduction training. RESULTS:
Female-male ACL tear incidences ratios were as follows: basketball, 3.5; soccer, 2.67;
lacrosse, 1.18; and Alpine skiing, 1.0. The collegiate soccer tear rate was 0.32 for female
subjects and 0.12 for male subjects. For basketball, the rates were 0.29 and 0.08,
respectively. The rate for recreational Alpine skiers was 0.63, and that for experts was 0.03,
with no gender variance. The two volleyball studies had no ACL tears. Training reduced the
ACL tear incidence in soccer by 0.24 but did not reduce it at all in basketball.
CONCLUSIONS: Female subjects had a roughly 3 times greater incidence of ACL tears in
soccer and basketball versus male subjects. Injury-reduction programs were effective for
soccer but not basketball. Recreational Alpine skiers had the highest incidences of ACL tear,
whereas expert Alpine skiers had the lowest incidences. Volleyball may in fact be a low-risk
sport rather than a high-risk sport. Alpine skiers and lacrosse players had no gender
difference for ACL tear rate. Year-round female athletes who play soccer and basketball
have an ACL tear rate of approximately 5%. LEVEL OF EVIDENCE: Level IV, therapeutic
case series.

1. What is the source of this article? _________________________
2. What year was it published? __________________________
3. How many authors were there? __________________________
4. The authors wanted to study _____.
a. the incidence of ACL tears among athletes
b. gender differences in ACL tears
c. the number of ACL tears in relation to preventative measures, sex and type of activity
d. age-related risk factors contributing to ACL tears
5. What variables seem to affect the likelihood of person experiencing an ACL injury? ________
___________________________________________________________________________

6. Which sport had the highest incidence of ACL tears? __________________________
7. Which sport had the lowest incidence of ACL tears? __________________________

Text 8

PHYS THER
Vol. 77, No. 8, August 1997, pp. 812-819

Predicting the probability for falls in
community-dwelling older adults
A Shumway-Cook, M Baldwin, NL Polissar, and W Gruber

Department of Physical Therapy, Northwest Hospital, Seattle, WA 98133, USA.

BACKGROUND AND PURPOSE: The objective of this retrospective case-control study
was to develop a model for predicting the likelihood of falls among community-dwelling
older adults. SUBJECTS: Forty-four community-dwelling adults (> or = 65 years of age)
with and without a history of falls participated. METHODS: Subjects completed a health
status questionnaire and underwent a clinical evaluation of balance and mobility function.
Variables that differed between fallers and nonfallers were identified, using t tests and cross
tabulation with chi-square tests. A forward stepwise regression analysis was carried out to
identify a combination of variables that effectively predicted fall status. RESULTS: Five
variables were found to be associated with fall history. These variables were analyzed using
logistic regression. The final model combined the score on the Berg Balance Scale with a
self-reported history of imbalance to predict fall risk. Sensitivity was 91%, and specificity
was 82%. CONCLUSION AND DISCUSSION: A simple predictive model based on two
risk factors can be used by physical therapists to quantify fall risk in community-dwelling
older adults. Identification of patients with a high fall risk can lead to an appropriate referral
into a fall prevention program. In addition, fall risk can be used to calculate change resulting
from intervention
1.
What background information do the authors give for this study? ___________________
2. What is their objective?____________________________________________________
3. What group of patients represents the case in this study? ________________________
4. What group of patients represents the control in this study? ______________________
5. How many variables contribute to a history of falls?______________________________
6. What are they?__________________________________________________________
Text 9

Md Med J 1999 Jan-Feb;48(1):7-11
Long-term functional results after
manipulation of the frozen shoulder.

Reichmister JP, Friedman SL.
Department of Orthopaedic Surgery, Sinai Hospital, USA.

The use of shoulder manipulation in the treatment of frozen shoulder syndrome remains
controversial. Opponents cite the risk of dislocation, fracture, nerve palsy, and rotator cuff
tearing as limiting the usefulness of manipulation. A retrospective study of 38 shoulder
manipulations in 32 patients was performed. These patients were followed for an average
time of 58 months. The patients were examined in follow up for combined shoulder range of
motion, external and internal rotation strength, and status of the long head of the biceps.
Manipulation was performed in all patients by the senior author and supervised physical
therapy was begun within 24 hours of the manipulation. The average recovery time was 13
weeks. In this series, 97% of patients had relief of pain and recovery of near complete range
of motion, although 8% required a second manipulation to obtain a successful result. Mild
weakness to manual muscle testing was present in 5.3% of patients in external rotation and
10.5% of patients in internal rotation. There was no deterioration of shoulder function with
time. In fact, most patients improved even more with passage of time. There was no
evidence of biceps tendon rupture or rotator cuff insufficiency at the time of follow up in
any of the patients. No fractures, dislocations or nerve palsies were observed, although one
patient who had no premanipulation arthrogram was found to have a rotator cuff tear a few
months after failed manipulation. Manipulation of the shoulder can therefore be offered to
reduce the pain and period of disability in patients who fail conservative treatment of frozen
shoulder syndrome.

1. This abstract describes a __.
a) randomized controlled trial
b) case report
c) retrospective study
d) review of the medical literature

2. This study was probably carried out __.
a) because frozen shoulder syndrome is a painful disorder
b) because other studies have criticized manipulation as a treatment for frozen shoulder
c) to determine if shoulder manipulation is an effective treatment for frozen shoulder
d) to determine the long-term effect of frozen shoulder syndrome

TRUE or FALSE?
3. ___ The subjects were probably former patients of one of the authors.
4. ___ Shoulder manipulation can be considered a conservative treatment for frozen shoulder.
5. ___ The 32 subjects probably began treatment for frozen shoulder at different baselines.
6. ___ Patients received no treatment for frozen shoulder apart from shoulder manipulation.
7. ___ No injury that could have been due to shoulder manipulation was found in any of the
subjects.
8. ___ Three patients were given shoulder manipulation twice.
9. ___ One outcome measure was probably a VAS for pain.
Text 10

Physical Therapy Volume 80 Number 4 April 2000
Work-Related Musculoskeletal Disorders in Physical Therapists: Prevalence,
Severity, Risks, and Responses
Jean E Cromie, Valma J Robertson, and Margaret O Best

Background and Purpose. Physical therapists are at risk for work-related musculoskeletal
disorders (WMSDs). Little is known of how therapists respond to injury or of what actions
they take to prevent injury. The purpose of this study was to investigate the prevalence and
severity of WMSDs in physical therapists, contributing risk factors, and their responses to
injury. Subjects. As part of a larger study, a systematic sample of 1 in 4 therapists on a state
register (n=824) was surveyed. Methods. An 8-page questionnaire was mailed to each
subject. Questions investigated musculoskeletal symptoms, specialty areas, tasks and job-
related risk factors, injury prevention strategies, and responses to injury. Results. Lifetime
prevalence of WMSDs was 91%, and 1 in 6 physical therapists moved within or left the
profession as a result of WMSDs. Younger therapists reported a higher prevalence of
WMSDs in most body areas. Use of mobilization and manipulation techniques was related
to increased prevalence of thumb symptoms. Risk factors pertaining to workload were
related to a higher prevalence of neck and upper-limb symptoms, and postural risk factors
were related to a higher prevalence of spinal symptoms. Conclusion and Discussion.
Strategies used to reduce work-related injury in industry may also apply to physical
therapists. Increased risk of thumb symptoms associated with mobilization techniques
suggests that further research is needed to establish recommendations for practice. The
issues for therapists who move within or leave the profession are unknown, and further
research is needed to better understand their needs and experiences. [Cromie JE, Robertson
VJ, Best MO. Work-related musculoskeletal disorders in physical therapists: prevalence,
severity, risks, and responses. Phys Ther. 2000;80:336-351.]
Key Words: Musculoskeletal disorders, Occupational injury, Physical therapy, Risk
factors.

1. What is the authors objective?

2. What were the features of the study population?

3. What was the study design?

4. Data was collected on ____. (Circle all that apply.)

5. What does WMSD mean? _______________________________________________

f) preventive measures adopted
g) work history
h) work responsibilities
i) body mass index
j) anthropometric variables

a) adaptation and attitudes toward injuries
b) areas of expertise
c) level of education
d) occupational risk factors
e) physical complaints

6. The results showed that __________.
a) 1 in 6 physical therapists reported lifetime prevalence of WMSDs.
b) 91% of young physical therapists moved within or left the profession due to
WMSDs.
c) there is a higher prevalence of symptoms among younger physical therapists.
d) use of mobilization and manipulation techniques was the cause of most disorders.

7. Based on your knowledge of your profession what types tasks performed by PTS are
likely to lead to the development of musculoskeletal disorders? What types of
preventative measures do you know of to reduce the risk of developing a WMSD?
Discuss with a partner.

8. _______ led to thumb problems.
a) lack of recommendations for practice
b) performing mobilization techniques
c) workload factors
d) work-related musculoskeletal disorders

9. _____ triggered cervical and arm problems.
a) amount and type of work
b) lifting patients
c) muscle strength
d) posture

10. Poor sitting or standing positions put a physical therapist at risk for ________.
a) back pain
b) hip joint and circulation problems
c) problems in the cervical vertebrae
d) upper and lower limb joint pain

11. Do you find it surprising that younger therapists reported a higher prevalence of
WMSDs in most body areas? What do you think might account for this phenomenon?
Discuss with a partner.

12. In the conclusion, the authors suggest that physical therapists can benefit from _____.
a) strategies used to prevent injury in industry
b) mobilization techniques to strengthen their thumbs.
c) existing research on their needs and experiences.
d) exercises that industrial workers do to reduce such problems as thumb
hypermobility

13. Which issues does the author believe need further research?
Text 11

Effect of acupuncture-like electrical stimulation on chronic tension-type headache: a
randomized, double-blinded, placebo-controlled trial
The Clinical Journal of Pain 2007 May;23(4):316-322

OBJECTIVE: The aim of this study was to examine the effect of acupuncture-like
electrical stimulation on chronic tension-type headache (TTH) in a randomized, double-
blinded, placebo-controlled study. METHODS: Thirty-six patients (18 men, 18 women)
with chronic TTH in accordance with the criteria of International Headache Society were
investigated. The patients were randomly assigned into 2 groups: a treatment group and a
placebo group. Pain duration, pain intensity on a 0 to 10 cm visual analog scale, number of
headache attacks, and use of medication were recorded in a diary for 2 weeks before
treatment (baseline), early stage of treatment (Treat-1; 2 wk), late stage of treatment (Treat-
2; 4 wk), and after the end of treatment (Post-1, Post-2, Post-3 corresponding to 2, 4, and 6-
wk follow-up). The patients also provided an overall evaluation of the treatment effect at
each stage. Patients were taught how to use either an acupuncture-like electrical stimulator
or a sham stimulator (identical but incapable of delivering an electric current) and then
instructed to use the device at home. Six acupoints, bilateral EX-HN5, GB 20, LI 4, were
selected to be stimulated 3 minutes for each point, twice a day. Friedman repeated measure
analysis of variance on rank was used to test the data. RESULTS: The pain duration was
shortened at Treat-1 and pain intensity was decreased at Treat-1 and Treat-2 compared with
baseline. The overall evaluation of the 2 treatments indicated improvements in both the
treatment and the placebo groups, but with no significant difference between the groups (p >
0.061). Despite the apparent improvement in both the treatment and placebo groups, a
decrease in analgesic use was only observed in the treatment group. There was also a
significant positive correlation between the reported intensity of the stimulus-evoked
sensation and the evaluation of the effect of either active or placebo treatments (p = 0.039).
CONCLUSIONS: The use of acupuncture-like electrical stimulation was not associated
with significant adverse effects. These results indicate that acupuncture-like electrical
stimulation is a safe and potentially analgesic-sparing therapy that may be considered as an
adjunctive treatment for patients with chronic TTH although the clinical effect on pain
seems to be marginal in the present set-up.

1. During the study did the researchers know which patients were receiving the acupuncture-like
electrical stimulation and which patients were receiving the placebo? _______

2. How many weeks was the duration of the study?_________

3. Mark the timeline with the various stages of the study.

4. Did the placebo treatment cause a sensation? _______

5. What factor affected the effect of the treatment?
a. the subjects sex
b. whether patients received acupuncture-like electrical stimulation or placebo
c. how intensely the patient felt the application of treatment

6. Do the authors feel acupuncture-like electrical stimulation is a possible substitute for other
treatments TTH? ________

7. Could the results of this study be applied to anyone suffering a headache? Why or why not?
______________________________________________________________
Text 12

PHYS THER
Vol. 88, No. 1, January 2008, pp. 98-104
DOI: 10.2522/ptj.20070033

Undetected Hangman's Fracture in a Patient
Referred for Physical Therapy for the
Treatment of Neck Pain Following Trauma
Michael D Ross and John M Cheeks

Background and Purpose: This case report describes a patient

referred for physical therapy
treatment of neck pain who had

an underlying hangman's fracture that precluded physical
therapy

intervention.

Case Description: This case involved a 61-year-old man who had

a sudden onset of neck
pain after a motor vehicle accident 8

weeks before his initial physical therapy visit.
Conventional

radiographs of his cervical spine taken on the day of the accident

did not reveal
any abnormalities. Based on the findings at his

initial physical therapy visit, the physical
therapist ordered

conventional radiographs of the cervical spine to rule out the

possibility of
an undetected fracture.

Outcomes: The radiographs revealed bilateral C2 pars interarticularis

defects consistent
with a hangman's fracture. The patient was

referred to a neurosurgeon for immediate review.
Based on a

normal neurological examination, a relatively low level of pain,

and the results of
radiographic flexion and extension views

of the cervical spine (which revealed no evidence
of instability),

the neurosurgeon recommended that the patient continue with

nonsurgical
management.

Discussion: In patients with neck pain caused by trauma, physical

therapists should be alert
for the presence of cervical spine

fractures. Even if the initial radiographs are negative for

a
fracture, additional diagnostic imaging may be necessary for

a small number of patients,
because they may have undetected

injuries that would necessitate medical referral and
preclude

physical therapy intervention.

1. What is the source of this abstract? ___________________

2. What year was it published? ___________________

3. The patients neck pain developed over time. True / False.

4. How was the hangmans fracture detected? ______________________

5. Was the patient able to continue with physical therapy? ___________

Why do the authors feel the presentation of this case was important?

UIC/ Idiomes/Angls
Cincies de la salut gn.66
Objective: Review of vocabulary for PowerPoint Presentation
gn.66 What is a systematic review

PRE-LISTENING: In English 1 and 2.1 you learned about two basic types of research: non-
experimental and experimental. Look at the following types of studies and say what type of
research it is.

1. ______________________ Cohort
2. ______________________ Case Report
3. ______________________ Randomized Controlled Trial
4. ______________________ Cross-sectional Survey
5. ______________________ Case-control
What do you remember about the designs of each type of study? What types of research
questions are they best for answering?

Here is the hierarchy of evidence pyramid we looked at in English 1. Do you remember where each type
of research is located in the pyramid?

Case-control studies
Case series and case reports
Systematic reviews
Editorials and expert opinions
Randomized controlled trials
Cohort studies

UIC/ Idiomes/Angls
Objective: to reflect on the importance of systematic reviews

Before you read:
1. Reflexology is a popular complementary therapy. What do you know about it?
2. For what sorts of conditions might it be a useful treatment?
3. Do you think it is effective therapy?
Med J Aust. 2009 Sep 7;191(5):263-6.

Is reflexology an effective intervention? A systematic review of
randomised controlled trials.

Ernst E.
Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth,
Exeter, United Kingdom. Edzard.Ernst@pms.ac.uk

OBJECTIVE:
To evaluate the evidence for and against the effectiveness of reflexology for treating any
medical condition.
DATA SOURCES:
Six electronic databases were searched from their inception to February 2009 to identify all
relevant randomised controlled trials (RCTs). No language restrictions were applied.
STUDY SELECTION AND DATA EXTRACTION:
RCTs of reflexology delivered by trained reflexologists to patients with specific medical
conditions. Condition studied, study design and controls, primary outcome measures,
follow-up, and main results were extracted.
DATA SYNTHESIS:
Of 217 publications identified, 18 RCTs met all the inclusion criteria. The studies examined
a range of conditions: anovulation, asthma, back pain, dementia, diabetes, cancer, foot
oedema in pregnancy, headache, irritable bowel syndrome, menopause, multiple sclerosis,
the postoperative state and premenstrual syndrome. There were > 1 studies for asthma, the
postoperative state, cancer palliation and multiple sclerosis. Five RCTs yielded positive
results. Methodological quality was evaluated using the Jadad scale. The methodological
quality was often poor, and sample sizes were generally low. Most higher-quality trials did
not generate positive findings.
CONCLUSION:
The best evidence available to date does not demonstrate convincingly that reflexology is an
effective treatment for any medical condition.

1. What is the source of this abstract? ____________
2. When was it published? _______________
3. Where does the researcher work? __________________
4. What were the inclusion criteria? ___________________________________
5. How many different aspects of the trials were compared? ________________
6. How many studies were included in this review? ________________

TRUE / FALSE: Write T or F in the blank
7. _____ The year of study publication was not an inclusion criteria.
8. _____ All the studies reviewed were in English.
9. _____ Five RCTs had high methodological quality.
10. _____ Only one RCT had been conducted for most conditions.

Reflect:

1. Why might the author be interested in whether more than one RCT had been
conducted on a particular condition?

2. Read the following statement from Reflexology Association of Australia and discuss
why the results of this systematic review are so different from the RAAs claims.
Think about what we have learned about different kinds of studies.

Reflexology can address your particular needs. Painful, congested or overactive states
within the body can be balanced and normalised. Thousands of documented case studies
from around the world have demonstrated the benefits for:
[premenstrual tension]
Migraine
Sinus
Colic
Menopause
Constipation/Diarrhoea
Back Pain
Neck Pain
Sciatica
Shoulder Pain
Asthma
Stroke
Menstrual Irregularities
Reflexology Association of Australia (http://www.reflexology.org.au)


UIC/ Idiomes/Angls
Objective: Introduce basic concepts of systematic reviews

Behavioural treatment for chronic low-back pain

Henschke N, Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Morley S, Assendelft WJJ,
Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database of
Systematic Reviews 2010, Issue 7. Art. No.: CD002014. DOI:
10.1002/14651858.CD002014.pub3.

Abstract
Background: Behavioural treatment is commonly used in the management of chronic low-
back pain (CLBP) to reduce disability through modification of maladaptive pain behaviours
and cognitive processes. Three behavioural approaches are generally distinguished: operant,
cognitive, and respondent; but are often combined as a treatment package. Objectives: To
determine the effects of behavioural therapy for CLBP and the most effective behavioural
approach. Methods: The Cochrane Back Review Group Trials Register, CENTRAL,
MEDLINE, EMBASE, and PsycINFO were searched up to February 2009. Reference lists
and citations of identified trials and relevant systematic reviews were screened. Randomised
trials on behavioural treatments for non-specific CLBP were included. Two review authors
independently assessed the risk of bias in each study and extracted the data. If sufficient
homogeneity existed among studies in the pre-defined comparisons, a meta-analysis was
performed. We determined the quality of the evidence for each comparison with the
GRADE approach.
Results: We included 30 randomised trials (3438 participants) in this review, up 11 from the
previous version. Fourteen trials (47%) had low risk of bias. For most comparisons, there
was only low or very low quality evidence to support the results. There was moderate
quality evidence that: i) operant therapy was more effective than waiting list (SMD -0.43;
95%CI -0.75 to -0.11) for short-term pain relief; ii) little or no difference exists between
operant, cognitive, or combined behavioural therapy for short- to intermediate-term pain
relief; iii) behavioural treatment was more effective than usual care for short-term pain relief
(MD -5.18; 95%CI -9.79 to -0.57), but there were no differences in the intermediate- to
long-term, or on functional status; iv) there was little or no difference between behavioural
treatment and group exercise for pain relief or depressive symptoms over the intermediate-
to long-term; v) adding behavioural therapy to inpatient rehabilitation was no more effective
than inpatient rehabilitation alone. Conclusion: For patients with CLBP, there is moderate
quality evidence that in the short-term, operant therapy is more effective than waiting list
and behavioural therapy is more effective than usual care for pain relief, but no specific type
of behavioural therapy is more effective than another. In the intermediate- to long-term,
there is little or no difference between behavioural therapy and group exercises for pain or
depressive symptoms. Further research is likely to have an important impact on our
confidence in the estimates of effect and may change the estimates.

1. What is the source of this abstract? ____________
2. When was it published? _______________


3. The goal of this review was to _____ (Circle Two)
a. compare behavioral therapy to other types of physical therapy in the treatment of
low-back pain.
b. Determine if behavioral therapy is an effective intervention for chronic low-back
pain.
c. See if one type of behavioral therapy is better than another.
d. Determine how different types of behavioral therapy are combined in the
treatment of CLBP.

4. How many databases were searched? _________

5. What does this statement from the methods section mean? I f sufficient homogeneity
existed among studies in the pre-defined comparisons, a meta-analysis was
performed.

6. Based on this abstract, under what circumstances (if any) would you recommend
behavioral therapy over other types of therapy?

7. In the conclusion the authors say that further research is likely to have an important
impact on their confidence in the estimates of effect and may change the estimates.
Why do you think they say this?

TRUE / FALSE: Write T or F in the blank
8. _____ This review looks at RCTs of people suffering long-term back pain resulting
from an injury.
9. _____ About half of the studies had a moderate to high risk of bias.
10. _____ Waiting list most likely refers to a control group.
11. _____ The authors have conducted this type of systematic review before.
12. _____ Overall the evidence supporting the effectiveness of behavioral therapy is
good.
Vocabulary: Find the term in the text for the following definitions.
a. to select, reject, consider, or group (people, objects, ideas, etc.) by examining
systematically ___________________.
b. Grading of Recommendations Assessment, Development and Evaluation
_____________.
c. A distortion of results that may occur if randomization is not properly carried out or
if subjects or researchers know which group they have been allocated to
_____________.
d. a patient who stays in a hospital while receiving medical care or treatment
_____________.

UIC Idiomes Angls jcp 10.04.12 Reading comprehension abstract of a systematic review

Exercise for the management of cancer-related fatigue in adults

1. Fiona Cramp
1,*
,
2. James Daniel
2

Editorial Group: Cochrane Pain, Palliative and Supportive Care Group
Published Online: 21 JAN 2009
DOI: 10.1002/14651858.CD006145.pub2
Copyright 2010 The Cochrane Collaboration.

Cramp F, Daniel J. Exercise for the management of cancer-related fatigue in adults.
Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD006145. DOI:
10.1002/14651858.CD006145.pub2.

Author Information
1. University of the West of England, Faculty of Health & Life Sciences, Bristol, UK
2. University of the West of England, School of Psychology, Bristol, UK
Publication History
1. Published Online: 21 JAN 2009
Background Cancer-related fatigue is now recognised as an important symptom
associated with cancer and its treatment. A number of studies have investigated the effects
of physical activity in reducing cancer-related fatigue with no definitive conclusions
regarding its effectiveness.
Objectives To evaluate the effect of exercise on cancer-related fatigue both during and
after cancer treatment.
Search methods The Cochrane Controlled Trials Register (CENTRAL/CCTR),
MEDLINE (1966 to July 2007), EMBASE (1980 to July 2007), CINAHL (1982 to July
2007), British Nursing Index (January 1984 to July 2007), AMED (1985 to July 2007),
SIGLE (1980 to July 2007), and Dissertation Abstracts International (1861 to July 2007)
were all searched using key words. Reference lists off all studies identified for inclusion and
relevant reviews were also searched. In addition, relevant journals were hand searched and
experts in the field of cancer-related fatigue were contacted.
Selection criteria Randomised controlled trials (RCTs) that investigated the effect of
exercise on cancer-related fatigue in adults were included.
Data collection and analysis Two review authors independently assessed the
methodological quality of studies and extracted data based upon predefined criteria. Where
data were available meta-analyses were performed for fatigue using a random-effects model.
Main results Twenty-eight studies were identified for inclusion (n = 2083 participants),
with the majority carried out on participants with breast cancer (n = 16 studies; n = 1172
participants). A meta-analysis of all fatigue data, incorporating 22 comparisons provided
data for 920 participants who received an exercise intervention and 742 control participants.
At the end of the intervention period exercise was statistically more effective than the
control intervention (SMD -0.23, 95% Confidence Interval (CIs) -0.33 to -0.13).
Conclusions Exercise can be regarded as beneficial for individuals with cancer-related
fatigue during and post cancer therapy. Further research is required to determine the optimal
type, intensity and timing of an exercise intervention.


UIC Idiomes Angls jcp 10.04.12 Reading comprehension abstract of a systematic review

Exercise for the management of cancer-related fatigue in adults

1. What is the source of this abstract?
2. How many authors are listed?
3. Where do the authors work?
4. When was this abstract published?
5. This is a/an___ study.
a. non-experimental b. experimental c. integrative
6. Why do the authors think that this study is necessary?
7. What did the authors want to determine?
8. How many databases were searched?
9. What other sources of studies were identified?
10. What were the inclusion criteria for studies?
11. How many studies met the inclusion criteria?
12. How many studies included patients who did not have breast cancer?
13. How many studies were submitted to meta analysis?
14. What outcome measure was compared in the meta analysis?
15. Exercise___cancer fatigue.
a. increases b. decreases c. has no effect on
16. Which kind of exercise is better in the treatment of cancer fatigue?
17. What areas need to be explored in future research?
18. What are the clinical recommendations based on this study?

Pre-reading activities
TASK I Read the following text.

Foot orthoses in lower limb overuse conditions: a systematic review and
meta-analysis--critical appraisal and commentary.

CLINICAL QUESTION: Among patients with or at risk for musculoskeletal overuse conditions,
(1) do foot orthoses provide clinically meaningful improvements, and (2) are foot orthoses cost-
effective? DATA SOURCES: Studies published through September 28, 2005, were identified by
using MEDLINE, EMBASE, CINAHL and Pre-CINAHL, Physiotherapy Evidence Database
(PEDro), PubMed, SPORTDiscus, Biological Abstracts, Web of Science, Allied Health and
Complementary Medicine Database, and the full Cochrane Library. Reference lists of included
randomized controlled trials (RCTs) and identified systematic reviews were searched by hand.
STUDY SELECTION: Studies were included if (1) they were RCTs that included the use of foot
orthoses (either custom or prefabricated) in 1 of the intervention groups, (2) the clinical problem was
an overuse condition as defined by the American College of Foot and Ankle Orthopedics and
Medicine guidelines for which foot orthoses were recommended, and (3) at least 1 clinically relevant
outcome was measured for a minimum of 1 week. Limits were not placed on year of publication,
status of publication, or language.

1. What were the authors inclusion criteria?
2. Where did they look for their information?
3. What do you think was the oldest source of information available in their search? The newest?

TASK II Answer the questions below about a study about interferential current
therapy.

You are going to read an abstract about a study with the title, The effects of interferential current
therapy in management of musculoskeletal pain.

1. Write what you think the authors initial research question was:
______________________________________________________________?

Analyze it using the PICO model.

2. How do you think this question arose? Why did they need to answer this question?

3. This study was a systematic review. If you were a member of this research team, what
inclusion criteria would you apply to find evidence to answer your question?
4. Where would you look?

5. How many articles do you think could meet your criteria? Explain your answer.
a. <50 c. 100-500
b. 50-100 d. >500

6. Write a hypothesispredict the answer to this research question.

TASK III Read the abstract below. Label the sections with the following terms:

BACKGROUND
CONCLUSION
DATA EXTRACTION
DATA SOURCES
DATA SYNTHESIS
PURPOSE

The effects of interferential current therapy in management of
musculoskeletal pain

Interferential current (IFC) is a common electrotherapeutic modality used to treat pain. Although IFC is
widely used, the available information regarding its clinical efficacy is debatable. The aim of this
systematic review and meta-analysis was to analyze the available information regarding the efficacy of
IFC in the management of musculoskeletal pain. Randomized controlled trials were obtained through a
computerized search of bibliographic databases (ie, CINAHL, Cochrane Library, EMBASE, MEDLINE,
PEDro, Scopus, and Web of Science) from 1950 to February 8, 2010. Two independent reviewers
screened the abstracts found in the databases. Methodological quality was assessed using a compilation
of items included in different scales related to rehabilitation research. The mean difference, with 95%
confidence interval, was used to quantify the pooled effect. A chi-square test for heterogeneity was
performed. A total of 2,235 articles were found. Twenty studies fulfilled the inclusion criteria. Seven
articles assessed the use of IFC on joint pain; 9 articles evaluated the use of IFC on muscle pain; 3
articles evaluated its use on soft tissue shoulder pain; and 1 article examined its use on postoperative
pain. Three of the 20 studies were considered to be of high methodological quality, 14 studies were
considered to be of moderate methodological quality, and 3 studies were considered to be of poor
methodological quality. Fourteen studies were included in the meta-analysis. Interferential current as a
supplement to another intervention seems to be more effective for reducing pain than a control treatment
at discharge and more effective than a placebo treatment at the 3-month follow-up. However, it is
unknown whether the analgesic effect of IFC is superior to that of the concomitant interventions.
Interferential current alone was not significantly better than placebo or other therapy at discharge or
follow-up. Results must be considered with caution due to the low number of studies that used IFC alone.
In addition, the heterogeneity across studies and methodological limitations prevent conclusive
statements regarding analgesic efficacy.
7. How did their question arise?
a. Because most practitioners question its effectiveness
b. Because of inconclusive evidence regarding its ability to reduce pain
c. The safety of IFC has not yet been tested

8. What were the authors inclusion criteria? Consider the following aspects:
a. Intervention
b. Study design
c. Outcome measures
d. Time limits

9. Where did they decide to search for their information?

10. How long have the effects of IFS been studied?
11. The results _____.
a. strongly support the use of IFS for musculoskeletal pain
b. do not support the use of IFS for musculoskeletal pain at all
c. suggest that the use of IFS in some cases of musculoskeletal pain may be somewhat
beneficial
d. cleared up the current debate about the use of IFS for musculoskeletal pain


Physical Therapy Volume 81:7 (July 2001)
A Review of Therapeutic Ultrasound: Effectiveness Studies
Valma J Robertson and Kerry G Baker

Background and Purpose. Therapeutic ultrasound is one of the most widely and frequently
used electrophysical agents. Despite over 60 years of clinical use, the effectiveness of
ultrasound for treating people with pain, musculoskeletal injuries, and soft tissue lesions
remains questionable. This article presents a systematic review of randomized controlled
trials (RCTs) in which ultrasound was used to treat people with those conditions. Each trial
was designed to investigate the contributions of active and placebo ultrasound to the patient
outcomes measured. Depending on the condition, ultrasound (active and placebo) was used
alone or in conjunction with other interventions in a manner designed to identify its
contribution and distinguish it from those of other interventions. Methods. Thirty-five
English-language RCTs were published between 1975 and 1999. Each RCT identified was
scrutinized for patient outcomes and methodological adequacy. Results. Ten of the 35 RCTs
were judged to have acceptable methods using criteria based on those developed by Sackett
et al. Of these RCTs, the results of 2 trials suggest that therapeutic ultrasound is more
effective in treating some clinical problems (carpal tunnel syndrome and calcific tendinitis
of the shoulder) than placebo ultrasound, and the results of 8 trials suggest that it is not.
Discussion and Conclusion. There was little evidence that active therapeutic ultrasound is
more effective than placebo ultrasound for treating people with pain or a range of
musculoskeletal injuries or for promoting soft tissue healing. The few studies deemed to
have adequate methods examined a wide range of patient problems. The dosages used in
these studies varied considerably, often for no discernible reason.

1. In your own words, why was this review carried out?
_____________________________________________________________
2. Give the author-date citation formula for his article. _______________
3. What does RCT stand for? _______________
4. How many articles in total did the authors study? ______
5. Why were the results of some of these articles excluded from this review? Explain in
your own words.
_____________________________________________________________
6. In all the studies reviewed, was ultrasound used alone as a treatment?
_____________________________________________________________
7. Translate the first sentence of the Discussion & Conclusion section.
_____________________________________________________________
8. In your own words, explain what the last sentence of the abstract means.
_____________________________________________________________
9. Rate this article in terms of its relevance and importance to your profession.

10. In your professional opinion, what are the clinical implications of this research?

Cincies de la Salut / Physiotherapy / mks.271
Objective: An abstract of a review article.

Not important Important

Group Project Steps

Steps that you will follow:

Step

Worksheet/document/dossier page
Identify your areas of interest jcp.21.03.12 Selecting a research topic
(individual) p39/40
Form a research group + Decide on your
topic+ narrow the topic
MESH Keywords related to your topic
P41/42
Set up a group glossary
Review the literature for basic background
Information: General websites and
abstracts

Literature search: General Information: General
Websites related to the topic jcp.27.03.12 p43

Literature search:
5 abstracts related to the topic p44
Formulate a research question using PICO
method
Mld.10.04.12 Formulating an answerable
question p45/46/47/48
Planning your search: Inclusion criteria Planning your search p49
Documenting your search: Flowcharts P50/51
Extracting Information/Tables P52-62
Synthesizing Information/draw
conclusions
P63-64
Evaluating Methodological Quality P65-67
Oral Presentation of your research
process process.
P68/69
jcp.09.05.12 Oral presentation guidelines
Write up a written report of your research P70


UIC/ Idiomes/ Angls
Cincies de la salut
mld.20.03.12
Objective to prepare for selecting an area of research
Selecting a general Topic

Identifying one workable study topic is perhaps the most challenging part of a
research project. Each of the infinite study topics has its own set of virtues and
shortcomings. Topic selection is one of the few steps in research
wherecreativity is not only allowed but required. Although study design, data
collection, and data analysis must all follow a restrictiveprotocol of accepted
methods, picking a study topic calls for expression of personal interests.
Brainstorming and concept mapping

A brainstorming session can be a good starting point for identifying a research
topic. Use the categories in (see table below) to identify areas of personal interest. Spend a day,
several days, or even weeks jotting down possible research areas. Check with friends and
colleagues about their ideas. Search abstract databases, and skim journals and books for ideas
about potential research themes.

The goal is to create a list of possible research topics and to make it as long as possible. This is not
the stage for eliminating ideas because they do not appear feasible. Think big! The ideas do not
need to be well formed. Begin by simply listing several health conditions or population groups that
might be interesting to study. Do some research areas show up several times on the list and appear
to be a central theme? Can those topics be grouped or mapped? (It may be helpful to use circles
and arrows to visibly group related topics to clarify the connections.) Which broad areas might be
enjoyable to explore?

Area Questions
Values What are my interests and personal values
What research topics are personally
meaningful?
Have some understudied conditions that I
could explore significantly affected me, my
family, or my friends?
Have certain health issues sparked my passion
because they reflect what I consider to be an
injustice?
Skills What knowledge and skills do I already have?
Personal growth What new skills do I want to develop?
Connections What source populations and/or data sources might
be available to me through professors, supervisors,
colleagues, and other personal and professional
contacts?
Job and /or course requirements What does my supervisor or professor want me to
study?
Gaps in the literature What information is not currently available that would
make a contribution to the discipline and/or
improving health practices or policies?

UIC Idiomes jcp.21.03.12 Identifying area of interest
Selecting a research topic: Read the table. Do you understand the
questions? Answer the questions that are appropriate for you.

I. Brainstorm some general topics you would be interested in researching. List them
here. Apply grouping or concept mapping techniques to identify a topic of
common interest. Base your final decisions on the content presented in the
table above.

Values What are my interests?
What research topics are personally
meaningful?
Have some understudied conditions that
I could explore significantly affected me,
my family, or my friends?

Skills

What knowledge and skills do I already
have?

Personal growth

What new skills do I want to develop?

Connections

What source populations and/or data
sources might be available to me
through professors, supervisors,
colleagues, and other personal and
professional contacts?

Job and /or course
requirements

What does my supervisor or professor
want me to study?

Gaps in the
literature

What information is not currently
available that would make a
contribution to the discipline and/or
improving health practices or policies?


Narrowing the topic

Key words
The next step is to refine the areas of interest that were
identified through brainstorming. A helpful approach is listing
related keywords. Write a long list of words that may help focus
the research question. For example, a person who identifies an
interest in child health in Africa during brainstorming might
then list works such
asmalaria.childrenAfrica...bednetsUgandameasles
vaccinationpreschool childrenmalnutritionvitamin A
deficiency.A person who identifies an interest in aging might
list works such as osteoporosisfallsbedsoresphysical therapycalciumbone density
making homes saferehabilitationprevention. The goal is to identify a wide range of specific
potential study themes within the major area of interest. The process of narrowing a topic can be
depicted by a inverted triangle, like the one below.

Broad topic

Narrow topic

Injuries

Knee injuries

Knee injuries in athletes

Knee injuries in German athletes

Knee injuries in German soccer players

Patellar dislocation in German soccer players

Patellar dislocation in German female
soccer players

Patellar dislocation
in German female
goal
keepers

Patellar dislocation
in older German
female
goal
keepers


The MeSH(Medical Subject Headings) database, developed by the U.S. National Library of
Medicine, can be helpful in narrowing the scope of a research area and in identifying the full extent
of a research area. Suppose, for example, that a potential area of interest is infection. The MeSH
database suggests a variety of narrower topics related to infections, such as cardiovascular
infections, sepsis, infectious skin diseases, and wound infection. Within the category of skin
diseases, the MeSH database lists a variety of narrower topics, such as cellulitis, dermatomycoses
(fungal skin infections), and bacterial skin diseases. Within the category of dermatomycoses, the
MeSH database lists yet narrower topics, such as blastomycosis, cutaneous candidiasis, and tinea.
Within these categories, MeSH offers even more refined points and still more refined points within
successive subcategories.

Searching through the MeSH database can help a researcher in several ways. The research can
move from a vague interest in infections or skin infections to a more focused interest in, for
example, fungal skin infections or, even more specifically, ringworm infections. Alternatively, the
MeSH database can be used to search for broader or related study ideas. Or a search for pre-
eclampsia shows that pre-eclampsia is a type of pregnancy complications. It is related to other
forms of pregnancy-induced hypertension, such as HELLP syndrome, which may be an equally
interesting study topic.

Once a list of keywords has been compiled, the researcher looks for the themes that emerge from
them. Can any topics be easily eliminated because they do not fit the researchers personal
interests? Are some key words particularly interesting?

II Access theMeSH database( http://www.nlm.nih.gov/mesh/), and identify some key
terms for your topic area.

MESH Keywords related to your topic:


Reviewing the literature: Basic Background Information: General websites
Once a general research area has been identified, the next step is to do background reading about
the topic. Usually, researchers start with informal sources that provide basic information about the
topic of interest, then move on to more formal reports as the aim and scope of the research idea
are refined. This process, as a whole, is called reviewing the literature.
A starting point for learning about the primary area of interest is to search the Internet for basic
background information. Many major public health organizations, such as the World Health
Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC), have fact
sheets about various diseases and risk factors for disease. National governments and international
governmental organizations (like the United Nations) also have fact sheets, brochures, and
websites that provide basic demographic, political, economic, geographic, and other health-related
information about countries and regions.
III Find some fact sheets and other websites for basic information about your topic.
Use the table to record your search .
Do a search for GENERAL WEBSITES about your topic area. This may include websites of patient
information/patient associations. For each website, carefully document the link, the type of
information it offers, and if it offers pertinent information about your topic.
Name of site/source of
information/ link
Accept/reject Type of Information

Abstract databases
Abstract databases allow researchers to sort through thousands of abstracts for key words or other
search terms. A careful and comprehensive search of at least one major abstract database is the
most important component of a careful literature search.
Many health abstract databases are available from libraries via subscription, like CINAHL
(Cumulative Index to Nursing and Allied Health), Embase, ISI web of Science, Medline, and
PsycINFO. The most important publicly available health science database is PubMed, which
provides access to more than 15 million abstracts (most of which are from MEDLINE). PubMed can
be searched with keywords or MeSH terms using Boolean operators like AND, OR and NOT Limits
can be set so that results include only abstracts with certain publication years, languages, or other
selected parameters. PubMed can also be searched for abstracts by article title, author (using a last
name and first initials format, such as Baker JD or Patel AR, journal, and/or publication year.

A rigorous review process is used to decide which journals are listed in MEDLINE, and not all
journals apply for inclusion are accepted if they apply. (The list of indexed journals is available
online.) As a result, there are many peer-reviewed journals that are not included in the MEDLINE or
PubMed databases. Therefore, a supplemental search, by means of a general search engine like
Google Scholar, may be helpful in identifying additional relevant abstracts. A supplemental search is
especially important when the topic of interest is narrow enough to yield only a small or moderate
number of hits. Another benefit of these search engines is that the can provide links to the full-text
versions of publicly available articles.

Answer the questions about the text:

1. T F It is necessary to search more than one major data base.

2. Two examples of health abstract databases are:__________________________________.

3. Examples of Boolean operators are:_____________________________________________.

4. Which of the following can you specify when searching on a database?
a. author b. title c. topic d. journal e. year of publication f. language

5. Medline includes all Health Science journals?

6. Why would you want to use a general search engine when looking for abstracts?

IV Access PubMed to identify general trends in your topic area.
Choose 5 abstracts that seem the most relevant and useful for your topic


UIC/ Idiomes/Angls
Cincies de la salut mld.10.04.12
Objective: to become familiar with the PICO technique to
formulate research questions

Formulating an Answerable Question: PICO
1

The P I C O principle
Questions often spring to mind in a form that makes finding answers in the medical literature a challenge.
Dissecting the question into its component parts and restructuring it so that it is easy to find the answers is an
essential first step in Evidence Based Medicine (EBM).

Many clinical or research questions can be divided into these four components, which we call P I C O. Try to
use all four parts of the question, if possible.

P Population/patient/ problem
I Intervention/indicator
C Comparator/control
O Outcome

Different types of questions
The most common type of clinical question is about how to treat a disease or condition. In Evidence Based
Medicine (EBM), treatments and therapies are called interventions and such questions are questions of
INTERVENTION.

Not all research questions are about interventions. Other types of questions may arise. Match the terms with the
type of questions :
Question Terms

1. ____ Diagnosis
2. ____ Etiology
3. ____ Prevalence
4. ____ Prognosis
5. ____ Risk factors

a. What causes the problem?
b. What is the frequency of the problem?
c. Does this person have the problem?
d. Who will get the problem?

The studies that you will need to find in the course of your work will be different for each type of question.

Discuss which type of research design would be appropriate for each question.

1
Access this information at
http://learntech.physiol.ox.ac.uk/cochrane_tutorial/cochlibd0e50.php

P I C O' examples

I nterventions
INTERVENTIONS cover a wide range of activities from drug treatments and other clinical therapies, to lifestyle
changes (e.g. diet or exercise) and social activities (e.g. an education program). Interventions can include
individual patient care or population health activities (e.g. screening for diseases such as cervical or prostate
cancer).
Example: A 28-year-old male presents with recurrent low back pain for past 8 months; these episodes have been
treated with interferential current and Pilates exercises but keep recurring. He asks if recurrences can be
prevented. To convert this to an answerable question, use the P I C O method as follows :

Question:
In patients with recurrent low back pain, do Pilates exericses, compared to no treatment, reduce the recurrence
rate?

P Population/patient/ problem = _________________________
I Intervention/indicator = _________________________
C Comparator/control = _________________________
O Outcome = _________________________

Etiology and risk factors
ETIOLOGY and RISK FACTORS relate to questions that probe possible causes of a disease or illness. They are the
reverse of intervention questions because they deal with the harmful outcomes of an activity or exposure. Such
questions commonly arise in relation to public health issues, such as whether eating certain foods increases the
risk of heart disease, or being exposed to an environmental chemical increases the risk of cancer, and so on.

Example: George wants to discuss the possibility of using ultrasound for shoulder pain. He says he has heard
something about ultrasound causing an increase in cancer later in life. You know that the risk of this is low but
want to give him a more precise answer.

Question:
Does undergoing ultrasound (compared to not undergoing ultrasound) increase the risk of getting cancer in the
future?

P Population/patient/ problem = _________________________
O Outcome = _________________________


Frequency or rate
Questions of FREQUENCY (prevalence ) are about how many people in the population have a disease or health
problem, such as what is the frequency of hearing problems in infants or the prevalence of Alzheimers disease in
the over 70s. If the question also includes a time period, such as for cases of influenza in winter versus summer, it
becomes a question of rate (incidence).

Example: Mabel is a 6-week-old baby at her routine follow-up. She was born prematurely at 35 weeks. You want
to tell the parents about her chances of developing motor problems.

Question:
In infants born prematurely, compared to those born at full term, what is the subsequent lifetime prevalence of
motor problems?'

P Population/patient = _________________________
O Outcome = _________________________

Diagnosis
Diagnosis questions are concerned with how accurate a diagnostic test is in various patient groups, and in
comparison to other available tests. Measures of test accuracy include its sensitivity and specificity.

Example: You are working in a sport clinic and frequently see patients with knee injuries. Your clinic routinely
performs MRI to rule out ACL injury, but you want to know if using a cheaper evaluative tool, such as drawer
sign is equally effective in diagnosing ACL injury.

Question:
For patients with knee injury, is drawer test as accurate (ie with equal or better sensitivity and specificity) as MRI
for diagnosing ACL injury?

P Population/patient = _________________________
O Outcome = _________________________

Exercises

For each exercise below, identify:
the type of research question ( etiology, diagnosis, intervention, etc.)
the different components based on the PICO model

Exercise: 1
"Is there evidence to suggest that the prophylactic use of vitamin B12 supplements is effective in improving the
quality of life (specifically cognition) of apparently healthy older people?"

Exercise: 2
"Would you recommend self-monitoring of blood glucose levels for patients with Non-Insulin Dependent Diabetes
Mellitus (NIDDM)?"

Exercise: 3
"In elderly patients with congestive heart failure, is digoxin effective in reducing the need for rehospitalization?"

Exercise: 4
"Is glucosamine sulphate an effective agent in the short-term treatment of osteoarthritis?"

Exercise: 5
"In a 70 year old woman with primary insomnia and a previous adverse reaction to hypnotics, can cognitive
behavior therapy improve sleep quality and duration?"


Planning your search.

1. Write your research question below. Use the PICO method.

2. List your inclusion criteria. Think of the following aspects:

Population:

Condition:

Intervention:

Comparator:

Outcome:

Study design:

Year of Publication:

Other criteria:


UIC/ Idiomes/ Angls
Cincies de la salut
mld.24.04.12b
Objective to review terms and concepts that are included in flow
charts depicting a search for evidence in a systematic review
Flow chart representation of data search in systematic reviews

The flow chart below depicts researchers procedures throughout their search for evidence
about the effectiveness of interferential current therapy for musculoskeletal pain. Based
on the abstract we read previously, fill in each blank with an appropriate word from the
following list:

a. database
b. duplicated
c. English
d. full-text
e. IFC
f. low back
g. manual
h. meta-analysis
i. PEDro
j. qualitative
k. randomized
l. screened
m. shoulder
n. title
o. 1
p. 4

2,231 articles identified
through
1
_____search
(CINAHL, Cochrane Library,
EMBASE, MEDLINE,
2
_____, Scopus, Web of
Science)

2,235 articles
5
_____
3
____ articles identified through
4
_____search
2,081 articles excluded on the
basis of the
6
_____ and
abstract
154
7
____articles assessed for
eligibility (57
8
_____): 97
finally selected
20 studies included in the
12
_____ synthesis
77 articles excluded:

23 Not clinical studies
24 Descriptive studies
10 Not written in
9
_____
No Pain outcome included
5 Not a
10
_____trial
3 No full text available
2 Did not truly assess
11
_____
1 Animal data

4 Knee osteoarthritis pain
5
13
_____ pain
2 Fibromyalgia/ myofascial
pain
1 Jaw pain
14
_____ Frozen
15
____pain
1 Bicipital tendonitis pain
14 studies included in the
quantitative synthesis
(
16
_____)

Answer the questions about the information provided in the flow chart.

1. How many were excluded because they were not experimental studies?

2. How many of the studies did not use a human population?

3. How many articles that were included in the final analysis provided data about pain
reported in the lower limb?

4. From how many of the studies were the results pooled and submitted to statistical
analysis?

5. How many of the studies included in the meta-analysis assessed effectiveness of IFC on
musculoskeletal pain?

6. The phrase Did not truly assess IFC in the third box on the right means that_____.
a. the article had not assessed IFC at all
b. some information initially assessed at the abstract level seemed promising, but
further evaluation proved it to be irrelevant to the authors study
c. the evidence about IFC was false, and therefore, unreliable
d. The initials IFC stood for some other type of therapy besides Interferential Current
Therapy

7. What do you think is the difference between qualitative and quantitative synthesis?

8. Using the flow chart as a guide, create one that represents your own search.


UIC/ Idiomes/ Angls
Cincies de la salut
mld.24.04.12
Objective: To become familiar with types of information that is
compared in systematic reviews, and means for comparison

Comparison tables for studies in a systematic review

Once researchers have selected their articles for their analyses, they must have a
simple instrument to facilitate their data synthesis. The following tables were
created for this purpose. Choose 2 tables to compare and analyze the type of
content listed. Share this information with your partners. Discuss which table
format and categories are the most useful for your own study
Colon Perforations Complicating Colonoscopies: What is the Best Known Evidence for
Prevention?


1. Incentive spirometry in major surgeries: a systematic review


2. A systematic review of studies comparing health outcomes in Canada and the United
States

3. Insulin versus an oral antidiabetic agent as add-on therapy in type 2 diabetes after
failure of an oral antidiabetic regimen: a meta-analysis


4. Somatization in Latin America: a review on the classification of somatoform
disorders, functional syndromes, and medically unexplained symptoms

5. Reminiscence Therapy and validations therapy in management of neuropsychiatric
symptoms of dementia


6. Apathy and its nonpharmacological treatment in dementia.

7. Physical therapy treatment on frailty syndrome: systematic review

8. Transcutaneous electrical stimulation for pain relief during labor: a systematic
review and meta-analysis


UIC/ Idiomes/ Angls
Cincies de la salut mld.jcp.08.05.12
Objective: to become familiar with data synthesis

Synthesizing the data

I The following items represent the type of data that researchers often study.
The tables on the previous pages have been extracted from a variety of systematic reviews.
Skim through the tables to identify the type of data that was collected. Classify the data
according to the categories below.

PREVALENCE/ INCIDENCE
Abstracts:

EFFECTIVENESS
Abstracts:

TAXONOMIC DATA
Abstracts:

II Write a possible research question for each of the studies listed.

III According to the data, answer the research questions.
look for tendencies; similarities or common variables

IV If you detect any discrepancy in the results of the different studies, can you explain them
by analyzing the data presented?

Data Extraction Table Practice

This is part of a data extraction table taken from a meta-analysis.

*IFC: Interferential Current SWD: Short-wave diathermy

Read these headings. Do you know what they mean?

Use the headings below to identify the information presented in the table.
The first heading has been done.

What conclusions can you draw based on this study results?

Study author and year of publication Quirk et al,1985
England
Knee OA
38 patients with knee OA
1. Active IFC* +Exercises
2. Active SWD*+exercises
3. Exercises
ROM
Pain (VAS)
Exercise endurance
Maximum knee girth
Exercises
3 and 6 months
12 patients in the IFC +exercise group
12 patients in the SWD +exercise group
14 patients in the exercise group
Frequency of 0100 Hz for 10 min and 130 Hz for 5
min, 3 times a week for 4 wk
Significant improvement in groups 1, 2 and 3 (P_.02,
P_.05, P_.03,respectively)
No significant difference among groups
Randomized
Confounders not controlled
Reliability and validity of outcomes not reported
Small sample size
No control/placebo group included
Poor description of intervention
Co-interventions
Condition
Country
Follow-up
Outcomes
Results
Sample
Strengths
Study Arms
Study author and year of publication
Treatment
Weaknesses

UIC/ Idiomes / angls
Cincies de la salut
mcs.26.04.12

DATA EXTRACTION

Design a Data Extraction Table for your study abstracts. This is only a model. You
SHOULD ADAPT the table to your question and your abstracts.

Inclusion
criteria

Condition Population Treatment
under study
Comparator
treatment
Outcome
measures
Results

Abstract 1

Abstract 2

Abstract 3

Abstract 4

Evaluating Methodological Quality

PEDro Scale

1. eligibility criteria were specified no yes where:
2. subjects were randomly allocated to groups (in a crossover study, subjects
were randomly allocated an order in which treatments were received) no yes where:
3. allocation was concealed no yes where:
4. the groups were similar at baseline regarding the most important prognostic
indicators no yes where:
5. there was blinding of all subjects no yes where:
6. there was blinding of all therapists who administered the therapy no yes where:
7. there was blinding of all assessors who measured at least one key outcome no yes where:
8. measures of at least one key outcome were obtained from more than 85%
of the subjects initially allocated to groups no yes where:
9. all subjects for whom outcome measures were available received the
treatment or control condition as allocated or, where this was not the case,
data for at least one key outcome was analysed by intention to treat no yes where:
10. the results of between-group statistical comparisons are reported for at least one
key outcome no yes where:
11. the study provides both point measures and measures of variability for at
least one key outcome no yes where:

Reading the PEDro Scale
Read the following definitions and find the following terms in the PEDro scale

1. _____________________: characteristics a study must meet to be included in a review.

2. _____________________: not in a systematic manner. Aleatoriamente.

3. _____________________: assigned to treatment or control group.

4. _____________________: hidden; kept unknown.

5. _____________________: at the initial point of a study; before the intervention is applied.

6. _____________________: a participant in a study is unaware of assignation to study or
control intervention; masking.

7. _____________________: the person who evaluates the outcome variables.

8. _____________________:variable which measures the effectiveness of an intervention.

9. _____________________: inclusion of data taken from subjects who have stopped
participating in a study. The inclusion of this data reduces one
source of bias.

10. _____________________: comparison of the results for the intervention group and the
control group.

11. _____________________: measure of results at one point in time; for example, at the end
of a study.

12. _____________________: range of results for a given variable; for example, standard
deviation.


UIC Idiomes. Angls jcp.24.04.12 Practice evaluating abstracts for methodological quality
EVALUATING METHODOLOGICAL QUALITY
Read this diagram of the process followed when using the JADAD Scale.

Read the methodology section of an RCCT to evaluate methodological quality using the JADAD scale

UIC/ Idiomes/ Angls
Cincies de la salut jcp.09.05.12
Objective to prepare students for their final oral presentations
about their research projects

Answering a research question: Guidelines for oral presentations
While you prepare for your presentation, remember:
The text on the slide should be minimal.
o Just enough to orient your audience
o Remember, the audience should listen to you and not simply read the slides
Know more than the contents on the slides,
o You should be able to answer questions and explain.
It is useful to have a printout of your presentation with the pagina de notas.
o To avoid looking at the screen

When you present, remember to:
Look at the audience when you speak (all of the audience, not just the teacher).
o DO NOT turn your back to the audience
Stand near the screen, so you can point to words or images you are referring to.
Speak loud enough for your audience to hear you.

What information do you need to include?
Remember, you may need more than one slide for some of these categories.
Use, but dont limit yourself to, the abstract as a guideline.

Title

Example:
Effectiveness of X on Y
A review Study

Your names

Background/ contextual
information

Research question

Search strategy

Inclusion criteria

Data sources

Study selection

Titles, study designs, and
populations of abstracts

Flow chart of search and
selection process

Data extraction

Table of data

Data synthesis

Results/ Answer to your
research question

Conclusions

Discuss study limitations
Recommendations

A bad idea!


Evaluation of Oral Presentation (Model)
Student: ______________________________ Date of presentation: ______________
Partners: _______________________________ Article reference: _________________

1. Mode of delivery / Eye contact with audience
Read / No eye contact Spoke / Appropriate contact

2. Clarification of vocabulary and content
None Appropriate

3. Use/organization/correctness of presentation slides
Too wordy, language errors Clear, concise, no mistakes

4. Language use (Grammar & Vocabulary)
Lack of variety and/or accuracy Wide variety and accuracy in
in structure and vocabulary structure and vocabulary

5. Clarity / Pronunciation (of crucial vocabulary)
Difficult to understand/Mispronunciations Easy to understand/Accurate

6. Understood abstracts / Was able to arouse interest and answer questions
No Yes

Evaluator: ____________________________ Final grade: __________________________

0 10
0 10
0 10
0 10
0 10
0 10

UIC Idiomes jcp.15.04.12a Give students a model of a brief reportof results of a literature
search to answer a research question.

PT 2.2 Writing a summary of findings
Structure of the text:
Paragraph 1: Introduce the topic and why it is important

Paragraph 2:

Present your research question and why
you chose it.
Paragraph 3:

Explain the major findings of the first
abstract
Paragraph 4:

Explain the major findings of the second
abstract
Paragraph 5:

Explain the major findings of the third
abstract
Paragraph 6:

Conclusions.
Answer to your question.

Useful language:
To present the research question The purpose of this report is to
present the major findings of a brief
review of three scientific abstracts which
investigated(area of interest or topic).
Our research question was
To present findings One study (author-year citation) found
that

To present conflicting findings: On the other hand, a second study
(author-year citation) showed that
Conversely,
However,
To present additional ideas In addition, the third study (author-year
citation) reported that
Furthermore,
Moreover,
To summarize In summary,
In conclusion,
To sum up,
We can conclude that

Include a bibliography with your report. Use the following format.
1. Authors.Title of article.Title of Journal.Date;volume:pages.
2. Authors.Title of article.Title of Journal.Date;volume:pages.
3. Authors.Title of article.Title of Journal.Date;volume:pages

UIC/ Idiomes/Angls
Cincies de la salut mks.253/gn.2012
Objective: To explain and illustrate citations and the their
relationship to a list of bibliographic references.
Citation Practice 1: Citation formats

In formal scientific writing that describes research, every statement must be supported by
evidence.
Direct evidence is provided by any original work that the author is describing, for
example, in the Results section of an article about a clinical trial.
Indirect evidence is provided by reference to other articles or books. In this way the
reader may check the sources on which the author is basing her or his work.

These references to other works are called citations.

There are two standard formats for indicating sources of citations. They are illustrated below
with excerpts from the introduction to the systematic review article we have been looking at
and its list of references.

A. The author-year system

Behavioral treatment for chronic low-back pain
*

Low-back pain is a major health and economical problem which affects large populations around the
world. In particular, chronic low-back pain (CLBP) is a major cause of medical expenses, work
absenteeism, and disability (Koes et al. 2006). Current management of CLBP includes a range of
different intervention strategies such as medication, exercise, and behavioural therapy. The main
assumption underlying a behavioural therapy approach is that pain and its resulting disability are not
only influenced by somatic pathology, but by psychological and social factors as well. In this way,
CLBP is not only a physical problem, but may also be influenced by the patient's attitudes and
beliefs, psychologic distress, and illness behaviour (Waddell 2004). Consequently, the goal of
behavioural treatment is to alter maladaptive thoughts, feelings and behaviours as well as
dysfunctional sensory phenomena, and thereby the experience of pain. In general, three behavioural
treatment approaches can be distinguished: operant, cognitive, and respondent (Turk and Flor 1984;
Vlaeyen et al. 1995). Each of these focuses on modifying one of the three response systems which
characterize emotional experiences: behaviour, cognition, and physiological reactivity.

References
Koes BW, van Tulder MW, Thomas S. Diagnosis and treatment of low back pain. British Medical
Journal 2006;332(7555):14304.
Turk DC, Flor H. Etiological theories and treatments for chronic back pain. II. Psychological models
and interventions. Pain 1984; 19:20933.
Vlaeyen JWS, Haazen IWC, Schuerman JA, Kole-Snijders AMJ, van Eek H. Behavioural
rehabilitation of chronic low back pain: comparison of an operant treatment, an operant-
cognitive treatment and an operant-respondent treatment. Br J Clin Psychol 1995;34:95118.
Waddell G. The Back Pain Revolution. 2nd Edition. London: Churchill Livingstone, 2004.

(Koes et al. 2006) indicates that the study has three or more co-authors. If there are two authors
both last names are cited (Turk and Flor 1984). If there is only one author the form is (Waddell
2004).

*
Henschke N, Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Morley S, Assendelft WJJ, Main CJ. Behavioural
treatment for chronic low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 7. Art. No.:
CD002014. DOI: 10.1002/14651858.CD002014.pub3.

B. The number system

Behavioral treatment for chronic low-back pain

Low-back pain is a major health and economical problem which affects large populations around the
world. In particular, chronic low-back pain (CLBP) is a major cause of medical expenses, work
absenteeism, and disability
1
. Current management of CLBP includes a range of different intervention
strategies such as medication, exercise, and behavioural therapy. The main assumption underlying a
behavioural therapy approach is that pain and its resulting disability are not only influenced by
somatic pathology, but by psychological and social factors as well. In this way, CLBP is not only a
physical problem, but may also be influenced by the patient's attitudes and beliefs, psychologic
distress, and illness behaviour
2
. Consequently, the goal of behavioural treatment is to alter
maladaptive thoughts, feelings and behaviours as well as dysfunctional sensory phenomena, and
thereby the experience of pain. In general, three behavioural treatment approaches can be
distinguished: operant, cognitive, and respondent
3,4
. Each of these focuses on modifying one of the
three response systems which characterize emotional experiences: behaviour, cognition, and
physiological reactivity.

References
1 Koes BW, van Tulder MW, Thomas S. Diagnosis and treatment of low back pain. British
Medical Journal 2006;332(7555):14304.
2 Waddell G. The Back Pain Revolution. 2nd Edition. London: Churchill Livingstone, 2004.
3 Turk DC, Flor H. Etiological theories and treatments for chronic back pain. II.
Psychological models and interventions. Pain 1984; 19:20933.
4 Vlaeyen JWS, Haazen IWC, Schuerman JA, Kole-Snijders AMJ, van Eek H. Behavioural
rehabilitation of chronic low back pain: comparison of an operant treatment, an
operant-cognitive treatment and an operant-respondent treatment. Br J Clin Psychol
1995;34:95118.

The number system is particularly practical for online articles because the superscripted
numbers may be coded so that a mouse click will automatically take the reader to the
References section.
The number system is also more practical if the evidence involves many references, e.g.
Galvanic current-induced cutaneous erythema is well documented.
26,30,31

In the author-year system, the list of references is alphabetical, whereas in the number
system, the references may be ordered according to the order in which reference is made
to them in the text.

EXERCISE
Write the proper author-datecitation form for the following articles. In this case, put the
parentheses only around the date.

1. Arms SW, Pope MH, Johnson RF. The biomechanics of anterior cruciate ligament
rehabilation and reconstruction. Am J Sports Med. 1984;12:8-18. Arms et al. (1984)

2. Betran-Aguilar ED, Szpunar SM. Fluoride in toothpastes for children: suggestions for
change. Pediatr Dent. 1988;10:185-8. _____________________

3. Grelsamer RP, Klein JR. The biomechanics of the patellofemoral joint. J Orthop Sports Phys
Ther. 1998;28:286-298. ________________________

4. Henning CE, Lynch MA, Glick KR Jr. An in vivo strain-gauge study of elongation of the
anterior cruciate ligament. Am J Sports Med. 1985;13:22-26. ___________________

5. Steinkamp LA, Dillingham MF, Markel MD. Biomechanical considerations in
patellofemoral joint rehabilitation. Am J Sports Med. 1993;21:438-444.
____________________

Note that one of the authors is from a Spanish-speaking country and has two last names. Joining
them with a hyphen is a common solution to the Catalan and Spanish convention of using two
surnames.

If you published a scientific article with no co-authors this year, what would the proper
author-citation reference be?

______________________________________

What is the solution on the rare occasion when a researcher has published two things in one year, as
in the following examples?

Manski RJ, Moeller JF, Maas WR. A comparison of dental care expenditures and office-
based medical care expenditures, 1987. JADA 1999;130:659-66.
Manski RJ, Moeller JF, Maas WR. Dental services: use, expenditures and sources of
payment, 1987. JADA 1999;130:500-8.

In this case, they are listed alphabetically, and the first one is referred to as Manski et al. (1999a)
and the second one is referred to as Manski et al. (1999b

Different use of parentheses: Parentheses are used in two different ways. Look at these
examples:

A recent study demonstrated the effectiveness of occupational rehabilitation in work-
related cases of upper-extremity disorder (Feuerstein et al. 2000).

In a previous report, a general relationship between a vasoconstrictive blanching effect
and cutaneous anti-inflammatory action was shown (Crins et al 1984).

Feuerstein et al. (2000) demonstrated the effectiveness of occupational rehabilitation in
work-related cases of upper-extremity disorder.

A general relationship between a vasoconstrictive blanching effect and cutaneous anti-
inflammatory action was shown by Crins et al. (1984).

In the second group, studies are given a direct role in the sentences. In this case, only the year is put
between parentheses.


Citation practice 2: Answering research questions

The following are the objectives for the systematic review Behavioural treatment for
chronic low-back pain.

Objectives

The objective of this systematic review is to determine whether behavioural therapy is more
effective than other treatments for non-specific CLBP, and to ascertain which type of
behavioural therapy is most effective.

The following comparisons were investigated:

1. behavioural treatment versus placebo, no treatment, or waiting list controls
2. between different types of behavioural treatment
3. behavioural treatment versus other kinds of treatment
4. behavioural treatment in addition to another treatment (e.g. physiotherapy) versus the
other treatment alone.

We will look at the abstracts from several of the RCTs included in this systematic review
and attempt to answer these questions and practice proper citation.

Read the following abstract and answer the question that follows:
Spine. 32(15):1578-1585, July 1, 2007.
Active Exercise, Education, and Cognitive Behavioral Therapy for Persistent Disabling Low
Back Pain: A Randomized Controlled Trial
Johnson, Ruth E.; Jones, Gareth T.; Wiles, Nicola J.; Chaddock, Carol; Potter, Richard G.; Roberts,
Chris; Symmons, Deborah P. M.; Watson, Paul J.; Torgerson, David J.; Macfarlane, Gary J.
BACKGROUND: There is evidence that both exercise and CBT delivered in specialist settings is
effective in improving LBP. There is a lack of evidence on whether such interventions, delivered by
trained individuals in primary care, result in improved outcomes. OBJECTIVES: To determine 1)
whether, among patients with persistent disabling low back pain (LBP), a group program of exercise
and education using a cognitive behavioral therapy (CBT) approach, reduces pain and disability over
a subsequent 12-month period; 2) the cost-effectiveness of the intervention; and 3) whether a priori
preference for type of treatment influences outcome. METHODS: The study was conducted in nine
family medical practices in East Cheshire, UK. Patients 18 to 65 years of age, consulting with LBP,
were recruited; those still reporting LBP 3 months after the initial consultation were randomized
between the two trial arms. Both arms received an educational booklet and audio-cassette. In
addition, the intervention arm received a program of eight 2-hour group exercise session over 6
weeks comprising active exercise and education delivered by physiotherapists using a CBT
approach. The primary outcome measures were pain (0100 Visual Analogue Scale) and disability
(Roland and Morris Disability Scale; score 024). RESULTS: A total of 196 subjects (84%)
completed follow-up 12 months after the completion of the intervention program. The intervention
showed only a small and nonsignificant effect at reducing pain (3.6 mm; 95% confidence interval,
8.5, 1.2 mm) and disability (0.6 score; 95% confidence interval, 1.6, 0.4). The cost of the
intervention was low with an incremental cost-effectiveness ratio of 5000 (U.S. $8650) per quality
adjusted life year. In addition, patients allocated to the intervention that had expressed a preference
for it had clinically important reductions in pain and disability. CONCLUSION: This intervention
program produces only modest effects in reducing LBP and disability over a 1-year period. The
observation that patient preference for treatment influences outcome warrants further investigation.

Which citation represents the best answer to each research question on the basis of this
abstract? Best answers accurately summarize the information from the abstract and
use proper citation format. Discuss the reasons for your choices with another student.

1. What impact does cognitive behavioral therapy have on low back pain when delivered by a
trained practitioner?
a. A study by Johnson et al. (2007) showed only a small and nonsignificant effect at
reducing pain and disability.
b. One study comparing exercise and CBT in a supervised setting to educational
information alone found little difference in pain reduction or disability after a year
(Johnson et al. 2007).
c. (Johnson et al. 2007) did not find a significant difference in the impact on pain reduction
and disability when comparing exercise and CBT in a supervised setting to educational
information alone.

2. How does patient treatment preference affect intervention outcomes in chronic low-back pain
sufferers?
a. Johnson et al. (2007) found that low-back pain sufferers who had a preference to be
allocated to a combined exercise and CBT intervention group over the control group
experienced more improvement than those who expressed no preference.
b. According to Johnson et al. (2007), patients allocated to the intervention that had
expressed a preference for it had clinically important reductions in pain and disability.
c. One study showed patient preference affects outcomes of chronic low-back pain
interventions. (Johnson et al. 2007)


Look at these examples of citations that use the author-year reference
format.

Research by Hearn et al. (1998) showed that weekend consumption of fruit and vegetables
by children was associated with availability and access, but weekday consumption was not.
Hearn et al. (1998) report that weekend consumption of fruit and vegetables by children is
associated with availability and access, but weekday consumption is not.
According to Hearn et al. (1998), weekend consumption of fruit and vegetables by children
is associated with availability and access, but weekday consumption is not.
Research has shown that weekend consumption of fruit and vegetables by children is
associated with availability and access, but weekday consumption is not (Hearn et al. 1998).
One study has shown that weekend consumption of fruit and vegetables by children is
associated with availability and access, but weekday consumption is not (Hearn et al. 1998).

Read the abstracts on the following pages. On a separate sheet, write one
sentence that answers the question or questions that correspond to each of
the following abstracts. Use standard author-date citation format to refer to
the source. Practice a variety of sentence forms, following the models
above.

NOTE: This is only an exercise. If you were writing a real scientific article it would
not be acceptable to cite a source only on the basis of reading the abstract. You must
cite from an article, not an abstract, because the abstract is only a summary and
does not give a full representation of the work of the authors.

ALSO: You must use your own words. Avoid copying more than two consecutive
words, unless it is a standard expression.


Medicina (Kaunas). 2007;43(2):145-52.
Peculiarities of medical students' nutrition.

Skemiene L, Ustinaviciene R, Piesine L, Radisauskas R.
Department of Environmental and Occupational Medicine, Kaunas University of Medicine, Kaunas, Lithuania.

The aim of the study was to investigate the peculiarities of medical students' nutrition, to compare the dietary habits
between first-year and third-year students, to compare male and female students' nutrition, and to evaluate the
tendencies of its change.MATERIAL AND METHODS: An anonymous survey using a specially designed questionnaire was
carried out on 349 first- and third-year students of the Faculties of Medicine and Pharmacy at Kaunas University of
Medicine. Students' factual nutrition was evaluated by the number of meals per day, the time of eating, and the
frequency of consumption of food products. The findings of the questionnaire-based study were stored in a database and
analyzed using Excel software. Statistical relationships were determined using EPI Info software by applying the
nonparametric chi(2) criterion. Statistical significance was determined using Student's criterion.RESULTS: The nutrition of
first- and third-year students is irregular and differs in the time and number of meals. Only 20% of students daily ate 400 g
of fruit and vegetables as recommended by the World Health Organization. Medical students, especially males, used
excessive amounts of animal fat. Every seventh student consumed too salty food. Medical students consumed insufficient
amounts of bread, potatoes, cereals, and other products that constitute the basis of the pyramid of healthy nutrition.
Twenty-three percent of males and nearly as many females used alcohol once per week. Nearly one-half of students did
not exercise at all, and 9.1% of third-year female and 14.5% of third-year male students were overweight.CONCLUSIONS:
The majority of students did not follow the dietary regimen and consumed the majority of food products during the
second half of the day. Students' nutrition was not balanced - medical students consumed too much fat, especially those
of animal origin. Students consumed insufficient amounts of vegetable fats and fish products, fruit and vegetables, and
thus their food may lack soluble dietary fibers and vitamins. First-year and third-year female students used vegetable oils
more frequently, used more vegetables, and complied with dietary regimen more often than male students. The nutrition
of first- and third-year students does not differ statistically significantly. Alternative types of nutrition (vegetarian
nutrition and various diets) are not popular among medical students.

1. Do medical students eat healthy food?
2. Are the diets of male medical students less nutritious than those of female medical students?
3. What is the prevalence of overweight among medical students?

Acta Physiol Hung. 2009 Dec;96(4):469-74.

Fitness and nutritional status of female medical university students.

Kiss K, Mszros Z, Mavroudes M, Szmodis MB, Zsidegh M, Ng N, Mszros J.
Budapest Faculty of Physical Education and Sports Sciences, Semmelweis University, Alkots u. 44 H-1123 Budapest, Hungary.

The aim of this comparison was to evaluate the nutritional status and cardio-respiratory fitness of future health
professionals, namely university students engaged in medical studies. It was assumed that the lifestyle of such students
would be reflected by healthy body composition and fitness performance indicators. Altogether 1,560 volunteer, female,
university students of three institutions were investigated in 2008. Height, body weight, BMI, body fat content and 800 m
run test means were compared. The height, weight and BMI means did not differ significantly but PE students recorded
the lowest mean body fat (18.34% vs. 24.37 and 25.12%) and shortest mean running time (203 s vs. 239 and 243 s).
Among the medical (11.23%) and technical university students (19.95%) statistically the same prevalence of obesity was
observed. High body fat content and low running performance of medical students were in contrast with our hypothesis.
Their prevalence of overweight/obesity and low fitness did not differ from that of relatively sedentary technical university
students and the average Hungarian young adult population. Thus, it is questionable how young health professionals will
promote the necessity and positive effects of regular physical activity if they do not apply them to their own lifestyle.

1. What is the prevalence of obesity among medical students?
2. Do medical students have a sedentary lifestyle compared to other university students?
3. In which area of university studies do students tend to be the healthiest physically?

BMC Public Health. 2009 Jul 3;9:218.

The association between Colombian medical students' healthy personal habits
and a positive attitude toward preventive counseling: cross-sectional analyses.
Duperly J, Lobelo F, Segura C, Sarmiento F, Herrera D, Sarmiento OL, Frank E.
Department of Social Medicine, Universidad de los Andes Medical School, Bogot, Colombia.

BACKGROUND: Physician-delivered preventive counseling is important for the prevention and management
of chronic diseases. Data from the U.S. indicates that medical students with healthy personal habits have a
better attitude towards preventive counseling. However, this association and its correlates have not been
addressed in rapidly urbanized settings where chronic disease prevention strategies constitute a top public
health priority. This study examines the association between personal health practices and attitudes toward
preventive counseling among first and fifth-year students from 8 medical schools in Bogot, Colombia.
METHODS: During 2006, a total of 661 first- and fifth-year medical students completed a culturally adapted
Spanish version of the "Healthy Doctor = Healthy Patient" survey (response rate = 78%). Logistic regression
analyses were used to assess the association between overall personal practices on physical activity,
nutrition, weight control, smoking, alcohol use (main exposure variable) and student attitudes toward
preventive counseling on these issues (main outcome variable), stratified by year of training and adjusting by
gender and medical training-related factors (basic knowledge, perceived adequacy of training and perception
of the school's promotion on each healthy habit).
RESULTS: The median age and percentage of females for the first- and fifth-year students were 21 years and
59.5% and 25 years and 65%, respectively. After controlling for gender and medical training-related factors,
consumption of >or= 5 daily servings of fruits and/or vegetables, not being a smoker or binge drinker were
associated with a positive attitude toward counseling on nutrition (OR = 4.71; CI = 1.6-14.1; p = 0.006
smoking (OR = 2.62; CI = 1.1-5.9; p = 0.022), and alcohol consumption (OR = 2.61; CI = 1.3-5.4; p = 0.009),
respectively.
CONCLUSION: As for U.S. physician and medical students, a positive association was found between the
personal health habits of Colombian medical students and their corresponding attitudes toward preventive
counseling, independent of gender and medical training-related factors. Our findings, the first relating to this
association in medical students in developing regions, also suggest that within the medical school context,
interventions focused on promoting healthy student lifestyles can potentially improve future physician's
attitudes toward preventive counseling.

1. Is a medical students diet a predictor of attitudes towards nutrition counseling?
2. Does a medical students tobacco use have an influence on his or her opinions about giving advice
about smoking to patients?
3. Do women medical students have more positive attitudes towards counseling patients about alcohol
consumption?


Cincies de la Salut gn.32

Objective: To introduce the grammar of linkers

Grammar in Science: Connecting Ideas and
Phrases

TASK 1: Discover the Rule Look at the following examples of different types of
transition expressions and linkers. What do you notice about the patterns of punctuation,
positioning and grammatical function in the sentence? Based on the examples, write the
rules:

TRANSITION EXPRESSIONS

Disorders of the neuromuscular system can be inherited or acquired. In addition, many
disorders whose causes are still unknown (idiopathic) or not well understood affect the
neuromuscular system.

Some medications that can halt or reverse the cascade of events after ischemia are effective
only if given with the first 3 to 6 hours after the stroke (cerbrovascular accident). Therefore,
a key issue is to educate the public regarding the symptoms of a stroke and have them seek
immediate attention for this brain attack, just as they would for a heart attack.

Rule 1: _____________________________________________________________
___________________________________________________________________

PREPOSITIONAL LINKERS

Due to their changing functional needs, multiple sclerosis patients require periodic
evaluation and recommendations.

Traumatic brain injury (TBI) is most often caused by motor vehicle accidents or by falls and
violence. Because of the nature of the brain injury, the brain trauma may be associated with
fractures, dislocations, lacerations, and the like.

Rule 2: _____________________________________________________________
___________________________________________________________________

ADVERBIAL LINKERS

Even though a cure for Parkinsons disease does not yet exist, medications that restore
neurochemical balance are available and help alleviate the symptoms.

It is important to maintain strength in the unaffected muscles of a spinal cord injury patient
while the healing process occurs.

Rule 3: _____________________________________________________________
___________________________________________________________________



CONJUNCTIONS

Most spinal cord injured patients use a wheelchair as a primary means of mobility, and they
must be custom ordered for each patient with specific size and adaptation requirements.

Balance disability is common after stroke,

but there is little detailed information about it.

Rule 4: _____________________________________________________________
___________________________________________________________________

TASK 2: Apply the Rule Complete the sentences using one of the words listed below.
You can use the summary chart on the following page to help you determine the type of
linker it is.

furthermore as long as regardless of because
so despite for instance yet

1. ____________ where Amyotrophic lateral sclerosis begins, eventually all muscles are
affected.
2. Arthroscopic examination of the shoulder before surgery

revealed a significant amount
of information that would have

been undetected without the aid of expensive diagnostic
tools.

____________, the labrum and rim of the anteroinferior glenoid

showed typical
abnormalities corresponding to different entities

of anterior instability.
3. Avulsion fractures of the pelvic apophyses are seen infrequently,

____________ they
show a consistent pattern in mechanism, patient's age,

symptoms, physical findings, and
roentgenographic appearance.
4. ____________ evidence that physical activity affects health and improves functional

ability in people following spinal cord injury (SCI), such people

are often physically
inactive.
5. Somatosensory as well as mental impairments

are easily overlooked after acute stroke.
____________, their

associations with activity limitations are not fully understood.
6. The interviews indicated that participants believed that WMSDs

could be prevented
____________ they had the "right" technique

or performed in the "correct" way.
7. Physical therapists, therefore, are more

likely to see a patient with muscular dystrophy,
____________ understanding

these muscle disorders and their management is essential.
8. ____________ musculoskeletal conditions contribute to functional

decline and activity
limitation, physical therapy intervention

may be an appropriate health care resource.




Summary Chart of Common Linkers, Transition Expressions and Conjunctions

Adverbial linkers Prepositional linkers
TIME
after
before
since
when
while
TIME since
CONTRAST
although
even though
though
while
whereas
despite the fact that
in spite of the fact that
CONTRAST
In spite of
Despite
In contrast to
Unlike

CAUSE and
EFFECT
because
as
since
so that
CAUSE and
EFFECT
because of
due to
on account of
as a result of
CONDITION
if
unless
provided that
as long as
in the event that
CONDITION regardless of

Transition expressions Conjunctions
ADDITION furthermore
in addition
moreover

EQUAL IDEAS and

CONTRAST

however
nevertheless
nonetheless
on the other hand
in contrast
CONTRASTING
IDEAS

but
yet
CAUSE and
EFFECT
as a result
consequently
therefore
thus

CAUSE and
EFFECT
so
EXAMPLE for example
for instance

CONDITION otherwise
if not


Summary of patterns and punctuation
2

ADVERBIAL
LINKERS
a) Because he was injured, he
didnt participate in the
match.
b) He didnt participate in the
match because he was
injured.
An adverb clause may precede or
follow an independent clause.
Punctuation: A comma is used if
the adverb clause comes first.

PREPOSITIONAL
LINKERS

c) Because of his injury, he
didnt participate in the
match.
d) He didnt participate in the
match because of his injury.

A preposition is followed by a
noun object, not by a subject and
verb.
Punctuation: A comma is usually
used if the prepositional phrase
precedes the subject and verb of
the independent clause.

TRANSITION
EXPRESSION

e) He was injured. Therefore,
he didnt participate in the
match.
f) He was injured. He,
therefore, didnt participate
in the match.
g) He was injured. He didnt
participate in the match,
therefore.

NOTE: e) is the most common
punctuation pattern.

A transition expression is used with
the second sentence of a pair. It
shows the relationship of ht second
idea to the first idea. A transition is
movable within the second
sentence.
Punctuation: A period is used
between the two independent
clauses.* A comma may NOT be
used to separate the clauses.
Commas are usually used to set the
transition off from the rest of the
sentence.

CONJUNCTION

h) He was injured, so he didnt
participate in the match.

A conjunction comes between two
independent clauses.
Punctuation: Usually a comma is
used immediately in front of a
conjunction.

*A semicolon (;) may b used instead of a period between the two independent clauses
that are very closely related in meaning. the word following the semicolon is not
capitalized.
He was injured; therefore, he didnt participate in the match.
He was injured; he, therefore, didnt participate in the match.
He was injured; he didnt participate in the match, therefore.

2
Adapted from Understanding and Using English Grammar by Betty Azar

Cincies de la Salut bjl.11

Objective: 1. To practice linking words expressing different
logical relationships
2. To reflect on punctuation

Linking Expressions 1
Task 1: Underline the linking word in each sentence. Then correct the punctuation if necessary.

1. He went to the doctor because his back hurt.
2. Although the diagnosis was difficult to make the medical team performed multiple tests to rule
out all other possibilities.
3. While some researchers feel that ultrasound is useful others disagree.
4. You will likely pass the exam provided that you study.
5. So that there would be no errors he carefully calibrated the goniometer.
6. Please call me as soon as the test results are ready.
7. The blood workup showed a diminished number of white blood cells in fact the patient was in
danger of an immediate infection.
8. He considered studying medicine however physical therapy seemed more interesting.
9. Unless you can find an internship it will be quite difficult to get a job after graduation.
10. In spite of the difficulty involved he was able to recover from the injury.

Task 2: Fill in the blank with an appropriate linker and add the correct punctuation.

1. Before therapy, the woman was unable to work ____________ she recovered completely after
three weeks of electrical stimulation and hydrotherapy.
2. ____________ many people who have had a

stroke are primarily interested in learning to walk,
some are

able to focus on a return to recreational and sporting activities.
3. Direct current had no beneficial

effect on cell migration ____________ prolonged stimulation
under

the highest voltage led to significant reduction in wound closure

and cell velocity.
4. Fifty-nine percent of

the patients with angina pectoris suffered a subsequent cardiac event within

one year ____________ only 17% of those without angina pectoris experienced another

cardiac
event.
5. Traditional belief is that most recovery will happen within the first six months after a stroke
____________ physical and occupational therapy is concentrated during this time.
6. Instruct the patient to stretch the muscle thoroughly before performing any exercises
____________ there is a risk of serious injury.


Linking Expressions 2

Rewrite the following sentences using the linking expressions provided.

Example: Although it is an invasive method, this treatment is widely used.
(despite)
Despite being an invasive method, this treatment is widely used.

1. Although the use of certain techniques of physical therapy goes back to ancient times, the
modern profession of physical therapy developed in the twentieth century.
(however)

2. The new drug has many side effects. Nevertheless, it is the most effective treatment.
(in spite of)

3. Because central activation failure and muscular

atrophy are common after knee joint
injury, exercises

that aim to stimulate muscular hypertrophy and increase neural

drive to the
muscle fibers should be used during rehabilitation.
(thus)

4. Physical therapy deals with pain, strength, range of motion, endurance, and gross motor
functioning. On the other hand, occupational therapy addresses fine motor skills, visual-
perceptual skills, strength, cognitive skill, and sensory-processing deficits.
(whereas)

5. Many physical therapists work in hospitals, but nearly 80% practice in outpatient clinics,
rehabilitation or skilled nursing facilities, schools, hospices, or patients' homes.
(although)

6. Because risk sports are increasingly popular among young people, there is a growing
demand for physical therapists specialized in sports medicine.
(due to)

7. Family physicians can serve as health advisors and motivators for persons of all ages.
They also often function as team physicians in the communities in which they practice.
(moreover)

8. Heart size is greater in endurance trained athletes by as much as 25%, as compared to a
sedentary person. Also, oxygen delivery of the blood supply to the heart is improved.
(in addition to)

U.I.C./ Idiomes / Angls
Cincies de la Salut / Physiotherapy jcp.062
Objective: To review linking expressions.

Paired conjunctions

Conjunctions are words which connect other words or phrases. The most common conjunctions are,
for example, and, or and but. They can join nouns, verbs, adjectives, adverbs, prepositions or
clauses. Look at the example below and circle the conjunction.

Example A: The medical staff and the patients family persuaded the patient to accept the new treatment.

What phrases does the conjunction join? What are their grammatical functions (noun, adjective,
verb, etc.)?

Circle the conjunctions and underline the words they connect in the following examples:

Example B: The doctor thoroughly examined the patients upper and lower limbs but neglected to check the
pelvic area.

Example C: Bone metabolism is dependent mainly on the parathyroid and thyroid glands, liver and kidneys.

A common error with conjunctions is lack of parallelism. The conjunctions must join two of the
same structures. The examples below demonstrate errors in parallel structures. Can you correct the
sentences?

1. During neck surgery the parathyroid tissue can be damaged or even the loss of it.

2. Pain assessment is not a simple procedure of measuring the pain and record it along with the patients vital signs.

3. The focus of the Asclepiadeans in the first century was similar to modern medical emphasis on classification, systematic
communication, and protocols were also an emphasis.

4. The Exercise Stress Test is a tool used to determine if there is blockage in the blood vessels that supply the heart,
monitor the progression of heart disease, evaluate the effect of medical therapy, and as part of a rehabilitation program
after a heart attack.

Paired or correlative conjunctions form another version of parallelism. In this case two or more
conjunctions are used to connect the words or phrases. Look at the following examples. The words in
italics are paired conjunction:

1. Either a qualified physiotherapist or a trained, supervised assistant administered the treatment.

2. Neither her questions about her overall oral health status nor her complaint specifically related to her prosthesis was
taken into account.

3. In many case aquatic therapy can be beneficial alternative because conventional activities for achieving and
maintaining fitness such as jogging and weight-training are neither suitable nor enjoyable for many people.

4. Neither behavior nor vital signs were used instead of the patients self-report of pain intensity.

5. Osteoporosis is characterized by the loss of both organic matrix and mineralized components of bones.

6. Both heat and massage are used to help relieve chronic muscle spasms.

7. Conventional hypothesis testing

serves to either reject or retain a null hypothesis.

8. The impact of treatment is related not only to its relative risk reduction, but also to the risk of the adverse outcome it is
designed to prevent.

UIC / Idiomes/ Angls
Cincies de la Salut mld.05d
adapted for pt by gn
Objectives: To recognize and then use the grammatical
structure, paired conjunctions.
Task I. Answer the questions about the examples in the box above.

1. Identify the grammatical functions of the words (verb, adjective, noun, etc.) that are joined by
conjunctions.
2. Where are the conjunctions positioned in the sentences?
3. Look at the main verb for examples 1, 2 and 4. What is the subject for each of these verbs?

Task 2. Use the given information to combine the sentences using paired
conjunctions.

1. Quantitative feedback was given to the feedback groups

during a trial (i.e., concurrent feedback)
Quantitative feedback was given to the feedback groups after a trial

(i.e., terminal feedback). (eitheror)

2. Skill acquisition in mobilization

can be enhanced by concurrent feedback.
Skill acquisition in mobilization

can be enhanced by terminal feedback. (eitheror)

3. The purpose

of this study was to identify predictors of change in disability following physical therapy
treatment.
The purpose

of this study was to identify predictors of level of disability following physical therapy
treatment. (bothand)

4. Balance was not able to explain falls in people with chronic stroke.
Mobility was not able to explain falls in people with chronic stroke. (neithernor)

5. Supraspinal inputs play a major role in initiating

locomotion.
Supraspinal inputs play a major role in adapting the locomotor pattern to environmental

and motivational
conditions. (not onlybut also)

6. An efficient, reliable, and valid instrument

for assessing motor function in patients with stroke is needed

by
clinicians.
An efficient, reliable, and valid instrument

for assessing motor function in patients with stroke is needed

by
researchers. (bothand)

7. Studies in subjects with spastic hypertonia indicate that the higher resistance to stretch in the spastic
muscles is due to hyperactive stretch reflexes.
Studies in subjects with spastic hypertonia indicate that the higher resistance to stretch in the spastic
muscles is due to changes in the muscle-tendon unit (nonreflex components). (not onlybut also)

8. Sensory-level TENS (transcutaneous electrical nerve stimulation) applied over peripheral nerves at
clinically relevant pulse durations and frequencies did not alter limb blood flow in asymptomatic
individuals.
Low-intensity motor-level TENS applied over peripheral nerves at clinically relevant pulse durations and
frequencies did not alter limb blood flow in asymptomatic individuals. (neithernor)

9. An infected wound heals more slowly.
There is the risk of systemic infection and even death. (not onlybut also)

10. Performing curl-ups on labile surfaces changes the level of muscle activity.
Performing curl-ups on labile surfaces changes

the way that the muscles

coactivate to stabilize the spine
and the whole body. (bothand)


This is part of the introduction to an article. Make sure you understand the title. Then, by
referring to the list of references at the end of the excerpt, fill in the missing citation
information. You will need to refer to one source twice

Does Growth Hormone Therapy in Conjunction With
Resistance Exercise Increase Muscle Force Production
and Muscle Mass in Men and Women Aged 60 Years or
Older?

Advancing age is associated with a reduction in skeletal muscle protein and muscle force
production, a syndrome referred to as sarcopenia. This process occurs during normal aging,
but it is accelerated by physical inactivity and degenerative or other disease conditions
(Dutta et al. 1995). Decreased muscle mass and force production are associated with an
increased risk of falling (Nevitt et al. 1989) and, therefore, an increased risk for hip fracture
( ). Reduced muscle force production with aging can also result in
physical disability and frailty and in a loss of independent function, and it contributes to
escalating health care costs ( ).

Our understanding of the mechanisms responsible for sarcopenia is limited. The most
obvious intervention is exercise, but the feasibility and effectiveness of exercise in this
population are still under investigation. Nutritional interventions for sarcopenia have been
proposed
( ), but preliminary evidence is not encouraging Efficacious
interventions for elderly people need to enhance both muscle protein mass and force
production.

The biological consequences of advancing age and the progressive decline in physical
activity with age contribute to sarcopenia. Exercise, especially resistance exercise training,
has the potential to improve overall fitness and quality of life ( ).
The physiological and functional benefits of increased muscle activity, even into the ninth
decade of life, have been reported ( ). Thus, human skeletal muscle
protein maintains the ability to respond to, and adapt favorably to, exercise-induced
increases in contractile activity throughout the life span.

The ability to adapt with advancing age, however, may be somewhat limited by other
biological processes. For example, circulating concentrations and the pulsatile release
patterns of several hormones that regulate metabolism are reduced with advancing age.
Because of their anabolic actions on body proteins, low serum growth hormone (GH)
( ; ; ), testosterone
( ; ), dehydroepiandrosterone (DHEA)
( ), and perhaps estrogen ( ) have been implicated as
mediators of the muscle protein wasting that typifies aging. []

U.I.C./ Idiomes / Angls
Cincies de la Salut Physiotherapy mks.255
Objective: To illustrate the relationship between citations and
bibliography. Based on an article of the same by J. J.
Zachwieja & K. E. Yarasheski in Physical Therapy 79 (1).
The text and one reference title have been slightly modified.
References

Bhasin S, Tenover JS. Age-associated sarcopenia: issues in the use of testosterone as an
anabolic agent in older men [editorial]. J Clin Endocrinol Metab. 1997;82:1659-
1660.
Dargent-Molina P, Favier F, Grandjean H, et al. Fall-related factors and risk of hip fracture:
the EPIDOS prospective study. Lancet. 1996;348:145-149.
Dutta C, Hadley EC. The significance of sarcopenia in old age. J Gerontol. 1995;50(suppl
1):1-4.
Fiatarone MA, Marks EC, Ryan ND, et al. High-intensity strength training in nonagenarians:
effects on skeletal muscle. JAMA. 1990;263:3029-3034.
Fiatarone MA, ONeill EF, Doyle N, et al. The Boston FICSIT Study: the effects of
resistance training and nutritional supplementation on physical frailty in the oldest
old. J Am Geriatr Soc. 1993;41:333-337.
Nevitt MC, Cummings SR, Kidd S, Black D. Risk factors for recurrent non-syncopal falls: a
prospective study. JAMA. 1989;261:2663-2668.
Phillips SK, Rook KM, Siddle NC, et al. Muscle weakness in women occurs at an earlier
age than in men, but strength is preserved by hormone replacement therapy. Clin Sci
(Colch). 1993;84:95-98.
Proctor DN, Balagopal P, Nair KS. Age-related sarcopenia in humans is associated with
reduced synthetic rates of dehydroepiandrosterone. J Nutr. 1998;128:351S-355S.
Rudman D, Feller AG, Nagraj HS, et al. Effects on human growth hormone in men over 60
years old. N Engl J Med. 1990;323:1-6.
Schneider EL, Guralnik JM. The aging of America: impact on health care costs. JAMA.
1990;263:2335-2340.
Sih R, Morley JE, Kaiser FE, et al. Testosterone replacement in older hypogonadal men: a
12-month randomized controlled trial. J Clin Endocrinol Metab. 1997;82:1661-1667.
Welle S, Thornton C, Statt M, McHenry B. Growth hormone increases muscle mass and
strength but does not rejuvenate myofibrillar protein synthesis in healthy subjects
over 60 years old. J Clin Endocrinol Metab. 1996;81:3239-3243.
Yarasheski KE. Growth hormone effects on metabolism, body composition, muscle mass,
and strength. In: Holloszy JO, eds. Exercise and Sport Sciences Review. Baltimore,
Md: Williams & Wilkins, 1994:285-312.

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PHYSICAL THERAPY ENGLISH 2.

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