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NPTE Study Guide 9
NPTE Week 9 - Professional Roles & Mgmt, Teaching & Learning, & Research & Evidence-Based Practice
141
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Graduate
08/14/2011

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Term
Describe primary care.
Definition
provided by primary care physicians (PCPs)
is provided on an outpatient basis
PCP is the "gatekeeper" to other subspecialists, including PT
Term
Describe secondary care.
Definition
Provided by medical specialists
often requires inpatient hospitalization or ambulatory same-day surgery
Term
Describe tertiary care.
Definition
highly specialized, technologically based medical services - ex. heart, liver, or lung transplants, & other major surgical procedures
- provided by highly specialized physicians in a hospital setting
Term
Medicare & Medicaid require at least _____ of hospice care is to be provided at home.
Definition
80%
Term
Standards related to safety are set forth & enforced by _____.
Definition
OSHA.
Term
What does OSHA stand for?
Definition
Occupational Safety & Health Administration
Term
T/F. National accreditation is voluntary.
Definition
True - however, it is mandatory for most third-party reimbursement agencies to meet eligibility for Medicare
Term
What does JCAHO stand for?
Definition
joint commission on the accreditation of health care organizations
Term
What settings does JCAHO accredit?
Definition
hospitals, SNF's, home health , PPO's, rehab facilities, HMO's, behavioral health & chemical dependency facilities, ambulatory clinics, physician networks, hospice, long-term care
Term
What does CARF stand for?
Definition
commission on accreditation of rehabilitation facilities.
Term
Who does CARF accredit?
Definition
free-standing rehabilitation facilities & rehab programs of larger hospital systems
Term
Who does Medicare cover?
Definition
people >65 y.o.
people with permanent kidney failure or other long-term disabilities
Term
The social security amendment of 1983 is based on ______.
Definition
DRG (diagnostic related groups)
- hospital is paid a specific amount per diagnosis regardless of length of stay, services rendered, or tests performed
Term
What does Med A cover?
Definition
Hospital stay, SNF stay - skilled first 100 days
HHA, hospice care
Patients who have been on social security disability for 24 months.
Term
What do patients have to pay with Med A?
Definition
deductible
Term
Once accredited, an organization undergoes periodic review, which is typically every ____ years.
Definition
3
Term
What does Med B cover?
Definition
physician visits, outpatient services, ambulance transportation, home health care provided by a PT in an independent practice, DME, medical supplies, residents of long-term care facilities
Term
What are patients required to pay with Med B?
Definition
monthly premiums
Term
Any employers with > ____ employees or high-risk employers must contribute to worker's compensation.
Definition
10
Term
Define capitation.
Definition
a system whereby providers are paid a certain amount per case no matter how many visits are rendered
Term
What is "shared-risk".
Definition
the provider is at financial risk if services are over-utilized
Term
Must have a _______ Health plan in order to have a health savings account.
Definition
high deductible - covers catastrophic health occurrences
Term
What does HIPAA stand for?
Definition
health insurance and portability accountability act
Term
How long are records usually required to be kept on file?
Definition
7 years
Term
T/F. white out is acceptable to use on documentation.
Definition
false. should never be used to correct text in a medical record.
Term
Of the following documents, which are PTA's allowed to complete: progress notes, Re-evaluation/summary progress report, D/C summary.
Definition
progress note; PTA's can write a D/C summary in SOME instances
Term
How often are performance appraisals completed?
Definition
3-6 mo. or annually
Term
Differentiate between an essay appraisal and a performance criteria-based method.
Definition
essay - a short paragraph on strengths and weaknesses
performance criteria-based - based on functional job description using a weighted rating scale (most important task gets highest rating)
Term
Differentiate between policies & procedures.
Definition
policy - broad statements that guide in decision making
procedure - specific guides to job behaviors for all departmental personnel, visitors, & patients that standardize activities with a high level of risk
Term
T/F. Incident reports are not part of the medical record, nor are they referenced in the medical record.
Definition
true
Term
Define MBO.
Definition
Management by objective - a complete system of management based upon a set of core goals to be accomplished by a program.
Term
Operating budgets are usually planned for a ___ year duration.
Definition
1
Term
A budget is planned for capital expenses - what are capital expenses?
Definition
all major renovation expenses or the purchase of equipment that is reusable and will last a minimum of 3 years. Capital budgeting should be part of the strategic plan.
Term
List & describe the two types of expense budgets.
Definition
operating expenses - related to day-day operation of the organization - salaries, benefits, supplies, utilities, linen, housekeeping, maintenance, continuing ed.

capital - purchase of larger items utilized for >3-5 years, such as purchase of new equipment or new buildings - equipment is depreciable & usually costs >$1000
Term
Define direct costs.
Definition
directly associated with the production of a service - salaries, treatment supplies, treatment equipment, continuing ed.
Term
Define indirect costs.
Definition
necessary to produce a service but indirectly associated with that service - utilities, housekeeping/laundry, marketing services
Term
Differentiate between fixed & variable costs.
Definition
fixed - don't change regardless of volume - rent, air conditioning

variable - change with direct proportion to volume of activity - ex. linen & labor costs increase as volume increases
Term
Define discretionary expenses.
Definition
costs which are not essential for providing PT services - include budgeting or continuing ed., recognition activities, etc.
Term
Define accounts payable.
Definition
money owed to a creditor for services rendered
- a part of the budget where debts are listed.
Term
Define accounts receivable.
Definition
money owed to a company (hospital, PT practice) for providing a service - ex. PT treatment on credit
- an asset expected to benefit future operations
Term
A patient in restraints must be checked on every _____ minutes.
Definition
30
Term
Describe an analytical learning style.
Definition
processes in step-by-step order
perceives information in an objective manner - able to use facts & easily understand relationships between them
learns best with structure, step-by-step learning - may have trouble comprehending the big picture.
Term
Describe an intuitive learning style.
Definition
processes information all at once, in a simultaneous manner, not in an ordered sequence
perceives information in a concrete manner - information is assimilated about practical, real-life experiences
reflects on personal experiences
-learns best if information is connected to personal experiences, presented in practical, real-life context - if not, may be disregarded - may have difficulty ordering steps & comprehending details.
Term
Define inductive reasoning.
Definition
observes similarities, can develop theoretical models to explain relationships

making generalizations from single experiences
Term
Define deductive reasoning.
Definition
analyzes problems in depth - applies information, theoretical models to practical situations
a conclusion follows from a sound hypothesis
Term
List & describe the 3 phases of motor learning.
Definition
cognitive - learner develops an understanding of the task & cognitively maps out what to do.

associative - determines strategy, practices it, & makes adjustments in how motor skill is performed

autonomous - practiced motor skill to the point that is is automatic - high level skilled performance with few adjustments needed
Term
Describe retention in motor learning.
Definition
patient can repeat skill after a period of no practice, termed the retention interval.
Term
Describe Generalizability in motor learning.
Definition
adapt the skill to perform other related tasks.
Term
Describe resistance to conceptual change with motor learning.
Definition
acquired capability to perform what is learned in other environments.
Term
What are evidence-based CPG's?
Definition
clinical practice guidelines - systematically developed statements to assist the clinician & patient in decisions about appropriate courses of action.
Term
Describe historical research.
Definition
investigation of a variety of data sources.
primary sources: original documents, eyewitness accounts, direct recordings of event
secondary: description of event by someone other than eyewitness, summary info in textbooks, newspaper accounts

investigates authenticity of data (external criticism & evaluates worth of data (internal criticism)
Term
In experimental research, the alleged cause or treatment (the ______ variable) is manipulated. The effect or difference is the ______ variable.
Definition
independent, dependent.
Term
Describe a cohort design for experimental research.
Definition
subjects are identified and followed over time for changes/outcomes following exposure to an intervention - lacks randomization, may or may not have a control group.
Term
Describe A-B, A-B-A, & A-B-A-B experimental designs with single-subjects.
Definition
A-B. pretreatment or baseline phase followed by intervention or treatment phase
A-B-A - baseline, treatment, second baseline
A-B-A-B - baseline, treatment, baseline, treatment
Term
Factorial design refers to the number of ______ variable utilized.
Definition
independent
Term
Describe causal-comparative research.
Definition
attempts to define a cause & effect relationship through group comparisons
- ex-post facto research - independent variable has already occurred; cannot be manipulated - or should not be manipulated

groups are compared based on the DEPENDENT variable.
Term
Define epidemiology.
Definition
the study of disease frequency and distribution in a community
Term
Define the independent & dependent variables.
Definition

independent - the activity or factor believed to bring a out a change in the dependent variable - the cause or treatment

 

dependent variable - the change or difference in behavior that results from the intervention - the effect

Term
What is a directional hypothesis?
Definition
generalization that predicts an expected relationship between variables
Term
Define null hypothesis. What are the two outcomes with a null hypothesis.
Definition
no relationship exists between variables - any relationship found is the result of chance or sampling error.

-null hypothesis is rejected - meaning a significant difference was observed between groups or treatments.

-null hypothesis is accepted - no significant difference observed between groups or treatments.
Term
Describe a nominal scale.
Definition
classifies variables or scores into two or more mutually exclusive categories based on a common set of characteristics - gender, tall or short, etc.
Term
Describe an ordinal scale.
Definition
ranks variables or scores in terms of the degree to which they possess a common characteristic - ex. ranked by GPA, MMT grades
Term
Describe an interval scale.
Definition
classifies and ranks variables or scores based on predetermined equal intervals - does not have a true zero point - IQ test scores 0-200, temperature scales
Term
Describe a ratio scale.
Definition
classifies and ranks variables or scores based on equal intervals and a true zero point - highest, most precise level of measurement - goniometry, scales for height, weight, or force allow the use of precise physical measures for research.
Term
Define an intervening variable.
Definition
a variable that alters the relationship between the independent and dependent variable - may not be directly observable or easy to control.
Term
Describe systematic sampling.
Definition
individuals are selected from a population list by taking individuals at a specified interval: ex. every 10th name
Term
Describe stratified sampling.
Definition
individuals are selected from a population from identified subgroups based on some predetermined characteristic
Term
Define effect size.
Definition
the magnitude of the differences between sample means - allows a statistical test to find a difference when one really exists
Term
Define generalizability.
Definition
the degree to which a study's findings based on a sample apply to an entire population.
Term
Differentiate between internal & external validity.
Definition
internal - the degree to which the observed differences of the dependent variable are the direct result of manipulation of the independent variable.

external validity - the degree to which the results are generalizable to individuals or environmental settings outside of the experimental study
Term
What is face validity?
Definition
The assumption of validity based on the appearance of an instrument as a reasonable measure of a variable - may be used for initial screening of a test instrument but psychometrically unsound
Term
What is content validity?
Definition
the degree to which an instrument measures an intended content area
Term
Define concurrent validity.
Definition
the degree to which the scores on one test are related to the scores on another criterion test with both tests being given at relatively similar times - usually involves comparison to the gold standard
Term
Define predictive validity.
Definition
the degree to which a test is able to predict future performance
Term
Define construct validity.
Definition
the degree to which a test measures an intended hypothetical abstract concept
Term
What is split/half reliability?
Definition
reliability of splitting a test in half and comparing the first half to the second half - a measure of internal consistency of an instrument
Term
What is the Hawthorne effect?
Definition
the subjects knowledge of participation in a study influences the results of the study.
Term
Define sensitivity.
Definition
a test's ability to correctly identify the proportion of individuals who truly have a disease or condition (true positive)
Term
Define specificity.
Definition
a test's ability to correctly identify the proportion of individuals who do not have a disease or condition (a true negative)
Term
Describe predictive value.
Definition
a test's ability to estimate the likelihood that a person will test positive for a target condition.
Term
Describe a cohort study.
Definition
a prospective study - a group of participants with a similar condition is followed for a defined period of time - comparison is to matched group that does not have the condition.
Term
Define homogeniety.
Definition
a systematic review free of variations (heterogeneity in the directions and degree of results between individual studies)
Term
Define a case control study.
Definition
a retrospective study of a group of individuals with a similar condition is compared to a group that does not have the condition to determine factors that may have played a role in the condition.
Term
Case reports are studies of individuals that are almost always ______.
Definition
retrospective.
Term
Describe level 1A evidence.
Definition
SR with homogeneity of multiple RCT's
Term
Describe level 1b evidence.
Definition
individual RCT with narrow confidence level
Term
Describe level 1c evidence.
Definition
all or none case series - overwhelming evidence of substantial treatment effect following introduction of a new treatment
Term
Describe level 2a & 2b B evidence.
Definition
2a: SR with homogeneity of cohort studies (comparision groups

2b: individual cohort study or low quality RCT - more than 80% follow-up of patients enrolled
Term
Describe level 3a & 3b B evidence.
Definition
3a:SR with homogeneity of case-control studies
3b: individual case-control study
retrospective
Term
Describe level 4 C research.
Definition
case-series & poor quality cohort & case-control studies
largely descriptive
Term
Describe level 5 D research
Definition
expert opinion without explicit critical appraisal based on physiology, bench research, or first principles - observations not made on patients
Term
Describe the formula for standard deviation.
Definition
subtract each score from the mean, square it, add up all the squares, and divide by the number of squares
Term
____% of all scores fall within 1 SD of the mean, ____% within 2, & ______% within 3.
Definition
68%, 95, 99
Term
What are tests of significance?
Definition
an estimation of true differences, not due to chance; a rejection of the null hypothesis.
Term
What are degrees of freedom in a study?
Definition
based on a number of subjects & number of groups - allows determination of level of significance based on consulting appropriate tables for each statistical test
Term
What are type I & type II errors?
Definition
Type I: rejecting the null hypothesis when it is true - differences are due to chance & researcher assumes means of scores are truly different

Type II: accepting the null hypothesis when it is false - means of scores are concluded to be chance when means are truly different
Term
What are parametric stats?
Definition
testing based on population parameters - includes tests of significance based on interval or ratio data
Term
Define a T-test. Differentiate between T-test for independent samples, & T-test for paired samples.
Definition

a parametric test of significance that is used to determine if there is a difference between two groups - can be done when two different groups are matched & tested or if one group is tested twice (pretest/posttest) - only used with ONE independent & ONE dependent variable.

 

independent: compares difference between two independent groups

 

paired samples: compares difference between two matched groups, ex. siblings -

 

one-tailed t-test - based on a directional hypothesis - can only go one way, neg. or positive -

 

two-tailed - can go either way - either treatment or control group can exhibit better rehab outcomes

Term
What are inappropriate uses of t-tests?
Definition
comparing more than two means within a single sample - ex. 3 modes of exercise are compared within a single sample
Term
Describe an ANOVA.
Definition
a parametric test used to compare three or more IV's or conditions at a selected probability level
-one-way ANOVA: compares multiple groups on a single IV
-factorial ANOVA - compares multiple groups on two or more independent variables
Term
Describe an ANCOVA.
Definition
a parametric test used to compare two or more treatment groups or conditions while also controlling for the effects of intervening variables (covariates)
Term
What are non-parametric statistics?
Definition
less powerful than parametric tests - more difficult to reject the null hypothesis
Term
Define a chi-square test.
Definition
non-parametric statistical test that tells the researcher if the observed pattern, trait or distribution is different than what would have been expected by chance alone. - compares relationships using NOMINAL data
Term
What are correlational statistics?
Definition
used to determine the relative strength of a relationship between 2 variables
Term
What is a pearson-product-moment coefficient?
Definition
correlates continuous data with underlying normal distribution on interval or ratio scales
Term
list the difference between discrete & continuous data.
Definition
discrete - only a finite number of values possible
continuous data - all possibilities - usually involved with physical measurement of something.
Term
What is Spearman's rank correlation coefficient?
Definition
nonparametric test used to correlate ordinal data
Term
What are point & rank biserial correlation tests?
Definition
point - one variable is dichotomous (nominal) & the other is ratio or interval

rank - one variable is dichotomous (nominal) & one is ordinal
Term
What is the ICC?
Definition
intraclass correlation coefficient - reliability coefficient based on ANOVA.
- high correlations >.76
-mod = .51-.75
-fair = .26-.5
-low = 0.0-.25
Term
Define common variance.
Definition
a representation of the degree that variation in one variable is attributable to another variable.
-determined by squaring the correlation coefficient (ex. .7^2 = .49 - common variance is 49%, the variation in one variable can be explained by the other 49% of the time)
Term
Describe linear regression.
Definition
establishes the relationship between two variables as a basis for prediction.
-an examination of two continuous variables that are linearly correlated - variable designated X is IV or predictor variable. Y is dependent or criterion variable

purpose is to generate an equation which relates X to Y, such that if given values of X, Y can be predicted, ex. BP (Y) is examined by age (X); answers question, can systolic BP be predicted from age?
Term
Define quality assurance (QA).
Definition
evaluates the quality of patient care and assures the accountability of those providing the care.
Term
Define Utilization Review (UR)
Definition
a written program that assures proper use of a facility's funds and personnel related to medical necessity.
Term
T/F. Interpretation of an examination is within the scope practice of a PTA.
Definition
False.
Term
T/F. A PTA can make a final house visit for HH PT if the patient care is to be terminated at home.
Definition
False.
Term
What are the three things required for negligence to occur?
Definition

Duty

Breach of Duty

Injury

Term
What is the doctrine of respondeat superior?
Definition
a facility may be responsible for an employee's negligent actions if the facility is expected to benefit from the work of that employee - therefore, the facility as well as the individual may be sued.
Term
In order for Medicare to pay for inpatient PT services, the patient must be seen at least ____ days per week.
Definition
5
Term
Define IPA & PGP.
Definition

Individual Practice Associations - organizations where physicians contract independently with the HMO

 

Prepaid group plans - physicians practice out of a central location for an HMO

Term
T/F. In Medicare terms, a patient in a vegitative state or severe coma has rehabilitation potential.
Definition
False
Term
A wheelchair ramp, if required, should have a slope of ____ foot of height for every ____ feet of length (__% grade)
Definition
1, 12, 8
Term
Medicare defines "daily" as ___ days/wk of skilled nursing and ___ days/wk of skilled therapy.
Definition
7, 5
Term
Orders in a SNF need to be re-written every ___ days.
Definition
60
Term
List the three educational domains.
Definition

cognitive (knowledge-based teaching)

psychomotor (teaching a motor skill)

affective (emotional attitudes and feelings of a skill)

Term
Knowledge of ____ focuses on consistent errors.
Definition
performance
Term
Knowledge of ____ focuses on successful movement outcomes.
Definition
results
Term
If a patient is completing a complex task, which practice is best?
Definition
distributed - frequent rest periods are needed for complex tasks
Term
After breaking a complex task into component parts that are easier, which practice should be used to practice them? What should you progress to?
Definition

blocked - repeated practice of the same task.

variable - have to make quick adjustments to increase cognitive processing

Term
Which practice should be used to improve performance & reduce anxiety?
Definition
mental practice
Term
T/F. KP & KR are examples of augmented feedback.
Definition
true
Term
Define summed & bandwidth feedback.
Definition

Summed - feedback is given after a preset number of task trials

Bandwidth - feedback is only given if a patient gives a performance outside a given acceptable range - can change 

Term
What kind of practice is good early on?
Definition
Blocked
Term
What kind of practice is good for retention of skills?
Definition
random, serial
Term
What is "transfer of learning"
Definition
learning taking place through practice with contralateral extremity first.
Term
When a test has a high sensitivity, it rules ____ the diagnosis.
Definition
out (SnOUT)
Term
When a test has a high Specificity, it rules ___ a diagnosis.
Definition
in (SpIN)
Term
Define likelihood ratio. What does it mean?
Definition

measure of power of sensitivity & specificity - likelihood a patient has a condition

 

with very high sensitivity, have very LOW likelihood ratio (<.1 rules out diagnosis)

 

with very high specificity, have a very HIGH likelihood ratio (>10 rules in diagnosis)

 

anything in between .1-10 is inconclusive

Term
What is an A-B-C single case design?
Definition

A represents the baseline measurement

B represents the first treatment

C represents the second treatment, procedure, or placebo

in this design, it may be difficult to determine how "B" or "C" interacted or what effects both "B" and "C" had separately on the patient, therapist, or department

Term
What is the most appropriate measure of a middle value to use in a skewed distribution with extreme scores?
Definition
median
Term
What is the most appropriate measure of a middle value to use in a skewed distribution with extreme scores?
Definition
median
Term
What is a confidence interval?
Definition
an estimated range of values, which is likely to include an unknown population parameter, with the estimated range being given from a given set of sample data

example - 95% confidence interval covers 95% of the normal curve - the probability of observing a value outside of this area is less than .05
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