CMT CMT Clinical Reasoning & Evidence-Based Practice 2 — Questions and Answers
Question 1: A randomized controlled trial (RCT) is considered the 'gold standard' for evaluating treatment effectiveness because:
- It is the cheapest research design available
- Random allocation controls for confounding variables, allowing causal inference (Correct answer)
- It uses the largest possible sample size
- Participants choose their preferred treatment group
Correct answer: Random allocation controls for confounding variables, allowing causal inference
Random allocation to treatment groups controls for known and unknown confounders, allowing causal conclusions about treatment effectiveness.
Question 2: Number Needed to Treat (NNT) is a clinical statistic representing:
- The average number of sessions to achieve full recovery
- How many patients must be treated to produce one additional positive outcome compared to control (Correct answer)
- The total number of adverse events in a study
- The percentage of patients who improve with treatment
Correct answer: How many patients must be treated to produce one additional positive outcome compared to control
NNT is the inverse of absolute risk reduction, indicating how many patients need treatment for one to benefit compared to control.
Question 3: In the ICF (International Classification of Functioning, Disability and Health) framework, 'activity limitations' refer to:
- Structural changes in organs or tissues
- Difficulties an individual has in executing tasks or actions (Correct answer)
- Restrictions in participating in life situations
- Environmental barriers to function
Correct answer: Difficulties an individual has in executing tasks or actions
ICF's activity domain covers difficulties executing tasks, distinguishing it from impairments (body structures/functions) and participation restrictions.
Question 4: A CMT uses the Global Rating of Change (GROC) scale to measure:
- Objective joint range of motion over time
- Patient's self-reported perception of overall change since baseline treatment (Correct answer)
- Therapist's clinical impression of patient progress
- Radiographic changes in joint space over treatment
Correct answer: Patient's self-reported perception of overall change since baseline treatment
The GROC is a patient-reported scale capturing the patient's perception of their overall change since beginning treatment, ranging from 'much worse' to 'much better.'
Question 5: Which bias occurs when patients or clinicians know which treatment group a patient is in, potentially affecting reported outcomes?
- Selection bias
- Attrition bias
- Performance and detection bias (Correct answer)
- Reporting bias
Correct answer: Performance and detection bias
Performance bias (altered care due to group knowledge) and detection bias (altered outcome assessment) both arise when blinding is absent.
Question 6: The minimal clinically important difference (MCID) for an outcome measure represents:
- The smallest change detectable by statistical analysis
- The smallest change in score that patients perceive as meaningful improvement (Correct answer)
- The maximum possible improvement on the scale
- The threshold above which treatment is considered successful by regulators
Correct answer: The smallest change in score that patients perceive as meaningful improvement
MCID is the smallest change in an outcome score that is perceived as meaningful and worthwhile by the patient, distinguishing clinical from statistical significance.
CMT CMT Clinical Reasoning & Evidence-Based Practice 2
A randomized controlled trial (RCT) is considered the 'gold standard' for evaluating treatment effectiveness because: