CMT CMT Clinical Reasoning & Evidence-Based Practice 1 — Questions and Answers
Question 1: In evidence-based practice (EBP), clinical decisions should integrate:
- Research evidence alone, regardless of patient preference
- Best available research, clinical expertise, and patient values and preferences (Correct answer)
- Practitioner intuition and traditional practice only
- Patient preference alone without regard to research
Correct answer: Best available research, clinical expertise, and patient values and preferences
EBP integrates the best available research evidence with the practitioner's clinical expertise and the individual patient's values and preferences.
Question 2: A systematic review differs from a narrative review in that it:
- Includes only expert opinion
- Uses explicit, reproducible methodology to identify, appraise, and synthesize all relevant studies (Correct answer)
- Is written by a single author summarizing their experience
- Focuses exclusively on case studies
Correct answer: Uses explicit, reproducible methodology to identify, appraise, and synthesize all relevant studies
Systematic reviews use predefined, reproducible search and appraisal methods to synthesize all available evidence on a question, minimizing bias.
Question 3: The clinical prediction rule (CPR) for lumbar spinal manipulation includes which of the following criteria?
- Pain duration > 16 weeks, high fear-avoidance beliefs
- Duration of symptoms < 16 days, no symptoms distal to the knee, low fear-avoidance beliefs (Correct answer)
- Positive SLR at less than 30°, dermatomal numbness
- BMI > 30, MRI-confirmed disc herniation
Correct answer: Duration of symptoms < 16 days, no symptoms distal to the knee, low fear-avoidance beliefs
Flynn's CPR for lumbar manipulation includes: symptoms < 16 days, no symptoms distal to the knee, low fear-avoidance, lumbar hypomobility, and hip IR > 35°.
Question 4: In clinical reasoning, a hypothesis-deductive approach involves:
- Treating all patients with the same standard protocol
- Generating diagnostic hypotheses from patient information and testing them through examination findings (Correct answer)
- Documenting outcomes without forming a working diagnosis
- Following a single algorithm without patient-specific adjustment
Correct answer: Generating diagnostic hypotheses from patient information and testing them through examination findings
Hypothesis-deductive reasoning generates diagnostic possibilities based on history and tests them systematically with physical examination findings.
Question 5: Which outcome measure is most appropriate to assess disability in a patient with chronic low back pain?
- Visual Analog Scale (VAS) for pain intensity only
- Oswestry Disability Index (ODI) (Correct answer)
- Patient Health Questionnaire-9 (PHQ-9)
- Mini-Mental State Examination (MMSE)
Correct answer: Oswestry Disability Index (ODI)
The Oswestry Disability Index (ODI) is a validated, widely used patient-reported outcome measure specifically designed for low back pain-related disability.
Question 6: The concept of 'clinical equipoise' is most relevant when:
- Choosing between two proven treatments with identical outcomes
- There is genuine uncertainty in the expert community about which treatment is superior (Correct answer)
- A practitioner is equally skilled in two different techniques
- Patient preference exactly equals clinical recommendation
Correct answer: There is genuine uncertainty in the expert community about which treatment is superior
Clinical equipoise justifies randomized trials when genuine uncertainty exists among experts about which treatment is better, making random allocation ethical.
CMT CMT Clinical Reasoning & Evidence-Based Practice 1
In evidence-based practice (EBP), clinical decisions should integrate: