The Adapted Fresno test for speech pathologists, social workers, and dieticians/nutritionists: validation and reliability testing

Figures & data

Table 1 Discipline-specific clinical scenarios

Clinical scenario 1	Clinical scenario 2
Speech pathology clinical scenarios
Laura is a 50-year-old lawyer who was recently diagnosed with squamous cell carcinoma of the nasopharynx. You have heard that providing swallowing exercises prior to her receiving chemoradiation therapy may help. You would like to find out from the literature whether there is any evidence to support the use of such exercise in improving swallowing function after chemotherapy treatment.	A 64-year-old lady with chronic anomic aphasia secondary to stroke has been referred to you for speech therapy. She had been participating in extensive language therapy and felt she was no longer progressing. You would like to know if using constraint-induced aphasia therapy would further improve her language skills.
Social work clinical scenarios
You have received a referral for a 38-year-old male client with alcohol-use disorder. He began drinking 6 years ago to manage work-related stress. He indicates that he wants to reduce his alcohol consumption, but has not been successful. You want to find out whether there is any evidence to support the use of motivational interviewing for alcohol abuse over an educational intervention.	A 52-year-old single lady with a long history of obsessive–compulsive disorder (OCD) has been referred to you for behavior therapy. Her obsessions involve severe fear of contamination and having to urinate. Her compulsions involve excessive washing behaviors and avoiding places without an easy escape or readily accessible bathrooms. She fears being “an OCD” her entire life, having received many years of therapy with little effect on her symptoms. You would like to know if there is value in using acceptance and commitment therapy to reduce feelings of anxiety and distress.
Dietetics/nutrition clinical scenarios
A 58-year-old housewife has been referred to a dietetics outpatient clinic for advice on dietary management of her chronic kidney disease, including high potassium levels. Her urea and creatine levels are significantly higher than normal, and have continued to gradually increase since diagnosis. This patient is not receiving dialysis; however, her renal specialist indicates that this will likely need to commence in a few years if there is ongoing deteriorating kidney function. You want to find out from the published literature the most effective dietary management to prevent progression of the kidney problem in a nondiabetic patient.	You have been referred to a 75-year-old male inpatient for possible enteral or parenteral feeding. The patient was admitted to hospital 3 days ago with severe abdominal pain and vomiting. He has been unable to manage an oral diet, and is currently receiving intravenous fluids. Tests indicate that the patient is suffering from pancreatitis, a condition that he has never experienced before. Doctors are managing the medical condition conservatively at present, with no indications for surgery. You want to find out the best nutrition-intervention approach for optimal outcomes.

Table 2 Questions in the Adapted Fresno test

Introduction: please read the two clinical scenarios, and try to answer all of the following questions to the best of your ability. Do not worry if you are unfamiliar with the diagnoses mentioned; this should not affect your answers. You will find most of the following questions quite challenging, and will need to think carefully when answering them. If you are unsure of an answer, please say so.

Q1: Write a focused clinical question for one of the scenarios that will help you to organize a search of the clinical literature.

Q2: Where might you find answers to these and other similar clinical questions? Name as many possible sources of information as you can, not just the ones you think are “good” sources. Describe the most important advantages and disadvantages of each type of information source you have listed.

Q3: What type of study (design) would best answer your clinical question (see Q1), and why?

Q4: If you were to search Medline for original research to answer your clinical question, describe the search strategy you might use. Be as specific as you can about which topics and search categories (fields) you would use. Explain your rationale for taking this approach. Describe how you might limit your search if necessary and explain your reasoning.

Q5: When you find a report of original research on this question or any others, what characteristics of the study will you consider, to determine if it is relevant? (Q6 and Q7 will ask you how to determine if the study is valid and how important the findings are. For this question, please focus on how to determine if it is really relevant to your practice.)

Q6: When you find a report of original research related to your clinical question or any others, what characteristics of the study will you consider, to determine if its findings are valid? (You’ve already addressed relevance, and Q7 will ask how to determine the importance of the findings. For this question, please focus on the validity of the study.)

Q7: When you find a report of original research that relates to your clinical question or any others, what characteristics of the findings will you consider to determine their magnitude and significance (clinical and statistical)?

Note: Copyright © 2009 The Alliance for Continuing Medical Education, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education. Reproduced with permission from John Wiley and Sons. McCluskey A, Bishop B. The Adapted Fresno Test of competence in evidence-based practice. J Contin Educ Health Prof. 2009;29(2): 119–126.¹²

Table 3 Interrater reliability of the Adapted Fresno test (individual items and total score)

Adapted Fresno item	Speech pathology n=10 ICC (95% CI)	Social work n=16 ICC (95% CI)	Dietetics/nutrition n=12 ICC (95% CI)
Q1: Write a focused clinical question for one scenario to help you organize a search of the clinical literature.	0.98 (0.94–0.99)	0.98 (0.96–0.99)	0.97 (0.93–0.99)
Q2: Where might you find answers to these questions? Name as many possible sources of information as you can. List advantages and disadvantages.	0.95 (0.88–0.98) 0.74 (0.35–0.92)*	0.88 (0.73–0.95) 0.24 (−0.70 to 0.71)*	0.85 (0.66–0.95) 0.16 (−0.41 to 0.65)*
Q3: What type of study (design) would best answer your clinical question and why?	0.94 (0.85–0.98)	0.99 (0.98–0.99)	0.97 (0.94–0.99)
Q4: Describe the search strategy you might use in Medline topics, fields, rationale, and limits.	0.93 (0.82–0.98) 0.34 (−0.45 to 0.80)*	0.81 (0.62–0.92) 0.21 (−0.68 to 0.69)*	0.84 (0.62–0.95) 0.35 (−0.26 to 0.76)*
Q5: What characteristics of a study determine if it is relevant?	0.91 (0.75–0.98) 0.20 (−0.61 to 0.74)*	0.93 (0.86–0.97) 0.28 (−0.26 to 0.68)*	0.84 (0.61–0.95) 0.51 (−0.06 to 0.83)*
Q6: What characteristics of a study determine its validity?	0.98 (0.95–0.99)	0.95 (0.88–0.97)	0.89 (0.74–0.96)
Q7: What characteristics of the study’s findings determine its magnitude and significance?	0.98 (0.95–0.99)	0.93 (0.87–0.97) 0.54 (0.11–0.81)*	0.84 (0.63–0.95) 0.48 (−0.19 to 0.83)*
Total score	0.93 (0.82–0.98) 0.83 (0.55–0.95)*	0.83 (0.62–0.93)	0.92 (0.82–0.98) 0.78 (0.42–0.92)*

Note:

* Reliability coefficients prior to further training and discussion among raters.

Abbreviations: ICC, intraclass correlation coefficient; CI, confidence interval.

McCluskeyABishopBThe Adapted Fresno Test of competence in evidence-based practiceJ Contin Educ Health Prof200929211912619530195

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