Role of EvidenceBased Review in Occupational Therapy Practice

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Role of Evidence-Based Review in Occupational
Therapy Practice

• Emily K. Schulz, PhD, OTR/L
• August 20, 2003

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What is Evidence-Based Medicine?

• Evidence-based medicine is the conscientious,
  explicit, and judicious use of current best
  evidence in making decisions about the care of
  individual patients. The practice of
  evidence-based medicine means integrating
  individual clinical expertise with the best
  available external clinical evidence from
  systematic research. (Sackett et al, 1996, as
  cited in Law, 2002, p. 5)

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What is Systematic Research?

• Systematic research is rigorous research that has
  been conducted in ways that limit bias.

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What is Research Bias?

• Biases in research involve how the study was
  conducted and can include
• subject selection
• (How was the sample selected? Did the subjects
  appropriately represent the population being
  studied?)
• measurement
• (Did the assessments tools used accurately
  measure what was being studied? Did they have
  strong validity and reliability?)
• intervention
• (Was the treatment carried out in a way that did
  not automatically lead the outcome to prove the
  desired hypothesis?)

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What is Evidence-Based Practice?

• The conscientious use of current best evidence
  in making decisions about the care of an
  individual or the delivery of health services
• (Hellan, 1997, as cited in Law, 2003, handout).

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Evidence-Based Rehabilitation

• Is a subset of evidence-based medicine/practice
• Evidence-based occupational therapy is a form of
  evidence-based rehabilitation
• There are 4 important concepts to remember about
  Evidence-Based rehabilitation
• Awareness, Consultation, Judgment, and Creativity

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Evidence-Based Rehabilitation - Four Important
Concepts, Part I

• Awareness -
• Having an awareness of the evidence that bears
  on clinical practice and the strength of that
  evidence (Law, 2002, p.8) -
• Therapists must maintain focussed awareness on
  the evidence and how it relates to practice
• Consultation -
• Use of the best evidence available in
  consultation with the patient, to decide upon the
  option which suits that patient best (p.9).
  (Client centered).
• Therapists must be good communicators and educate
  their clients on best practice methods available
  based upon sound research.

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Evidence-Based Rehabilitation - Four Important
Concepts, Part II

• Judgment -
• Practitioners must possess good judgment to
  differentiate how to apply the recommendations of
  evidence-based practice and how they must be
  tailored to the specifics of each clients
  situation. (p.9).
• Therapists must make sound decisions about how to
  apply the research evidence to specific client
  needs.
• Creativity -
• Using the best effort will not always be
  straightforward, and practitioners will have to
  use their creative skills to meet the challenges
  of real life (p. 9).
• Therapists must find creative ways to apply the
  evidence found in the research to address
  specific client needs.

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Some Reasons to do Evidence-Based Review in
Occupational Therapy Practice

• 1. To discover if the intervention you use with a
  particular client/population is the most
  effective.
• 2. To find the best assessment tools to use to
  measure outcomes for a specific program
• 3. To determine the cost-effectiveness of a
  specific type of intervention.

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Therapist Attributes Needed to Successfully
Engage in Evidence-Based Review and Apply it in
Occupational Therapy Practice

• 1. Being Flexible - to be able to blend old ways
  of thinking and doing with new ways of thinking
  and doing
• 2. Being a self-directed learner - taking the
  initiative to seek out research-based information
  to best meet the needs of your clients
• 3. Having Humility - maintaining a humble
  attitude about your practice and a willingness to
  improve on it.
• 4. Being a reflective practitioner - Being able
  to critically assess your own clinical work and
  make changes as needed.

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Meeting the Expectations of Our Clients-Our
Clients Expect

• 1. We will do science-based interventions
• 2. We will be competent in providing services
• 3. Our interventions will be appropriate and
  address their needs and priorities
• 4. We will provide effective treatment
• Doing Evidence-Based Reviews allows OTs to be
  informed about the best ways to meet the
  expectations of their clients.

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Ways to do Evidence-Based Review

• We will discuss 3 main ways to do evidence-based
  review in this class
• 1. Meta-analysis
• 2. A systematic literature review
• 3. CATs (Critically Appraised Topics)

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Questions and Answers

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