Should occupational therapists do research

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Should occupational therapists do research?
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Why?

• To develop new knowledge
• To support our clinical practice
• To demonstrate that new techniques and methods
  developed by occupational therapists are
  effective
• To provide evidence to reimbursement agencies
  that occupational therapists should be paid for
  their services

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What is research?

• The systematic search for knowledge the
  process of understanding the relationships
  between variables

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Basic Research vs. Applied Research

• Basic or bench research - carried out in the lab
  under carefully controlled circumstances which
  the researcher manipulates
• Clinical research - focused on solving practical
  problems with functional implications
  examination of clinical conditions and outcomes
  to establish relationships between clinical
  phenomena to generate evidence to help with
  decision making

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What is the relationship between treatments for
spasticity and functional changes?Does
positional splinting on a routine basis help
maintain hand function?What work situations
contribute to injuries in occupational therapists?
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Other Factors in Clinical Research

• Changes in health care
• Reimbursement mechanisms
• Changes in health status of populations
• Increase in knowledge base
• Evolution of new conditions and diseases

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Health Care Outcomes
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Health Outcomes

• The results of health care service provision
  the changes seen as a result of health care
  intervention
• Every aspect of health care has an outcome
• Originally outcomes were tracked as mortality and
  morbidity
• Increasingly outcomes are seen as changes in
  quality of life
• Function is an important measure in quality of
  life studies

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http//www3.who.int/icf/icftemplate.cfm
The WHO Disablement Model
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What is a paradigm?
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A philosophical and theoretical framework of a
scientific school or discipline within which
theories, laws, and generalizations and the
experiments formulated in support of them are
formalized
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Two Major Research Paradigms

• Positivistic paradigm, also called quantitative
  research, deductive reasoning, the scientific
  method...
• Naturalistic paradigm, qualitative research,
  inductive reasoning, ...

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Deductive Reasoning

• Acceptance of a general proposition
• Inferences are drawn from the proposition
• Conclusions are then developed either
  acceptance or rejection of the proposition
• Dependent on the truth of the proposition

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Inductive Reasoning

• Observations of a phenomenon are made
• Generalizations about the phenomenon are then
  developed
• Phenomenon may not be representative of the
  larger whole

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Research Process

• Identify the Research Question
• Design the Study
• Methods
• Data Analysis
• Communication

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What is the history of occupational therapy
research?
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OT History

• OT (as well as other allied health fields) has
  traditionally not been well funded due to the
  lack of doctorally prepared OTs
• This means that the bulk of the literature tends
  to be limited to small experimental studies,
  observational studies, descriptive -studies and
  quasi-experimental studies
• To date, there are very few randomized controlled
  trial in the OT literature...

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What is a randomized, controlled trial and why is
it important?
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A form of experimental design that is considered
the gold standard of research methods in
quantitative paradigms
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Theory - a set of interrelated concepts,
definitions or proposals that specify
relationships between variables and represents a
systematic view of specific phenomena
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Theories should be validated and refined through
ongoing research.
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Purpose of Theories

• Summarize existing knowledge
• Explain events
• Enable us to predict with some accuracy
• Stimulate the development of new knowledge
• Provides the basis for questions in research

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It is important to remember that research does
not prove or disprove theories, rather
supports or fails to support theoretical
premises
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Consistent research outcomes that fail to support
theoretical premises are indicators that
alternative explanations to theory need to be
considered
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Example NDT Theory over the years
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NDT Original Premises (circa 1950)

• The CNS is hierarchically organized
• Normal development occurs in a proximal to distal
  sequence
• Once movement sequences are learned, they are
  automatically transferred to functional tasks

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NDT premises have not themselves been tested,
however research in other fields demonstrated
that these original 1950 premises were based on
incorrect assumptions
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Example The CNS is hierarchically organized

• Studies have demonstrated that the CNS has
  redundancy throughout the system and is in fact
  organized in a more parallel fashion

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Premise Development occurs in a proximal to
distal sequence

• Research has demonstrated that development occurs
  in a parallel manner across body areas..
• Example - Parallel development of grasp and
  shoulder movements

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Once movements are learned, they are
automatically transferred to functional tasks

• Motor learning theory has demonstrated that
  functional tasks must be practiced in order to be
  learned. This includes learning motor components
  of movement sequences

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As a result of this kind of research, NDT theory
has changed dramatically since its conception in
the early 50s. There still is not strong
evidence that the approach works.
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In summary

• OTs need to do research and are starting to do
  more
• The most relevant type of research to OTs is
  clinical research
• Health research in general looks at outcomes of
  intervention and the best kinds of intervention
  to develop functional outcomes

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More Summary..

• New disablement models are being used to generate
  outcomes rather than death or life
• Different paradigms are used in research
• Often these paradigms are used to develop or
  refine existing theories
• The three major kinds of research are
  descriptive, exploratory and experimental