Comparison of OT Practice Framework and UT III

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Comparison of OT Practice Framework and UT III

• OT 653

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Comparison of OT Practice Framework to UT III
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Comparison of OT Practice Framework to UT III
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Comparison of OT Practice Framework to UT III
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Comparison of OT Practice Framework to UT III
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Comparison of OT Practice Framework to UT III
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Comparison of OT Practice Framework to UT III
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Comparison of OT Practice Framework to UT III
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Comparison of OT Practice Framework to UT III
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Summary of Issues Changed in OT Practice
Framework From UT III

• OT Practice Framework
• (is now)
• Areas of Occupation
• Performance Skills
• Client Factors (Body functions and Body
  Structures)
• Performance Patterns (Roles)
• Context or Contexts

• UT III
• (used to be)
• Performance Areas
• Performance Components
• Performance Components
• Roles as part of Performance Components
• Performance Contexts

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Summary of Issues Addressed in OT Practice
Framework NOT Addressed in UT III

• Occupations
• Performance Patterns
• (Habits and routines)
• Activity Demands
• Outcomes

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Levels of Evidence

• OT 653

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What is evidence?Support for clinical practice,
theory, assessments, and clinical research
evolved from systematic study
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Randomized Controlled Trials

• Control group
• Manipulate a variable
• Random assignment
• Double-blinded (persons administering the
  treatment and evaluating the outcomes are both
  blinded to who receives what intervention)

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Other Kinds of Experimental Designs

• Studies where groups are small (under 30)
• Single subject design
• Lack of blinding of researcher or data collector
  or data analyzer

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Quasi-experimental Studies

• Studies without a control group
• Studies without a control group and without
  random assignment
• Studies where either pre and post intervention
  measures are collected, or sometimes just post
  intervention measures

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Exploratory Studies

• Data collected on a group at one point in time
• The group studied may be stratified
• Conclusions are drawn about the trait
• studied
• Survey is one form of exploratory design
• Regression analysis is often used to explore
  predictive elements of a condition or treatment

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Descriptive Studies

• Studies which describe some aspect of a
  condition, disease, trait or other
• Studies where there is no treatment but there is
  assessment of levels of a given variable
• Case studies
• Qualitative research

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Methodological Studies

• Studies which seek to develop psychometric
  properties for a new assessment tool
• Reliability studies
• Validity studies

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So how are all these kinds of research worked
into an evidence-based review??
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Evaluating the Evidence

• Doing a CAT, systematic review or a
• meta-analysis
• All of these formats include deciding which
  articles to include in your review
• Ranking kinds of research

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One aspect of ranking articles for any
evidence-based review is carried out using levels
of evidence hierarchies.
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Such hierarchies are a way to rank kinds of
research studies in a systematic and consistent
manner.
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Levels of Evidence

• There are a number of different levels or
  typologies of evidence
• Groups like the Cochrane Collection or the
  PEDRO group out of Australia use very rigorous
  levels

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For your research projects (systematic reviews or
meta-analyses) in this class, we will use the
Holms levels of evidence as one criteria with
which to judge articles
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Holms Levels of Evidence

• Level I - Systematic reviews, meta-analytic
  studies
• Level II - Randomized controlled trials
• Level III - Trials without randomization
• Level IV - Nonexperimental studies from more than
  one center
• Level V - Opinions of respected authorities based
  on clinical evidence, descriptive studies or
  reports of expert committees
• (Holm, 2000, p.581)

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Level I - Systematic reviews, meta-analytic
studiesthat have already been done by other
researchers
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Level II - Randomized controlled trials
experimental designs with random assignment,
control groups, and large sample size (above 30
clients)
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Level III

• Studies included in Level III are studies
  without randomization, which includes
  quasi-experimental design where a control group
  exists.
• (FOR THE PURPOSE OF THIS CLASS, PUT SINGLE
  SUBJECT DESIGNS IN LEVEL III).

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Level IV

• To be classified as Level IV, studies must
  include descriptive data from more than one site,
  i.e. multiple classrooms, several clinical or
  practice sites, more than one university setting.

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Level V criteria

• Qualitative studies
• Descriptive studies from individual centers
• White papers, The Issue is, published
  standards of care

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In the Future

• Presently inclusion of only high levels of
  evidence often results in finding very limited
  studies
• Fields like physical and occupational therapy
  (even medicine) will have more RCTs available in
  the future as evidence
• Use of more rigorous levels of evidence will be
  mandatory
• In the meantime, practicing clinicians often
  need to include levels commiserate with existing
  evidence (descriptive and exploratory evidence)