Evidence Based Practice

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Evidence Based Practice
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What is Evidence Based Practice?

• Using research literature to identify the current
  best evidence for a treatment intervention
• Using this evidence to provide the best possible
  treatment intervention for the client

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Why is Evidence Based Practice Needed?

• OT is both an art and a science
• The art of therapy is developed through clinical
  experience
• But art must be justified by science
• The science behind therapy is needed to
  facilitate and guide clinical reasoning
• Sound clinical reasoning is necessary to justify
  treatment outcomes

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This is the Age of Accountability

• High cost of therapy means that therapy has to be
  efficient and effective
• No time to waste on ineffective treatment
• Therapists are held accountable for treatment
  outcomes
• Must be able to justify your treatment
  intervention in order to get paid

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Most Importantits the right thing to do

• Would you want a loved one or yourself to be
  given unproven therapy?

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Evidence base is integrated into practice through
5 steps

• Write down a clinical question
• Gather current published evidence that might
  answer the question
• Evaluate the gathered evidence to determine the
  best evidence for answering the question
• Communicate with the client and colleagues about
  the evidence as clinical decision are being made
• Evaluate the chosen evidence based procedures as
  they are being implemented and revise and
  individualize as needed
• Tickle-Degnen, 2000

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Formulating the clinical question

• Questions usually surface while working with the
  client ( or observing a treatment session)
• Why is this treatment technique being used?
• Would treatment X be more effective?
• Could this treatment be used with X diagnosis?
• Which evaluation would be most effective in
  identifying the clients problems?

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Qualities of a Good Research Question

• Well written question is critical to completing
  the evidence gathering process
• Refines the literature search
• Question should be specific but not so specific
  that sufficient literature cannot be found
• Example-what is the role of occupational therapy
  in working with urban dwelling male teenagers
  with fragile X syndrome within the middle school
  setting?

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Question Qualities

• Concise questions are best
• Wordiness confuses both writer and reader
• But question must contain sufficient information
  to guide the search
• Example What is vestibular stimulation?
• Doesnt provide enough key words to narrow the
  focus of the search
• Better Is vestibular stimulation an effective
  treatment intervention for children with autism
• Key words include vestibular stimulation,
  treatment intevnetion, children, autism

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Question Qualities

• Questions that are worded too broadly can created
  super-sized lit reviews
• What type of visual perceptual deficits are
  associated with brain injury?
• Typing in the two key words-visual perceptual
  deficit and brain injury will yield 600 articles
• Better question do persons display visual
  scanning deficits following hemispherial CVA?

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Completing the Literature Review

• Articles reviewed should have the following
  qualities
• 1.The study investigates an outcome variable that
  is relevant to the selected treatment
  intervention (for example if your treatment
  intervention is training persons to use bioptic
  lenses in driving, then the outcome variable must
  be success in resuming or beginning driving).

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Article Qualities

• 2.The study assessed the outcome variable in a
  manner that is valid and reliable (for example,
  if the outcome variable in criteria 1 is success
  in resuming driving then rated performance on a
  behind-the-wheel test or obtaining a license
  would be valid measures but asking the persons
  opinion of whether he/she was satisfied with the
  training is not valid or reliable).

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Article Qualities

• 3.Study participants include members of the
  population identified to receive the treatment
  intervention. For example, if your treatment
  intervention addresses carpal tunnel syndrome,
  then literature that addresses tendon transplants
  would not be appropriate.

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Article Qualities

• 4.The study was designed to rule out
  non-intervention explanations of the studys
  outcome. The study shows evidence of control for
  factors that might affect measured outcomes such
  as use of control groups, blind designs, random
  assignment of subjects, etc.
• Literature published in peer reviewed journals is
  more likely to use higher quality research
  designs but not always
• All studies should show evidence of study
  controls
• Asking a persons opinion on whether the
  treatment was effective is NOT quality research!

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Article Quality

• Most areas of treatment intervention are very
  dynamic
• Intervention approaches change as new information
  is discovered
• The majority of articles comprising any
  literature review should have been published with
  the last 10 years
• If an area has been blessed with a lot of
  research investigation, look for articles that
  synthesize the research ( those employing
  meta-analysis are best)

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How is Evidence Based Practice Carried Out?

• By carefully observing client outcomes and not
  being afraid to question current practice
• By subscribing to peer reviewed journals relevant
  to your practice area
• By regularly attending continuing education
  venues
• Good ones will provide a bibliography of the
  research used to develop the course
• By conducting literature reviews to answer
  clinical questions

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Incorporating EB into practice cont..

• By joining an internet listserv for your area of
  practice
• By organizing or joining a professional study or
  journal group
• By obtaining practice guidelines for treatment
  areas from AOTA or other reputable organizations

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Guidelines for Completing the Literature Review
for the Portfolio
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Purpose of Completing the Literature Review

• To demonstrate that you (the student) are able to
  pose and develop a clinical question and then
  answer it by reviewing the research literature

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Criteria for Selection of the Topic

• Must be relevant to the practice of occupational
  therapy
• Must address an aspect of evaluation or treatment
  intervention

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Literature Requirements

• A minimum of 10 articles
• All articles must be published in peer-reviewed
  journals
• Articles appearing in the popular press (Newsweek
  etc.) or trade publications (OT Advance or OT
  Practice) are not acceptable
• Websites can not be used
• All articles must be published within the last 10
  years (exceptions approved by the advisor)
• Full text articles must be reviewed
• Abstracts are not acceptable

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Components of the Literature Review

• There are three parts to the literature review
• Part 1. Clinical research question
• Use criteria previously discussed to formulate
  the question
• In addition provide a reason why thus particular
  question was selected

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Literature Review Components

• Part 2Review of the related research
• Articles should provide direct evidence for or
  against the clinical question
• After reading the articles, identify the major
  concepts supported by the articles
• Write