Role of Evidence-Based Review in Occupational Therapy Practice by ert554898

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									Role of Evidence-Based Review in
 Occupational Therapy Practice

    Emily K. Schulz, PhD, OTR/L
          August 20, 2003
     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)
 What is Systematic Research?


Systematic   research is
 rigorous research that has
 been conducted in ways
 that limit bias.
    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?)
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).
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
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.
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 client’s
         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.
    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.
        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.
    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
    OT’s to be informed about the best ways to
    meet the expectations of their clients.
    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. CAT’s (Critically Appraised Topics)
Questions and Answers


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