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:
(How was the sample selected? Did the subjects appropriately
represent the population being studied?)
(Did the assessments tools used accurately measure what was
being studied? Did they have strong validity and reliability?)
(Was the treatment carried out in a way that did not
automatically lead the outcome to prove the desired
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).
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
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
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
Evidence-Based Rehabilitation -
Four Important Concepts, Part II
“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
Therapists must make sound decisions about how to apply
the research evidence to specific client needs.
“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
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
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
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:
2. A systematic literature review
3. CAT’s (Critically Appraised Topics)
Questions and Answers