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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