Evidence Based Practice

							Criteria for Selection of
Portfolio Projects




                            1
      Stuff to keep in mind…
Selection of projects is a personal decision
and should reflect the student’s interests in
field of OT
May choose to focus on 1 population or
aspect of treatment (a theme approach)
Or be diverse and explore many topics
Portfolio is also the method by which you
demonstrate that you are prepared to practice
as an OT

                                            2
         Key Attributes
       The 4 Commitments
Life long learning
Community service
Advocacy and leadership
Excellence in practice




                           3
          Required Projects

Must select at least one project to
address each attribute (4 projects total)
– At least one must be written up applying
  the OPPM
Literature review



                                             4
           Life Long Learning

Demonstrated through participation in
continuing education
– Workshops, seminars, conferences held by UAB,
  professional organizations, consumer groups
– Professional presentations by candidates for
  faculty positions, grand rounds, speakers from
  university Centers etc.
– Self paced clinical study courses including online
  courses

                                                       5
            Life Long Learning
– Non-credit education classes offered by UAB
   • Introductory sign language etc
– For credit classes taken in addition to the electives
  required for graduation
   • Low vision or gerontology certificates
Must complete a minimum of 10 hours of CE
– May do this through a variety of venues but only
  one portfolio project is written



                                                      6
          Community Service

Volunteer in some capacity in a project to
serve persons in the community
Project may be sponsored by UAB or a
private organization
Involvement MUST extend over 4 sessions or
1-2 days
– Week at camp ASCCA (good)
– Participate as a walker in a walk to raise money
  (no good)
                                                     7
    Advocacy and Leadership

Assume a leadership role with a professional
organization such as SOTA or a service
organization
Participate in an event
– Promoting occupational therapy, SHRP
– Advocating for needs of a special needs group
   • Homeless persons, low vision etc.




                                                  8
 Excellence in Clinical Practice
Observe in a clinic or shadow a practitioner
for several weeks to learn how a specific tx is
applied
Participate in providing tx to clients under the
supervision of a faculty member or another
clinician
Develop and implement a research project or
assist in completing a research project being
conducted at UAB
Develop a therapeutic tool for tx of a specific
client population                                9
Evidence Based Practice




                          10
     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


                                            11
      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


                                                     12
          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

                                              13
    Most Important
    it’s the right thing to do
Would you want a loved one or
yourself to be given unproven
therapy?

                                 14
      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


                                                  15
        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 client’s problems?




                                                     16
 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?

                                                     17
            Question Qualities
Concise questions are best
– Wordiness confuses both writer and reader
But the question must contain sufficient
information to guide the search
– Example What is vestibular stimulation?
   • Doesn’t 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
     intevention, children, autism
                                                            18
           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?

                                                        19
    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).

                                             20
              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 person’s opinion of whether he/she was
  satisfied with the training is not valid or reliable).




                                                      21
            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.




                                                   22
                Article Qualities
– 4.The study was designed to rule out non-
  intervention explanations of the study’s 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 person’s opinion on whether the treatment was
         effective is NOT quality research!


                                                                  23
              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)                        24
      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
                                                 25
       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




                            27
      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




                                          28
       Criteria for Selection
            of the Topic
Must be relevant to the practice of
occupational therapy
Must address an aspect of evaluation or
treatment intervention




                                      29
      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                   30
 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 2     Review 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 a paragraph describing each major concept
  and then document support for that concept using
  corroborating research literature
   • Ex: 5 for a tx intervention, 3 against and two-not sure
– DO NOT STACK ARTICLES ONE ON TOP OF
  ANOTHER
   • (they said and then they said and then they said)
                                                               32
         Literature Review
            Components
Part 3 Summarize findings and draw
conclusions
– Provide a brief summary of the overall
  findings of the lit review
– Draw a conclusion to answer your question
  based on what you read.



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                 IRB Training
Must be completed by the end of this
semester and certificate given to the advisor
for your file
Route
UAB main website (uab.edu)
Administrative departments
Institutional review board
Investigator and staff training
IRB investigator training
Initial training
Online option                                  34