OT A to Z: E is for Evidence

In the A to Z Challenge for the letter E, there were several OT words and concepts that came to mind including environment, evaluation, and education. However, evidence is the “E” of the day because how OTs identify, use and convey evidence about our practice is so vital.

The prominence of using the best evidence to support our OT practice, or evidence-based practice has certainly increased in the past decade in OT. Evidence-based practice is defined as the conscientious use of best evidence to make decisions regarding care of individual clients, and is the integration of clinical expertise, systematic research, and patient goals (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000).

Gutman (2010) has stated that occupational therapy – like other health professions – has not fully answered questions regarding treatment efficacy and efficiency. Consequently, this has placed third-party payers in the decision-making role regarding many aspects of treatments including who receives services, for how long, and even what treatments are denied (Gutman, 2010). In an effort to build the evidence needed to respond to these external challenges, the publication goals of the American Journal of Occupational Therapy (AJOT) were aligned to match the research needs of the profession. The stated publication priorities of AJOT include: high-quality effectiveness studies; efficiency studies including cost and time efficiency, patient satisfaction, safety, and patient compliance; studies addressing the psychometric properties of occupational therapy assessment measures; studies demonstrating the relationship between participation in occupation and health indicators; and analyses of current professional issues (Gutman, 2010).

While research priorities of the profession have been stated, it is important to recognize that challenges exist in the utilization of research. Research on professional practice indicates that many barriers such as lack of time, resources, and training on how to locate and incorporate research into daily practice creates a gap in the utilization of research in clinical practice (Grol & Grimshaw, 2003).

But what about the instances where there is little systematic research or perhaps conflicting findings? Keep in mind that evidence-based practice also considers clinical experience and patient goals. The key is that we are aware of the evidence – or perhaps lack of evidence – related to an intervention and are prepared to discuss that with our clients and families.

Last week, @virtualOT shared an eye-opening blog post (which was brought to her attention by Bronnie Thompson and Claire Hayward) that was written by a parent of a child with autism. Please keep in mind that in no way do I intend for this to be a commentary on the intervention being discussed (of which I know almost nothing), nor do we know of the conversation that occurred between the OT and the parent regarding the OT’s clinical experience in using this intervention. But what is clear is that the parent is well-informed and readily obtained information regarding the lack of published evidence related to this intervention. Furthermore, it is clear from the post that this experience has substantially reduced his view of OT.

In thinking about evidence-based OT…

  • What is your reaction to the parent’s post?
  • What are barriers you experience in identifying and utilizing evidence in your practice?
  • How do you work to incorporate best evidence into your practice – despite the challenges in doing so?

References

Grol, R. & Grimshaw, J. (2003). From best evidence to best practice: Effective implementation of change in patents’ care. Lancet, 362(9391), 1225–1230.

Gutman, S. (2010). AJOT publication priorities. American Journal of Occupational Therapy, 64(5), 679–681.

Sackett, D. L., Straus, S. E., Richardson, W. S., Rosenberg, W., & Haynes, R. B. (2000). Evidence based medicine: How to practice and teach EBM (2nd ed.). London: Churchill Livingstone.

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2 Responses to OT A to Z: E is for Evidence

  1. Kirsty says:

    Just a brief comment today.
    I agree wholeheartedly that we should be prepared to talk openly and honestly about the benefits and limitations (or lack of evidence) about our interventions, especially when there is a potential cost implication for our clients.
    If we don't do this then fundamentally we aren't gaining their informed consent.

    Kirsty

  2. Very good point, Kirsty. I am not sure I have ever seen the connection made between EBP and informed consent, but you have suggested a very important perspective.

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