Evidence-Based Practice Strategies for Busy

Clinicians

Yvonne Swinth, PhD, OTR/L, FAOTA

Associate ProfessorUniversity of Puget Sound

“How do you know that what you do and how you do it really works?” Holm, 2000

Common Definition “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

3-Prongs to EBP EBP is the integration of best

research evidence with clinical expertise and client values. When these three elements are integrated, clinicians and clients form a diagnostic and therapeutic alliance which optimizes clinical outcomes and quality of life.

Sackett et al, 1996

Levels of Evidence Several different approaches/models

Center for Evidence-Based Medicine (CEBM)-often referenced

American Academy for Cerebral Palsy and Developmental Medicine (AACPDM)

American Occupational Therapy Association (AOTA)-based on the CEBM model with some additions/clarification

Types of Evidence Peer reviewed journals Book Chapters Case Studies Clinical Data Online Resources Clinical Experience Expert Opinion

Peer reviewed Non-peer reviewed

EBP is guided by, as well as guides, clinical reasoning

As much as possible, practice of EBP skills should be integrated with current clinical experience, to ground intervention into a meaningful context.

An EBP orientation includes:

An expectation that knowledge will change constantly.

Tolerance for uncertainty. Willingness to question established practice. An expectation for self-directed learning. Collaborative effort and open sharing of

resources

How do we do Evidence-Based Practice?

“Health care is an imperfect science that requires both overarching clinical guidelines and individual judgment in equal parts”

Law, 2001

Application to Occupational Therapy Services Articulate your hypothesis Ask a target question Complete a search Analyze the evidence Draw conclusions Implement intervention Use data to support or adjust your

intervention plan

Articulate your Hypothesis Ask questions like:

What are the strengths/concerns? What intervention are you

considering? What are some potential

contraindications?

Ask a Target Question PICO Model

Patient relevant characteristics of child/student or population

Intervention strategy or approach you are considering applying

Comparison Intervention may or may not use this – strategy or approach you

want to compare with “I” Outcome

anticipated benefit from the intervention

Complete a Search Access to university? Access to the internet? Websites to consider

Medline – www.ncbi.nlm.nih.gov/PubMed CINAHL (Cumulative Index of Nursing and Allied

Health Literature) – www.cinahl.com PsychInfo – www.psycinfo.com/psycinfo/ ERIC (Educational Resources Information Center) –

www.eric.ed.gov OT Seeker www.otseeker.com OTDBase (must join except for free trial periods

twice per year) - http://www.otdbase.org/

How to Complete Search If unfamiliar with search strategies,

consider an online tutorial to learn strategies such as: Choosing appropriate key words Narrowing/widening search strategies Combining words (use of “and”, “or”, etc..)

Online tutorial site: Centre for Evidence-Based Medicine

www.cebm.net/searching.asp

Analyze the Evidence Critically appraise the validity and

usefulness of information found Interpret for applicability to the

specific client Consider the three-pronged

approach, include: the therapist’s clinical reasoning the client’s perspective(s)

Websites that can Help with Analyzing the Evidence http://www.cebm.utoronto.ca/

practise/ca/therapyst/ http://www.cebm

.net/levels_of_evidence.asp http://www.pedro.fhs.usyd.edu.au/

tutorial.html#part_one http://www.psychstat.smsu.edu

/sbk00.htm

Draw Conclusions Should I pursue this intervention

strategy with this client? What indications/contraindications

should I watch for? How should I set up my intervention? How should I set up my intervention

review?

Implement Intervention “NIKE moment” – Just DO IT

Evaluate the Effectiveness of Your Intervention Use your data to determine

if the intervention is taking you where you want to go….

Other Resources of Evidence Reviews American Occupational Therapy Association,

Evidence-Based Practice Series (AOTA members only): www.aota.org (click on Practice and Ethics)

American Occupational Therapy Foundation, Evidence-Based Practice Resources: http://www.aotf.org/html/evidence.html

American Academy for Cerebral Palsy and Developmental Medicine: http://www.aacpdm.org/home.html

CanChild Centre for Childhood Disability Research: www.fhs.mcmaster.ca/canchild

Center for Evidence-Based Practices: www.evidencebasedpractices.org

Child and Family Studies Research Programs, Occupational Therapy Department, Thomas Jefferson University: www.tju.edu/cfsrp/home/html

Cochrane Library: www.cochrane.org ERIC Digests:

www.ericfacility.net/ericdigests/index/ OT Seeker--Occupational Therapy

Systematic Evaluation of Evidence: www.otseeker.com

PEDro: www.pedro.fhs.usyd.edu.au Research and Training Center on Early

Childhood Development: http://www.researchtopractice.info/products.php

University of Puget Sound (UPS): www.ups.edu/ot (click on Evidence Based Practice Symposium)

Implications for Occupational Therapists….

EBP is an orientation toward practice. A commitment to EBP has implications for all

service delivery activities Effective dissemination (sharing) is an

important element of EBP

The Process Illustrated

Presentation Adapted From: 2003 Faculty Summer Institute: Teaching Evidence Based

Practice in Rehabilitation Professional Curricula Law, 2002 Evidence-Based Rehabilitation: A Guide to

Practice Muhlenhaupt, 2004 Applying Evidence-based Practice

Approaches to Support Children’s Participation in Home and Community Experiences

Muhlenhaupt, 2004 Evidence-Based Practice: What Does It Look Like in School-Based Practice?

Swinth, 2002 First Annual Evidence-Based Practice Symposium

Swinth, 2003 Second Annual Evidence-Based Practice Symposium