ROBIN STEED, PHD, LOTR CHRISTINE WRIGHT, PHD, LOTR (CO-CONSPIRATORS) Evidence-Based Practice
What is EBP? Best Practice Clinical Reasoning Research Client Factors 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.
Yes, you too can be an evidenced based practitioner in just 5 easy steps! The Process of Evidence Based Practice
Identify the clinical problem I want my clients to: be more functional have a higher quality of life have better outcomes faster transfer skills to home environment have maintained gains at follow-up have better adherence to treatment plan 1
Ask a PICO question Patient or Problem Intervention Comparison Intervention Outcomes 2
PICO Examples In children with autism, vigorous vs. mild exercise, on stereotyped behaviors In clients with Schizophrenia, environmental supports on ability to transition to community In children with ABI hemiplegia, constraint induced therapy on function
Systematic Review P : serious or chronic mental illness, psychosis, schizophrenia, mood disorder, anxiety disorder I : child care, meal preparation, home management, shopping, time management, safety, social participation, education exploration, retirement exploration, employment seeking O : employment and education Arbesman, M., & Logsdon, D. (2011). Occupational Therapy Interventions for Employment and Education for Adults With Serious Mental Illness: A Systematic Review. American Journal of Occupational Therapy, 65, 238-246. 3
Where do we find the evidence? The Cochrane Collaboration Working together to provide the best evidence for health care JOANNA BRIGGS INSTITUTE
Critically evaluate the evidence Study Design randomization control for bias ethical control group Sample size described Assessment Properties Intervention detailed/replicable Statistical Analysis Threats to Validity internal external 4 Critical Review Forms at McMaster’s University
Make a decision Given the quality of the evidence, what are the implications for clinical practice?
Implement Evaluate What is the risk? What is the cost? Do you need special training? Getting client consent Facility support Choose outcome measures Keep records of outcomes and adverse events Do a ROI assessment Implement and evaluate 5
LIKE I AM REALLY GOING TO HAVE TIME FOR ALL THIS! Get Real!
EBP in just 10 minutes a day! Join AOTA Read one or two journal articles a month Look up the quick summaries on EBP web sites Sign up for evidence alerts at McMaster’sMcMaster’s Start an EBP file at work Join a journal club