MeOTa fall conference October 22, 2016 Evidence-based Practice In OT: What Is It And What Do I Need To Know About It? Susan Noyes, PhD, OTR/L MeOTa fall conference October 22, 2016

A Starting Place: What do you already know about Evidence-Based Practice (EBP) and its relationship to OT?

Evidence-Based Practice: “a tailored, client-centered approach based on integrating the best evidence with professional judgment and expertise and with client preferences.” --Lin, S., Murphy, S, Robinson, J. (2010, p.167)

Context of EBP for OT: 1990’s = Evidence based medicine (EBM) 2004: International Conference on Evidence-Based Occupational Therapy—AOTA, AOTF sponsor creation of web-based EBP portal Increasing choices in healthcare and treatments Clients’ expectations of healthcare increasing Vast quantity of research literature of varied quality Large number of sources of information Much is out of date Scientific quality varied Limited time available for reading

Ebp: Why? Why focus on integrating evidence into practice? Continue to evolve OT practice Add to the knowledge base of the profession Establish OT as important contributor to health of society Continuing education programs are helpful but not sufficient sources of information Evidence based practice helps clinicians stay current

Ebp for ot: Using EBP, occupational therapists can: Improve their knowledge base Deliver efficient and effective services Be reimbursed for providing services Be recognized for contributions to promoting health and participation through the engagement of occupations

1. Identify The Clinical Problem What concerns you about your clients? Or about their response to your interventions? What new ideas have you had, that you wonder if anyone else has done yet? What gaps exist in your practice? Determine if you have: Background (broad) or foreground (specific) question? Formulate a question that is: Searchable Answerable

2. Formulate The Clinical Question: PICO P = patient or problem I = intervention C = comparison intervention (if relevant) O = outcome (can also be a “PIO” question) PICO format “facilitates asking a focused, clinically relevant question” (Lin et al., 2010, p. 165) PICO also provides key words or phrases for searching

Examples: PICO Questions Does a university based occupational health promotion program implemented by occupational therapy students and faculty result in improved health and well-being among the university population compared to current university wellness practices? What is the effect of equine-facilitated wellness therapy on the quality of life for adults with substance abuse disorders? Do classroom-level interventions for preschool students with emotional disturbances reduce dysfunctional behaviors and improve academic performance? What is the evidence for the effectiveness of interventions to improve and maintain participation and performance in employment and education for people with serious mental illness?

3. Search Efficiently For The Best Available Evidence Systematic reviews (SRs): extensive, systematic synthesis of all research on the review topic Narrative reviews: answer broader clinical questions, not systematically conducted or reproducible, subject to author bias Practice guidelines: combination of clinical experience, expert opinion, and research evidence Critically appraised topics (CAT) and critically appraised papers (CAP): brief summaries/appraisals of a specific question or study

Different types of research provide ‘best’ answers for different types of questions: RESEARCH METHOD Systematic Reviews, Randomized Controlled Trials, in some cases single-case experimental studies Qualitative Cohort/ follow-up studies Economic studies comparing all outcomes against costs TYPE OF QUESTION Treatment Patient/staff experiences and concerns Likely course of disease/disability Cost-effectiveness Bennett JW, Glasziou P. Evidence-based practice: what does it really mean? Disease Manage Health Outcomes 1997; 1: 277–85.

Levels Of Evidence

4. Critically Analyze The Evidence For Validity And Usefulness Internal validity: strength and quality of research design and method External validity: generalizability, or translating research results to different setting/clients Trustworthiness of research findings Statistical significance vs. clinical significance

5. Integrate The Analysis Of The Evidence With Your Clinical Expertise And Client’s Preferences Decision making includes all 3 critical elements: Best available external evidence (NOT the best possible) Clinical expertise Consideration of client’s contexts, rights, and preferences

Client preferences 1. Could these results/findings apply to your client? 2. Does it fit in with your client’s context? Consider client’s values, preferences, goals, environment etc. Can it improve your understanding of a client’s situation(qualitative research) 3. Consider the context of practice, e.g. Are there resources available to implement a treatment? Sackett et al, 2000

6. Evaluate The Process And Outcome REFLECT! Process: How efficiently and effectively did you follow the EBP steps? What would you do differently? Outcome: What did you find out? What effect did the intervention yield? How does the intervention compare with others?

7. Communicate Your Knowledge! Present about your experiences with EBP Write up your findings for publication Connect with local OT programs to engage in research and EBP projects Create and facilitate “Journal Clubs” with co-workers Join a MeOTA Community of Practice (CoP) in your area of specialty/interest Practitioners, educators, students and consumers all benefit from increasing the knowledge base in OT profession

Evidence based practice: Summary EBP is a process for making informed clinical decisions EBP is about USING research - not doing it EBP involves clinical reasoning to integrate: clinical experience clients’ preferences highest quality evidence available (both quantitative and qualitative)

Population: Intervention: Comparison: Outcome: PICO QUESTION: Key words for search:

AOTA EBP Page: http://www.aota.org/Practice/Researchers.aspx

Aota practice guidelines

References Bennett, J.W.; Glasziou, P. (1997). Evidence-based practice: what does it really mean? Disease Manage Health Outcomes, (1), 277–85. Lin, S. H., Murphy, S. L., & Robinson, J. C. (2010). Facilitating evidence- based practice: Process, strategies, and resources. American Journal of Occupational Therapy, 64(1), 164-171. Sackett, D. L., Richardson, W. S., Rosenberg, W., & Haynes, R. B. (2000). Evidence-based medicine: how to practice and teach. EBM. Second Edition. Churchill Livingstone: Edinburgh.