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Evidence-Based Practice in Occupational Therapy, 2000-
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Atwal, A. (2002). Getting the evidence into practice: the challenges and successes of action research. The British Journal of Occupational Therapy, 65, 335-341.
In health and social care, occupational therapists are acknowledging the importance of being evidence-based practitioners. The challenge is not only how to find the evidence but also how to implement research findings
or best evidence in clinical practice. Furthermore, the pressure for more effective implementation of research findings is likely to increase. This paper discusses the issues and challenges that occupational therapists may
face and must overcome when doing action research from the inside. Action research can be used to improve clinical practice by identifying and solving practical problems. The paper demonstrates the use of action research to
change practice by implementing a new interprofessional discharge model with fractured neck of femur patients in an inner-London teaching hospital. The strategies used to help to overcome the challenges of action research are
discussed. The main problems encountered were the difficulties in reaching amicable solutions and in empowering health care professionals who often had little or no influence on decision making. While the aims of the research
project were not net, it did highlight further areas that needed to be resolved in order to enhance interprofessional working
August-Dalfen, S. (2001). Literature digest column: occupational therapy and evidence based practice. The Israel Journal of Occupational Therapy, 10, E34-E40.
Evidence based occupational therapy is being welcomed by therapists and academics as a new trend in occupational therapy. And it is a good thing! How many times have you sat during a treatment session and wondered if this
was the best treatment intervention? When was the last time you were asked by a desperate family what your client's chances are for a good functional recovery? And finally I am sure we can all recall the last time we had to
define and defend the need for occupational therapy. The good news is that evidence based occupational therapy is now being pursued as the approach which attempts to resolve many of these issues. The bad news is that overworked
occupational therapists, and other medical professionals, rarely have the resources or skills to follow new research nor the time to read, scrutinize and apply new concepts that are discovered with evidence based practice (EBP)
(Dubloulz, Egan, Vallerand & Zweck, 1999; http://www.occupational-therapy.co.za/journal). Moreover, the language barrier to scientific literature that we hear in Israel makes this task an even more onerous task. The purpose of
the present column is therefore to introduce the concept of EBP and to give some direction in pursuing this approach. It is the hope that in the future this research digest column will provide us with relevant studies to assist
in the formative task of surveying and assessing literature to promote evidence based practice, thereby improving the quality of occupational therapy.
Ballinger, C, & Wiles, R. (2001). Opinion: A critical look at evidence-based practice. The British Journal of Occupational Therapy, 64, 253-255.
Bennett, S & Bennett, JW. (2000). The process of evidence-based practice in occupational therapy: informing clinical decisions. Australia, Occupational Therapy Journal, 47, 171-180.
As we move into the 21st century, there are increasing demands placed on occupational therapists to ensure their practice is based on sound evidence. Evidence-based practice is an approach to clinical decision making that has gained
considerable interest and influence during the last decade. This article describes and explains the process of evidence-based practice and its application to clinical occupational therapy practice. Directions for resources that may
assist therapists' self-directed learning are also provided. As health care becomes more evidence-based, awareness of the principles, skills, and resources for evidence-based practice is of relevance to all occupational therapists.
Bennett, S, Tooth, L, McKenna, K, Rodger, S, Strong, J, Ziviani, J, Mickan, S & Gibson, L. (2003). Perceptions of evidence-based practice: a survey of Australian occupational therapists. Australian Occupational Therapy Journal, 50, 13-22.
Evidence-based practice (EBP) requires clinicians to access, appraise and integrate research literature with clinical experience and clients' perspectives. Currently, little is known about occupational therapists' attitudes to EBP,
their perception of implementation barriers or their educational needs. A questionnaire reflecting these issues was sent to a proportionate random sample of 1491 members of the national professional occupational therapy association,
OT AUSTRALIA. The questionnaire was completed by 649 (44%) participants. Occupational therapists were positive about EBP with most (96%) agreeing that EBP is important to occupational therapy. Although 56% used research to make
clinical decisions, more relied on clinical experience (96%), information from continuing education (82%) and colleagues (80%). Lack of time, evidence and skills were identified as the main barriers to the implementation of EBP.
Over half (52%) expressed some strong interest in EBP skills training, and most (80%) indicated an interest in the availability of brief summaries of evidence. Targeted educational initiatives, resources and systems are needed to
support EBP in occupational therapy.
Bowman, J, & Llewellyn, G. (2002). Clinical outcomes research from the occupational therapist's persepctive. Occupational Therapy International, 9, 145-166.
With increasing costs and scarcity of resources, occupational therapists need to embrace outcomes research to demonstrate the effectiveness of its clinical interventions. To explore clinicians' perspectives on clinical
outcomes research a qualitative study was undertaken involving three in-depth group interviews with 15 occupational therapists from the South Western Sydney Area Health Service. Five broad themes permeated participants' perception:
(a) defining the process, (b) factors that impact on participation in clinical outcomes research, (c) organizational influences, (d) the value of clinical outcomes research, and (e) potential partnerships with academics. Three
conceptual categories are identified: knowledge and understanding about clinical outcomes research, clinicians' experience conducting or participating in clinical outcomes research and the relevance of clinical outcomes research
to occupational therapy clinical practice. Similarity to findings in the international literature on occupational therapists' engagement in clinical research suggests that the findings from this small sample of Australian therapists
are robust. The implications of the findings for continuing professional education programmes and clinical supervision are presented.
Cameron, KA, Ballantyne, S, Kulbitsky, A, Margolis-Gal, M, Daugherty, T, & Ludwig, F. (2005). Utilization of evidence-based practice by registered occupational therapists. Occupational Therapy International, 12, 123-136.
Although the use of evidence-based practice (EBP) is presently on the rise, there have been limited studies examining its use by occupational therapists within the US. The purpose of this study was to examine the use of EBP among registered occupational therapists in
the occupational therapy intervention planning process. This descriptive study surveyed 500 members of the American Occupational Therapy Association (AOTA), of which 131 participants responded (26%). The results of the study supported the hypothesis that, within the sample
studied, a minority of registered occupational therapists in the US utilize EBP in the intervention planning process. Other results included: (1) As level of academic education increased, the view of the importance of research to occupational therapy decreased. (2) As the
years of practice increased, the use of research evidence in making clinical decisions decreased. As the occupational therapy profession moves towards utilization of EBP as a professional standard, it is imperative that the profession examines specific strategies to promote
the adoption of such practice by its members, including the promotion of competency in evidence utilization, and the valuing of the established clinical reasoning skills of the practitioner while integrating research evidence into intervention planning to support professional practice.
Christiansen, C. (2001). Ethical considerations related to evidence-based practice. The American Journal of Occupational Therapy, 55, 345-349.
In this article, we have identified some of the ethical considerations related to evidence-based practice and surrounding issues as they bear on occupational therapy and rehabilitation. We acknowledge that practitioners are professionally and morally obligated to ensure that their
decisions are informed and reflect best practices. Further, we recognize the value of encouraging practitioners to assume responsibility for searching and appraising available evidence so that informed options can be shared with patients. Table 1 summarizes the ethical considerations
in evidence-based practice. Ethical dilemmas are a natural part of the health care enterprise. They existed before evidence-based practice became an everyday term, and they present themselves whether or not evidence-based practice is introduced into a clinical decision. From a moral
and professional standpoint, the dangers of not attending to evidence are just as significant as the ethical issues attending to its application. Evidence-based practice has clear limitations in occupational therapy and rehabilitation. Currently, these limitations loom as major
obstacles to practice behaviors that are better informed and influenced by research. In the United States, the implementation of a prospective payment system in rehabilitation will provide increased impetus for research and for attention to the results of that research. As we consider
and apply this research to practice, we must do so judiciously, mindful that evidence-based practice is a gift that comes to health care in ethical wrappings.
Coster, W. (2005). International conference on evidence-based practice: A collaborative effort of the American Occupational Therapy Association, the American Occupational Therapy Foundation, and the Agency for Healthcare Research and Quality. The American Journal of Occupational Therapy, 59, 356-358.
Craik, J, & Rappolt, S. (2006). Enhancing research utilization capacity through multifaceted professional development. The American Journal of Occupational Therapy, 60, 155-164.
Some occupational therapists report that they do not feel adequately prepared to perform the arduous tasks involved in integrating research into their practice. To explore how research utilization can be conducted by practicing clinicians, self-reported research utilization behaviors
of a sample of 11 occupational therapists practicing in adult stroke rehabilitation were analyzed. The constant comparison of the interview data revealed that participants' clinical experiences, engagement in continuing education, involvement in research activities, and their mentoring
of students contributed to their capacity to translate research evidence into practice. The results of the study suggest a model for enhancing research utilization capacity through professional development. Implications for practitioners, provider organizations, educators, and regulators
of occupational therapy are discussed.
Curtin, M, & Jaramazovic, E. (2001). Occupational therapists' views and perceptions of evidence-based practice. The British Journal of Occupational Therapy, 64, 214-222.
In spite of the developments within health and social care, little research has been published that specifically identifies the views and perceptions that occupational therapists working in England have of evidence- based practice (EBP). This study used qualitative and quantitative
methodologies in two distinct phases. Initially, focus groups were used to explore the views and perceptions that senior occupational therapists working in different settings had of EBP. In the second phase, the findings from the focus groups, alongside the results from a study
conducted by Wiles and Barnard (1998), were used to design a questionnaire to canvass the views and perceptions of a larger number of occupational therapists within the South and West Region of England. Of 653 questionnaires distributed, 500 (76.5%) were returned and analysed.
The findings indicated that the respondents were positive about EBP. The lack of time and the high staff turnover and staff shortages were seen as major barriers to the implementation of EBP. Support from managers and colleagues, along with personal motivation and access to resources,
enabled the implementation of EBP. Many respondents felt that they required more training about EBP. This research indicates that practical initiatives assisting the implementation of EBP are likely to be met with enthusiasm by occupational therapists.
Cusick, A. (2001). OZ OT EBP 21C: Australian occupational therapy, evidence-based practice and the 21st century. Australian Occupational Therapy Journal, 48, 102-117.
Occupational therapy in Australia is entering the 21st century as a dynamic and growing profession. The adoption of evidence-based practice is an important feature to ensure the profession's continued success. There are also other issues evident in Australian occupational therapy
today that need to be considered to ensure the profession's continued growth. These are: The terminology that is and could be used in occupational therapy; the possibility of 'collateral damage' to occupational therapy concepts and processes if deterministic elements of evidence-based
practice predominate; and the importance of making explicit our national position on occupational therapy core concepts and processes. Regarding the latter, the author proposes that this position is best described as 'finding unity in diversity. This position reflects the national
heritage, character and social/health priorities facing Australian occupational therapy'. The implications of these issues are explored.
Deane, KHO. (2006). Randomised controlled trials: part I, design. The British Journal of Occupational Therapy, 69, 217-223.
Occupational therapists need to be able to evaluate the profession's interventions critically: to stop the ineffective, to reduce the hazardous and to promote the effective. Randomised controlled trials are a research tool for testing the efficacy of interventions with small to
moderate effects. This review aims to cover the issues to be considered when designing a randomised controlled trial of complex interventions, such as occupational therapy.
Deane, KHO. (2006). Randomised controlled trials: part II, reporting. The British Journal of Occupational Therapy, 69, 248-254.
Without good quality trials and trial reports, the profession will continue to be dogged by systematic reviews that conclude that there is insufficient evidence to support or refute the use of occupational therapy. These, in turn, will mean that the use of occupational therapy
cannot be promoted strongly in national guidelines and, therefore, services may become restricted. Occupational therapists reading reports of randomised controlled trials and trying to interpret the reliability and size of effects stated are frequently frustrated by poor standards
of reporting. They need to be able to evaluate the profession's interventions critically: to stop the ineffective, to reduce the hazardous and to promote the effective. This review covers some of the issues to be considered when writing or reading a report of a randomised controlled
trial of a complex intervention, such as occupational therapy.
Deane, KHO, Ellis-Hill, C, Dekker, K, Davies, P, & Clarke, CE. (2003). A Delphi survey of best practice occupational therapy for Parkinson's disease in the United Kingdom. The British Journal of Occupational Therapy, 66, 247-254.
This study was designed to determine the character of best occupational therapy practice for Parkinson's disease in the United Kingdom. Two hundred and forty-two occupational therapists treating people with Parkinson's disease were sent a Delphi survey containing statements
about best practice and asked to indicate their level of agreement with each statement. The second survey contained the same list of statements, with group levels of agreement from the first round for each statement. The respondents re-rated their answers and gave their opinion
on the efficacy of various interventions. One hundred and fifty occupational therapists (62%) completed both rounds. Ninety-nine percent of the respondents agreed that Parkinson's disease required lifelong provision of occupational therapy, within multidisciplinary teams, and
that the social and psychological aspects of the disease were as important as the physical ones. The occupational therapists had confidence in many techniques for achieving physical, social and psychological goals. However, 40% of the respondents could not rate the efficacy of
social and psychological techniques owing to a lack of knowledge. There was a high level of consensus nationally on the character of best practice occupational therapy for Parkinson's disease. The survey highlighted a need for more postgraduate training, especially in psychological
techniques.
Dysart, AM, & Tomlin, GS. (2002). Factors related to evidence-based practice among U.S. occupational therapy clinicians. The American Journal of Occupational Therapy, 56, 275-284.
OBJECTIVE: The purpose of this study was to examine how U.S. occupational therapists access and use clinically relevant research results. METHOD: During the spring of 2000, 209 clinically practicing occupational therapists who were members of the American Occupational Therapy
Association responded to a survey (58% response rate). The distribution of opinions and self-reported behavior was portrayed by descriptive statistics, and chi-square cross-tabulations and Pearson correlation coefficients were calculated between demographic and evidence-based
practice variables. RESULTS: Respondents occasionally accessed research information through a variety of resource media. The majority (57%) implemented between one and five new, research-based treatment plans in the past year. Compared with respondents with less experience, a
greater proportion of respondents with 15 or more years of clinical experience did not believe that research conclusions usually translated into treatment plans for individual clients (chi 2 = 20.620, p < .01). Almost three fifths (59%) of respondents reported that time was
provided on the job to attend continuing education; however, 45% strongly disagreed that time was available at work to access research information. Other reported barriers to research utilization included lack of time on the job, high continuing education costs, weak research
analysis skills, and placing higher value on clinical experience than on research. CONCLUSIONS: These findings suggest that therapists are currently engaging in a modest amount of evidence-based practice. Removing the barriers identified in this study may increase research
utilization among clinicians.
Forsyth, K, Melton, J, & Mann, LS. (2005). Achieving evidence-based practice: a process of continuing education through practitioner-academic partnership. Occupational Therapy in Health Care, 19(1/2), 211-227.
Occupational therapy is required to deliver and generate evidence-based practice. As currently articulated, evidence based practice requires particular skills and takes time and is rarely realized. This paper illustrates a collaborative approach to building
an evidence based training program within a practice context. The aim of the training program was to enable therapists in a large mental health setting to engage in evidence-based practice. Specifically, the partnership between the United Kingdom Centre for
Outcomes Research and Education (UK CORE) and Gloucestershire Partnership NHS Trust (GPT) will be described. This article describes the GPT/UKCORE partnership, the process of building an evidence based practice training program, the final structure of the
evidence based practice training program, and the evaluation of the evidence based practice training program.
Goldstand, S. (2005). Evidence-based occupational therapy practice: a new paradigm for best practice. The Israeli Journal of Occupational Therapy, 14, E103-E111.
Hammell, KW. (2001). Using qualitative research to inform the client-centred evidence-based practice of occupational therapy. The British Journal of Occupational Therapy, 64, 228-234.
Demands for increased accountability for health care expenditure, and recognition of clients' rights to interventions and methods of service delivery that are grounded in sound evidence, are compelling occupational therapists to use
research findings to inform their clinical decision making. Occupational therapists also state that they embrace a client- centred orientation to practice, yet this espoused ethic seems rarely to influence decisions concerning what
research is undertaken and how it is undertaken or what counts as evidence for practice. Given the widely divergent perspectives, priorities and values between health care professionals and their clients, practice based upon
therapist-centred research may be neither relevant nor valid. This paper explores the philosophical underpinning of methods used to develop theory, proposing that occupational therapy's evidence-based practice must be ethically
consistent with its espoused client-centred philosophy to avoid a tendency towards hypocrisy. It explores issues concerning client-centred practice and evidence-based practice and suggests that qualitative research methods may
be the most appropriate tools to identify and address client priorities. While traditional quantitative research approaches render client voices silent, qualitative methods may enable occupational therapists to explore the
complexities of clinical practice and of living with a disability, thereby informing a more client-centred, evidence-based practice of occupational therapy./font>
Handoll, HHG. (2004 Summer). The Cochrane Database of Systematic Reviews. The British Journal of Hand Therapy, 9, 40-42.
This paper reminds readers of this journal of an important source of summaries of the evidence of effectiveness of healthcare interventions, namely the Cochrane Database
of Systematic reviews.
Harrison-Paul, J & Drummond, AER. (2006). A randomized control trial of occupational therapy in oncology: challenges in conducting a pilot study. The British Journal of Occupational Therapy, 66, 130-133.
In order to ascertain whether occupational therapy improved the mood, fatigue management and activities of daily living performance of oncology outpatients, a randomised controlled trial was used to compare an
occupational therapy intervention at home with statutory service input. However, there were problems with recruitment and the collection of data, attributable in part to the nature of the disease, and therefore
no conclusions regarding the role of occupational therapy could be drawn. Nevertheless, it is believed that this trial is important because it might assist clinicians planning future research in this area and
because it counteracts publication bias (ISRCTN71264775).
Holm, MB. (2000). The 2000 Eleanor Clarke Slagle Lecture. Our mandate for the new millennium: evidence-based practice. The American Journal of Occupational Therapy, 54, 575-85.
The health care environment of the past quarter century went through numerous evolutionary processes that affected how occupational therapy services were provided. The last iterations of these processes included requests for
the evidence that supported what we were doing. This year's Eleanor Clarke Slagle Lecture (a) examines the strength of the evidence associated with occupational therapy interventions--what we do and how we do it--(b) raises dilemmas
we face with our ethical principles when some of our practices are based on limited evidence, and (c) proposes a framework of continued competency to advance the evidence base of occupational therapy practice in the new millennium.
Humphris, D, Littlejohns, P, Victor, C, O'Halloran, P & Peacock, J. (2000). Implementing evidence-based practice: Factors that influence the use of research evidence by occupational therapists. The British Journal of Occupational Therapy, 63, 516-522.
Developing a professional and organisational culture within National Health Service (NHS) trusts that is supportive of improving evidence-based practice will require both the generation and use of research evidence. This article reports
the findings of a study that explored the factors that inhibit and facilitate the use of research evidence by occupational therapists. The sample of 100 occupational therapists was drawn from across seven acute NHS trusts, in one NHS region,
including two teaching hospitals. The postal survey achieved a 78% response rate. The findings illustrate that whilst occupational therapists have a positive attitude towards the use of research and are keen to make use of that evidence in
practice, workload pressures are a major inhibiting factor. The challenge for practitioners and managers alike is to create organisational conditions that are supportive of the NHS policy objectives to enhance the use of evidence-based practice.
Ilott, I, Taylor, MC & Bolanos, C. (2006). Evidence-based therapy: it's time to take a global apporach. The British Journal of Occupational Therapy, 69, 38-41.
This opinion piece advocates that the time is right to adopt a worldwide strategic approach to evidence-based occupational therapy (EBOT). This means globalising the evidence and localising decision making in a context-sensitive way.
The main barriers to and needs for collaborative action over the next 10 years are identified. The analysis is based on our experience and on reflections upon an international meeting on EBOT held in Washington DC in 2004. We hope to
challenge readers to think about what they can do to make EBOT a reality for everyone everywhere.
Jerosch-Herald, C. (2005). An evidence-based approach to choosing outcome measures: a checklist for the critical appraisal of validity, reliability and responsivienss studies. The British Journal of Occupational Therapy, 68, 347-353.
Selecting outcome measures for clinical practice or research needs to be based on a critical evaluation of the evidence on the validity and reliability of the available measures. This paper presents both a theoretical framework based
on the methodological literature of how these psychometric properties can be assessed and a checklist designed to facilitate the critical appraisal of studies on outcome measures. Through examples drawn from the published literature,
the concepts of instrument validity, reliability and responsiveness and how these can be evaluated and reported are illustrated. It is suggested that a structured checklist can facilitate a more evidence-based approach to the selection
and employment of outcome measures in clinical practice and research.
Law, M, Pollock, N, & Stewart, D. (2004). Evidence-based occupational therapy: concepts and strategies. New Zealand Journal of Occupational Therapy, 51, 14-22.
Evidence-based practice is a growing influence on occupational therapy practice in many countries. While therapists acknowledge the importance of research informing practice, there are many challenges to developing an
evidence-based occupational therapy practice. In this paper, common myths or misunderstandings about evidence-based practice are outlined. Evidence-based occupational therapy does not rely solely on research, but works
most effectively when research information is used in conjunction with clinical judgment and information about client's values and preferences. In developing an evidence-based occupational therapy practice, a specific
process to identify issues, search for evidence and use evidence is described. Two clinical examples of using this process to gather information to support evidence-based decision-making within an occupational therapy
practice are discussed.
Lloyd, C, King, R, & Bassett, H. (2002). Evidence-based practice in occupational therapy--Why the jury is still out. New Zealand Journal of Occupational Therapy, 49, 10-14.
Evidence-based practice requires treatment decisions to be based on critically appraised published outcome studies rather than clinical judgment has been heralded as a means of providing more accountable and effective
health services. In this review, two categories of obstacle to the implementation of evidence-based practice in occupational therapy practice are considered. The first is the absence of an adequate research literature for
most areas of occupational therapy practice. The second is difficulties in ascertaining the clinical validity of such published research. We conclude by suggesting that it is time for occupational therapists to develop a
greater commitment to outcome research and at the same time of develop a more critical awareness of both the potential and the limitations of such research.
Mairs, H. (2003). Evidence-based practice in mental health: a cause for concern for occupational therapists? The British Journal of Occupational Therapy, 66, 168-170.
This opinion piece considers the profile of occupational therapy within the literature informing the evidence base for current mental health practice. It highlights a number of concerns for occupational therapists
practising in this field and advocates that it is time to engage with the available evidence base and generate a research agenda to support the activity of mental health occupational therapists.
McCluskey, A. (2003). Occupational therapists report a low level of knowledge, skill and involvement in evidence-based practice. Australian Occupational Therapy Journal, 50, 3-12.
This study was conducted to collect information about Australian occupational therapists' involvement in evidence-based practice. The study aimed to document: (i) respondents' level of knowledge and skills; (ii) their level
of participation in continuing education; and (iii) perceived barriers to evidence-based practice. A purposive sample of 85 occupational therapists was invited to complete a questionnaire prior to attending an introductory workshop
on evidence-based practice. Sixty-seven questionnaires were returned and analysed (78.8% response rate). Half of the respondents rated their level of knowledge and skills required for evidence-based practice as low (conducting database
searches = 50.7%; critically appraising literature = 53.0%). The majority of respondents (79.1%) reported a low level of knowledge about electronic databases. Few respondents had attended education sessions on evidence-based practice
(15.0%). The six most commonly reported barriers to adopting evidence-based practice were lack of time, a large caseload, limited searching skills, limited appraisal skills, difficulty accessing journals and a perceived lack of evidence
to support occupational therapy intervention. The majority of occupational therapists in this sample were entering the first phase of continuing professional development in relation to evidence-based practice.
McCluskey, A, & Cusick, A. (2002). Strategies for introducing evidence-based practice and changing clinician behaviour: A manager's toolbox. Australian Occupational Therapy Journal, 49, 63-70.
Significant behaviour change is required if occupational therapy practice in Australia is to become more evidence-based. Occupational therapy managers, both clinical and academic, are well positioned to be key players in this process. Indeed,
it is suggested that managers need to drive the change process. The aim of this paper is to help occupational therapy managers better understand and prepare for the change process, and the shift to evidence-based practice. Two models of change
are presented and applied to evidence-based practice; (i) the stages of readiness for change; and (ii) individual responses to change, according to how quickly a person alters their behaviour and practice when confronted with change. Practical
strategies are suggested for managers to use during the change process, including a review of the attitudes and values of staff, identifying barriers to implementation, strategic planning, and the use of SWOT analysis (strengths, weaknesses,
opportunities, and treats). Recommendations for further research are also discussed. Unfortunately, there are no quick-fix strategies or 'magic bullets'. Evidence-based practice requires a change in attitudes and values, a major change in work
behaviours, and a commitment to lifelong, self-directed learning.
McCluskey, A, Lovarini, M, Bennett, S McKenna, K, Tooth, L & Hoffmann, T. (2005). What evidence exists for work-related injury prevention and management? Analysis of an occupational therapy evidence database (OT Seeker). The British Journal of Occupational Therapy, 68, 447-456.
This study aimed to summarise the quantity and quality of research contained in an online evidence database (OTseeker) in one practice area, work-related injury prevention and management, to highlight the available evidence. In May 2004,
the systematic reviews and randomised controlled trials (RCTs) contained in OTseeker were analysed. The number and proportion of systematic reviews and RCTs and the number and proportion of RCTs meeting each of the 10 criteria on the PEDro
scale (partitioned) were calculated and the topics and conclusions of the systematic reviews were summarised. Of the 2330 records contained in OTseeker, 346 (14.8%) related to work-related injury prevention and management (86 systematic
reviews and 260 RCTs). Of the 260 RCTs, the majority (n = 140, 53.8%) scored between 3/8 and 5/8 for internal validity on the PEDro scale (partitioned); a few scored 6/8 or more (n = 13, 5.0%). The majority of the RCTs scored 2/2 for the
reporting of results (n = 217, 83.5%). Evidence was identified, mostly for the treatment of low back pain, to support the use of multidisciplinary biopsychosocial rehabilitation including workplace visits, back schools, workplace exercise,
and advice to stay active and/or return to normal activities. OTseeker contains a substantial body of research on the effectiveness of work-related injury prevention and management, although this research is of varying methodological quality.
McKenna, K, Bennett, S, Hoffman, T, McCluskey, A, Strong, J, & Tooth, L. (2004). OTseeker: Facilitating evidence-based practice in occupational therapy. Australian Occupational Therapy Journal, 51, 102-105.
Mickan, S, & Rodger, S. (2002). Quality activities: Utilising evidence and informing clinical research. Australian Occupational Therapy Journal, 49, 93-99.
This paper defines and contextualises quality activities and clinical research within occupational therapy. Their characteristics are explained using a clinical example and cyclical models. It is argued that quality activities are a
means by which clinicians can utilise existing research evidence and inform further clinical research. To familiarise clinicians with the quality activity process, a framework to assist them to engage in and analyse quality activities
is presented. Quality activities and clinical research are compared to clarify their similarities and differences. It is proposed that quality activities are an important strategy for clinicians to be informed consumers and contributors
to clinical research while maintaining high quality client care.
Ottenbacher, KJ, Tickle-Degnen, L, & Hasselkus, BR. (2002). From the Desk of the Editor - Therapists awake! The challenge of evidence- based occupational therapy. The American Journal of Occupational Therapy, 56, 247-249.
Peterson, EW, McMahon, E, Farkas, M, & Howland, J. (2005). Completing the cycle of scholarship and practice: a model for dissemination and utilization of evidence-based interventions. Occupational Therapy in Health Care, 19(1/2), 33-46.
The scholarship of practice stresses that knowledge should arise out of a dialogue and collaboration between scholars and practitioners. Bringing evidence back to practice completes the scholarship of practice cycle. This article describes
a strategic approach to the process of knowledge dissemination and utilization and how that approach was used to increase knowledge and utilization of the Matter of Balance fear of falling intervention among occupational therapy practitioners.
To illustrate how the approach supported clinicians' efforts to engage in evidence-based practice, the paper features a description of actions taken by a Maine-based health care system to successfully integrate Matter of Balance into its programming.
Recommendations to policy makers, researchers and clinicians based on the authors' experiences with approach are presented.
Roberts, AEK, & Barber, G. (2001). Applying research evidence to practice. The British Journal of Occupational Therapy, 64, 223-227.
One of the important factors in the process of clinical governance is the use of research evidence to inform practice. However, it is not enough to search for and appraise research evidence. Once the information has been appraised, it may be
necessary to change practice in order to implement the knowledge. This paper considers the responsibility of occupational therapists to address this change. It is widely accepted that it is notoriously difficult to bring about change in
established professional practice. Strategies to help to effect change in practice are discussed and recent research regarding the most effective strategies is considered. The value of combined strategies, including continuing education,
clinical guidelines and opinion leaders, is addressed.
Steward, B. (2004). Writing a literature review. The British Journal of Occupational Therapy, 67, 495-500.
The processes of searching for literature and appraising evidence critically are well documented. Yet effective ways to report literature reviews, either as pieces of research in their own right or as part of primary research reports,
are less easily found. Reviews are often criticised for their lack of coherent construction, of synthesis of key themes and of well argued analysis. More importantly though, reviews are often the Cinderella or research, being less valued
than primary research, or dull preludes to research reports. This article considers the structure and content of a good literature review and calls for a new injection of enthusiasm to reflect the fascination of finding ideas, engaging with
others' research and building new theories from the assembled evidence. Publishing a review demands art as well as skill to help readers to make sense of a particular world of evidence and make them want to go and find out more for themselves.
The article suggests ways to write better reviews and encourages the writing of more papers based on reviews.
Stoffel, VC, & Moyers, PA. (2004). An evidence-based and occupational perspective of interventions for persons with substance-use disorders. The American Journal of Occupational Therapy, 58, 570-86.
An interdisciplinary evidence-based review of interventions among persons with substance-use disorders was completed in 2001 as part of American Occupational Therapy Association's (AOTA's) Evidence-Based Literature Review Project
(Lieberman & Scheer, 2002). Four effective interventions for adults and adolescents with substance use were identified, including brief interventions, cognitive behavioral therapy, motivational strategies, and 12-step programs. The
research studies reviewed reported outcomes primarily related to reduction in alcohol and drug use. Occupational therapy interventions grounded in current evidence-based literature are suggested. Interventions are modified to include
an occupational perspective leading to outcomes consistent with the Occupational Therapy Practice Framework (American Occupational Therapy Association [AOTA], 2002). Study findings propose research questions to encourage further investigation
of the effectiveness of these best practice interventions.
Sudsawad, P. (2005). A conceptual framework to increase usability of outcome research for evidence-based practice. The American Journal of Occupational Therapy, 59, 351-355.
Although evidence-based practice is the current practice approach recommended for use in occupational therapy, practitioners often report difficulties in using research evidence because of its content and presentation.
This paper discusses a conceptual model that researchers can use to create research evidence that is easier for practitioners to understand and use. The Diffusion of Innovations Theory is used as a framework to identify
desirable characteristics that may facilitate practitioners' adoption and utilization of research evidence. The concepts of social validity, ecological validity, and clinical significance are presented and discussed as
ways to create those desirable characteristics that could make research information more usable for evidence-based practice. Examples for implementation of the conceptual model are also discussed.
Unsworth, CA, & Cunningham, DT. (2002). Examining the evidence base for occupational therapy with clients following stroke. The British Journal of Occupational Therapy, 65, 21-29.
In order to conduct occupational therapy services that are evidence based, studies are urgently required which demonstrate the effectiveness of interventions offered. This paper presents the findings of a study
undertaken to determine occupational therapy outcomes for clients with stroke during inpatient rehabilitation. The participants were 43 clients with stroke and four occupational therapists. Therapy outcomes for personal
activities of daily living were measured using the Functional Independence Measure (Adult FIM); instrumental activities of daily living were measured using the Assessment of Living Skills and Resources (ALSAR); and quality
of life was measured using the Quality of Life Index (Q-L Index) and a semi-structured interview. The semi-structured interview was also used to understand clients' perceptions of the outcome of their participation in
occupational therapy. The data were collected at client admission, discharge and 3 months' follow-up. The results indicated that the clients believed that their ability to perform activities of daily living
(Adult FIM t(38)= -7.80, p=0.000, and ALSAR t (35) = 4.82, p=0.000) and their quality of life (Q-L Index t (39) = -7.23, p=0.000) improved over the course of their inpatient rehabilitation. The therapists also
rated the clients as improving during their rehabilitation in relation to activities of daily living (Adult FIM t(42) =-9.71, p=0.000, and ALSAR t (40) = 7.75, p=0.000) and quality of life (Q-L Index t(39) =-11.20, p=0.000).
Many of the clients interviewed attributed these gains to participation in the occupational therapy programme. In conclusion, this study demonstrated that a triangulated approach to data collection and analysis was useful
in providing evidence that occupational therapy, as part of comprehensive rehabilitation, made a difference to the lives of many of the clients studied.
Retrieved from OT SEARCH June 27, 2006
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