Week 1: Intro

Definition of Evidence-Based Practice (Sackett et al.)

The integration of best research evidence with clinical expertise and patient values.

3 Components of EBP (diagram)

• Best available scientific evidence

• professional expertise

• client values and preferences.

Ultimate Goal of EBP

To improve client outcomes.

Crucial Rule of EBP Decision-Making

Evidence does not make decisions; people do (healthcare providers and patients)

Origin of EBP

Emerged in the 1970s and 1980s as critical appraisal of medical literature.

Misconception: EBP as 'Cookbook' Medicine

EBP requires clinical judgment and client values, not rigid protocol adherence.

Misconception: Evidence Tiers in EBP

EBP is not restricted solely to randomized trials and systematic reviews.

Regulatory Drivers of EBP in OT

• ACOTE standards

• AOTA Centennial Vision

• regulatory/consumer accountability demands.

EBP Benefit: Knowledge

Improves therapists' knowledge and expands the overall OT knowledge base.

EBP Benefit: Rationale

Justifies practice recommendations to clients, families, and interprofessional teams.

EBP Benefit: Effectiveness

Demonstrates clinical and cost-effectiveness to colleagues, managers, and administration.

Choosing Wisely: Non-Purposeful Activities

Avoid non-purposeful activities like cones, pegs, shoulder arcs, or arm bikes.

Rationale Against Non-Purposeful Activities

Purposeful daily tasks intrinsically motivate engagement, motor performance, and attention.

Choosing Wisely: Sensory-Based Interventions

Do not provide sensory interventions without documented assessment of sensory processing deficits.

Research-to-Practice Time Lag

takes ~17 years for research findings to reach clinical practice

Goal of Research Translation in OT

To make direct connections between research findings, evidence, and clinical OT care.

Clinical Task 1: Getting to Know the Client

Search research on occupational experiences of similar populations and assessment quality.

Clinical Task 2: Choosing Interventions

Examine evidence on the relative effectiveness of different interventions for similar clients.

Clinical Task 3: Monitoring Response

Evaluate the quality of assessments used to track progress toward intervention goals.

Step 1 of EBP

Formulate a clinical practice question using the PICO framework.

Step 2 of EBP

Search literature for quantitative and qualitative evidence across relevant databases.

Step 3 of EBP

Critically appraise evidence for validity, impact, applicability, and evidence level.

Step 4 of EBP

Integrate evidence with clinical expertise and client values in decision-making.

Step 5 of EBP

Intervene and evaluate clinical outcomes.

PICO: 'P' Stand-For

Patient, Population, or Problem.

PICO: 'I' Stand-For

Intervention (therapy, assessment, or preventative measure).

PICO: 'C' Stand-For

Comparison (alternative treatment, standard care, or no treatment).

PICO: 'O' Stand-For

Outcome (functional recovery, pain reduction, or goal achievement).

Top Level of the Evidence Pyramid

Systematic Reviews.

Difference Between Filtered and Unfiltered Information

• Filtered information: synthesized evidence

• unfiltered information: primary research.

Top Tier (Filtered) Evidence Types

• Systematic Reviews

• Critically-Appraised Topics (CAT)

• Critically-Appraised Individual Articles (CAPs).

Highest Level of Unfiltered Primary Research

Randomized Controlled Trials (RCTs).

Hierarchical Ranking of Observational Studies

1. Cohort studies

2. Case-control studies

3. Case series/reports.

Base of the Evidence Pyramid

Background information and expert opinion.

OT Databases (trusted)

• Cochrane Reviews

• PubMed

• CINAHL

• OTseeker

• Google Scholar.

Critical Appraisal Questions

1. Is the quality of the study good enough?

2. What do the results mean for my clients?

3. Are the findings applicable in my setting?

Purpose of CAT and CAP Papers

To

• summarize

• critically evaluate

• determine clinical implications of research.

STOP Technique: 'S'

Stop: Pause and focus.

STOP Technique: 'T'

Take a deep breath in and out (5s in, hold 1-2s, 8s out).

STOP Technique: 'O'

Observe and acknowledge current feelings or thoughts.

STOP Technique: 'P'

Proceed with calmness.

STOP technique (Linehan)

• brief distress tolerance skill from Dialectical Behavior Therapy

• meant to interrupt impulsive, emotion-driven behavior in the moment