Pima Medical Institute OTA 110 Chapter 40 Evidence-Based Practice

Fundamentals of Evidence-Based Practice

• Definition of Evidence-Based Practice (EBP):

  • A combination of clinical (external) evidence and clinical expertise.

  • External evidence provides quantitative, qualitative, or both types of information.

  • The practitioner is required to interpret research information and determine its clinical applicability to individual patients.

• The Randomized Controlled Trial (RCT):

  • Recognized as the gold standard in research design.

  • Consists of a highly controlled experiment.

  • Participants are randomly assigned to $1$ of $2$ distinct groups:

  • Group $1$: Receives the specific intervention being tested or questioned.

  • Group $2$: Receives a standard intervention or no intervention at all.

• Meta-Analysis:

  • Viewed as one of the strongest types of evidence available.

  • Employs a scientific method to gather a variety of research studies on a similar topic.

  • Performs a statistical analysis to interpret, compare, and summarize quantitative findings across studies.

• Statistical Criteria for Study Strength:

  • Determined statistically by having an adequate sample size (number of participants) relative to the data gathered.

  • Designed to show a significant change from pre-test to post-test or a significant difference when compared with a treatment group.

Rationale and Professional Standards for EBP

• Key Motivations for Practice:

  • Ten distinct reasons justify why occupational therapy practitioners must adopt EBP principles (documented on page $546$).

• Occupational Therapy Code of Ethics Mandates:

  • Demands that practitioners fully inform clients regarding the nature, associated risks, and potential outcomes of all proposed interventions.

  • Promotes continuous professional development requiring occupational therapists to stay current with emerging knowledge.

Implementation Steps and Research Resources

• Core Steps of Evidence-Based Practice:

  • Becoming an evidence-based practitioner involves a structured $4$\text{-step} process (outlined on page $546$).

• Step A: Framing the Question:

  • Questions may focus on a specific clinical problem, a target intervention, or a comparison between different treatment techniques (pages $546\text{--}547$).

• Step B: Searching, Sorting, and Interpreting Evidence:

  • Free Access Online Databases:

  • PubMed (www.ncbi.nlm.nih.gov/pubmed): Provides free access to biomedical literature, including select articles from the American Journal of Occupational Therapy (AJOT).

  • Cochrane Collaboration (www.cochrane.org): Provides free access to systematic reviews and health evidence.

  • American Occupational Therapy Association (AOTA): Offers free or open-access articles without requiring paid membership via standard search engines.

  • Targeted Search Strategies:

  • Google search string: "AJOT articles for stroke" locates free research literature regarding stroke rehabilitation.

  • Google search string: "AJOT articles for multiple sclerosis" locates research literature regarding multiple sclerosis.

  • AOTA Member Resources for Outcome Literature:

  • Primary navigation path: AOTA.org Home Page -> Practice -> Under "Elevate Your Practice" Select: All Practice Resources -> Evidenced-based Practice/Knowledge Translation.

  • Subsections include Systematic Reviews and Practice Guidelines (historically referenced under the term Critically Appraised Topics).

  • Categories of Evidence Documents:

  • Systematic Reviews: Scholarly syntheses that summarize evidence on a focused clinical question, incorporating background research, methodology, and direct implications for practice (specifically evaluated over $5$\text{-year} publication windows).

  • Critically Appraised Topics (CATs): Brief critical appraisals and syntheses of research articles detailing key findings and practical bottom-line implications for occupational therapy practice.

  • Practice Guidelines: Clinical recommendations and translation tools derived from systematic review findings to directly guide daily practice ("View the Practice Guidelines & Related Resources").

• Step C: Communicating Findings:

  • Clinical reasoning models integrate evidence-based findings directly into clinical decision-making and stakeholder communication (illustrated in Figure $40\text{-}2$, page $553$).

Statistical Analysis, Clinical Measurement, and Levels of Evidence

• Statistical Significance and Metrics:

  • $p$\text{-value}: A calculated statistical metric associated with the statistical significance of a study's observed effect.

  • $p > .05$: Represents a potential low level of statistical significance, particularly when associated with a small sample size.

  • $p < .05$: Possesses the statistical power to detect a significant level of confidence in study outcomes, representing a $95\%$ confidence level that the observed relationship between $2$ study variables is statistically significant.

• Standardized Assessments and Functional Measures:

  • Clinical Applications:

  • Measure patient improvements or lack of improvements over time (e.g., evaluating Functional Independence Measure score gains from admission to discharge).

  • Establish functional relationships (e.g., quantifying the precise grip strength required to open a jar).

  • Justify the clinical necessity of initial occupational therapy services or the continuation of ongoing services.

  • Assessment Tools and Diagnostic Instruments:

  • Functional Independence Measure (FIM) scores

  • Pinch meter

  • Dynamometer

  • Manual Muscle Testing (MMT)

  • Range of Motion (ROM)

  • Box & Blocks Test of Coordination

  • Functional Reach Test

  • $9$\text{-hole peg test}

  • Rehabilitation Measure Databases:

  • https://www.strokengine.ca/assess/

  • https://www.sralab.org/rehabilitation-measures

• Hierarchy of Evidence in OT Literature:

  • Evidence levels for research reviews (outlined in Table $40\text{-}1$, page $548$):

  • Level I

  • Level II

  • Level III

  • Level IV

  • Level V: Expressed opinions of individuals who have written and reviewed guidelines based on their clinical or theoretical experience and knowledge.