Evidence-Based Practice I - Vocabulary Flashcards

Overview of Evidence-Based Practice

• EBP integrates: best available research evidence, clinical expertise, client values, and clinical circumstances.
• Core idea: EBP starts and ends with the client; it is not cookbook medicine.

Foundations of Research for EBP

• Research supports practice by:
  • generating foundational knowledge
  • providing evidence about the need for OT services
  • developing and testing theory underlying practice
  • generating findings about process & outcomes of therapy
• Useful resource: EBP MUSC Libraries (EBP website).

Defining Research: Characteristics

• Key characteristics:
  • Rigor: follow accepted rules and procedures
  • Skeptical: open to doubt; tested by observation
  • Logical: link knowledge to explanations; deductive or inductive reasoning
  • Communal: subject to public scrutiny and peer review

Reviewing the Literature & Research Process

• Activities:
  • Searching, obtaining, analyzing literature to identify what is known, gaps, and how knowledge is generated
  • Disseminating findings via presentations, posters, articles, consumer formats
  • Identifying questions to be answered that guide research
  • Interpreting results to generate findings
• Background considerations:
  • Rigor, logistics, available resources
• Organizing and analyzing data
• Selecting methods: design, sample, recruitment, data collection, analysis
• Ethical approval to protect subjects and ensure informed consent
• Writing the research plan (literature review, methods, management, budget)

Research Designs

• Quantitative and Qualitative designs:
  • Quantitative: experimental, quasi-experimental, descriptive, non-experimental
  • Qualitative: phenomenology, life history, ethnography, narrative, grounded theory, heuristic narrative
• (Kielhofner & Fossey, 2007) reference

Why a New Model? The Tomlin View

• OT practice is complex, contextual, and client-centered
• RCTs are not always feasible or ethical
• Need a broader view of what counts as evidence

The Tomlin Evidence Pyramid

• Four equally valued types of evidence:
  • Experimental
  • Outcomes
  • Qualitative
  • Descriptive
• Evidence hierarchy is broadened beyond traditional single-path models

Applying the Pyramid to Clinical Questions

• Mapping questions to evidence type:
  • Is it effective? → Experimental
  • Does it work in practice? → Outcomes
  • What’s the lived experience? → Qualitative
  • What’s typical or emerging? → Descriptive

Step 3: Problem Analysis — Evaluate and Appraise the Evidence

• Activities:
  • Obtain the article
  • Review abstract, background, methodology, results, conclusions, discussion
  • Use critical thinking and standardized critique formats
  • Use the Tomlin Evidence Pyramid to determine level of evidence

Step 3: Appraise the Literature

• Three primary questions:
  • Is the study valid?
  • Are the results meaningful?
  • Are the results relevant to my patient?
• Consider the statistic vs. the individual in the data

Step 4: Remedy & Operationalize

• Apply the evidence to practice by answering:
  • WHO, WHEN, HOW the intervention is best implemented (or not)
  • Is it appropriate for my client?
  • Is my client represented in the study?
  • What is the gold standard of current practice, and why?

Barriers to Implementing AAT (example case)

• Barriers: People, Policy, Procedures, Technology
• Develop a plan to implement AAT; lack of policy or procedure can impede adoption
• An EB review suggests AAT may reduce anxiety in older adults with dementia

Step 5: Evaluate

• Assess evidence given client, setting, and clinical circumstances
• Develop and implement a plan for the facility with clients
• Track outcomes at 30/60/90/120 days to assess effectiveness, safety, cost, feasibility
• Refine/update practice; review guidelines periodically; consider dissemination

IMPROVE: Five-Step EBP Process

• Five-Step Process (IMPROVE):
  • Step 1 IDENTIFY
  • Step 2 MEASURE
  • Step 3 PROBLEM ANALYSIS
  • Step 4 REMEDY & OPERATIONALIZE
  • Step 5 VALIDATE & EVALUATE

Step 1: IDENTIFY

• Define the problem; ask a clinically relevant question
• Use PICO (or similar) format
• PICO components:
  • Patient/Population/Problem: Who is the question focused on?
  • Intervention: What is the proposed new intervention?
  • Comparison: What is the current or alternative state? (optional)
  • Outcome: What is the measurable outcome?
• Example:
  • Patient/Population/Problem: Premature infants with respiratory distress syndrome/respiratory failure
  • Intervention: Early enteral feeding
  • Comparison: Late enteral re-feeding
  • Outcome: Feeding complications and growth

Step 2: MEASURE — Best Evidence

• Search, acquire, and organize evidence
• Efficiently search using reliable databases
• Use the pyramid of evidence (e.g., meta-analyses, systematic reviews, RCTs, cohorts, case-control, case series, expert opinion)
• Organize evidence for evaluation (audit trail, reference managers, tables)

Step 3: PROBLEM ANALYSIS — Evaluate & Appraise

• Obtain the article; review the entire article (abstract, background, methodology, results, conclusions)
• Discuss with critical thinking; critique using standardized forms
• Use the Tomlin Pyramid to determine level of evidence

Step 4: REMEDY & OPERATIONALIZE

• Determine how to implement: WHO, WHEN, HOW
• Questions to consider:
  • Is it appropriate for my client?
  • Is my client represented in the study?
  • What is the current gold standard and why?

Step 5: VALIDATE & EVALUATE

• After implementation, assess outcomes in context of client and setting
• Track metrics over time to judge effectiveness, safety, cost, feasibility (e.g., 30/60/90/120 days)
• Refine and share findings; update guidelines as needed

Clinical Relevance & the Role of the Research Consumer

• Research findings must be evaluated for clinical relevance, not just statistics
• OT practitioners are research consumers: apply generalized findings to individuals
• Consider context: client values, settings, goals
• The individual in the statistic matters; personalize evidence to lived experiences
• Practice involves integrating research, clinical judgment, and client-centered perspectives

Scholarship and Practice: Engaged Scholarship

• Emphasis on integrating practical needs with research methods; avoid privileging only methods with status or funding
• Focus on questions and methods that matter for real-world practice