Post on 25-Feb-2016
description
Evidence-Based Practice Strategies for Busy
Clinicians
Yvonne Swinth, PhD, OTR/L, FAOTA
Associate ProfessorUniversity of Puget Sound
“How do you know that what you do and how you do it really works?” Holm, 2000
Common Definition “Evidence-based medicine is the
conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research”
Sackett et al, 1996
3-Prongs to EBP EBP is the integration of best
research evidence with clinical expertise and client values. When these three elements are integrated, clinicians and clients form a diagnostic and therapeutic alliance which optimizes clinical outcomes and quality of life.
Sackett et al, 1996
Levels of Evidence Several different approaches/models
Center for Evidence-Based Medicine (CEBM)-often referenced
American Academy for Cerebral Palsy and Developmental Medicine (AACPDM)
American Occupational Therapy Association (AOTA)-based on the CEBM model with some additions/clarification
Types of Evidence Peer reviewed journals Book Chapters Case Studies Clinical Data Online Resources Clinical Experience Expert Opinion
Peer reviewed Non-peer reviewed
EBP is guided by, as well as guides, clinical reasoning
As much as possible, practice of EBP skills should be integrated with current clinical experience, to ground intervention into a meaningful context.
An EBP orientation includes:
An expectation that knowledge will change constantly.
Tolerance for uncertainty. Willingness to question established practice. An expectation for self-directed learning. Collaborative effort and open sharing of
resources
How do we do Evidence-Based Practice?
“Health care is an imperfect science that requires both overarching clinical guidelines and individual judgment in equal parts”
Law, 2001
Application to Occupational Therapy Services Articulate your hypothesis Ask a target question Complete a search Analyze the evidence Draw conclusions Implement intervention Use data to support or adjust your
intervention plan
Articulate your Hypothesis Ask questions like:
What are the strengths/concerns? What intervention are you
considering? What are some potential
contraindications?
Ask a Target Question PICO Model
Patient relevant characteristics of child/student or population
Intervention strategy or approach you are considering applying
Comparison Intervention may or may not use this – strategy or approach you
want to compare with “I” Outcome
anticipated benefit from the intervention
Complete a Search Access to university? Access to the internet? Websites to consider
Medline – www.ncbi.nlm.nih.gov/PubMed CINAHL (Cumulative Index of Nursing and Allied
Health Literature) – www.cinahl.com PsychInfo – www.psycinfo.com/psycinfo/ ERIC (Educational Resources Information Center) –
www.eric.ed.gov OT Seeker www.otseeker.com OTDBase (must join except for free trial periods
twice per year) - http://www.otdbase.org/
How to Complete Search If unfamiliar with search strategies,
consider an online tutorial to learn strategies such as: Choosing appropriate key words Narrowing/widening search strategies Combining words (use of “and”, “or”, etc..)
Online tutorial site: Centre for Evidence-Based Medicine
www.cebm.net/searching.asp
Analyze the Evidence Critically appraise the validity and
usefulness of information found Interpret for applicability to the
specific client Consider the three-pronged
approach, include: the therapist’s clinical reasoning the client’s perspective(s)
Websites that can Help with Analyzing the Evidence http://www.cebm.utoronto.ca/
practise/ca/therapyst/ http://www.cebm
.net/levels_of_evidence.asp http://www.pedro.fhs.usyd.edu.au/
tutorial.html#part_one http://www.psychstat.smsu.edu
/sbk00.htm
Draw Conclusions Should I pursue this intervention
strategy with this client? What indications/contraindications
should I watch for? How should I set up my intervention? How should I set up my intervention
review?
Implement Intervention “NIKE moment” – Just DO IT
Evaluate the Effectiveness of Your Intervention Use your data to determine
if the intervention is taking you where you want to go….
Other Resources of Evidence Reviews American Occupational Therapy Association,
Evidence-Based Practice Series (AOTA members only): www.aota.org (click on Practice and Ethics)
American Occupational Therapy Foundation, Evidence-Based Practice Resources: http://www.aotf.org/html/evidence.html
American Academy for Cerebral Palsy and Developmental Medicine: http://www.aacpdm.org/home.html
CanChild Centre for Childhood Disability Research: www.fhs.mcmaster.ca/canchild
Center for Evidence-Based Practices: www.evidencebasedpractices.org
Child and Family Studies Research Programs, Occupational Therapy Department, Thomas Jefferson University: www.tju.edu/cfsrp/home/html
Cochrane Library: www.cochrane.org ERIC Digests:
www.ericfacility.net/ericdigests/index/ OT Seeker--Occupational Therapy
Systematic Evaluation of Evidence: www.otseeker.com
PEDro: www.pedro.fhs.usyd.edu.au Research and Training Center on Early
Childhood Development: http://www.researchtopractice.info/products.php
University of Puget Sound (UPS): www.ups.edu/ot (click on Evidence Based Practice Symposium)
Implications for Occupational Therapists….
EBP is an orientation toward practice. A commitment to EBP has implications for all
service delivery activities Effective dissemination (sharing) is an
important element of EBP
The Process Illustrated
Presentation Adapted From: 2003 Faculty Summer Institute: Teaching Evidence Based
Practice in Rehabilitation Professional Curricula Law, 2002 Evidence-Based Rehabilitation: A Guide to
Practice Muhlenhaupt, 2004 Applying Evidence-based Practice
Approaches to Support Children’s Participation in Home and Community Experiences
Muhlenhaupt, 2004 Evidence-Based Practice: What Does It Look Like in School-Based Practice?
Swinth, 2002 First Annual Evidence-Based Practice Symposium
Swinth, 2003 Second Annual Evidence-Based Practice Symposium