Aims of the Session

To increase your understanding of Evidence Based Practice (EBP), including:

○ What EBP is○ Why use EBP○ How to be an evidence based practitioner

What is Evidence Based Practice?

A process whereby research evidence, clinical knowledge and reasoning are used to make

decisions about interventions that are effective for a specific client(s)

What is EBP?

A review of the evidence in relation to a clinical practice question

EBP is only a part of the decision making process

EBP considers client’s preferences, beliefs and views

Aims to improve the quality of care and life for the client

Research vs. EBP

EBP is not about conducting research it is about USING

RESEARCH

Research= systematic process of gathering and synthesising empirical data to generate knowledge about a given topic

EBP= the conscientious, explicit and judicious use of best current evidence in making decisions about care for clients

Why is EBP important?

Clinical decisions can be clearly explained and justified to clients and their families

Demonstrate interventions are clinically and cost effective to colleagues, managers and administration

Maintaining and improving therapists knowledge base and the evidence base of OT for the future

How to use EBP

OverviewFive Steps: Identify and formulate a clear review

question Search the literature for relevant clinical

articles and evidence Critically appraise the evidence Implement the evidence within practice Evaluate the impact of the evidence

Step 1: Formulate a review question

Questions can be in relation to: The cause of a condition Diagnosis and assessments Prevention of conditions Prognosis of conditions Treatment outcomes Client concerns Economic evaluation

Clinical vs. Review Questions

Clinical Question: A general question relating to a clinical practice

situation

Review Question: Comes from a clinical question It is clear and specific to guide the search A useful question consists of a problem, intervention

and outcome and often takes the form of:

“What is the evidence for the effectiveness of X (intervention) for Y (outcome) in a client with Z (problem or diagnosis)”

How to Write a Review Question

Use PICO format:

P= The population or problem you are interested in (client group, problem)

I= The intervention that you are interested in

C= The comparison or alternative intervention (if relevant)

O= The outcome or reason for using the intervention

Example of PICO Question

What evidence is there for the validity and relevance of the Barthel Index vs. the

COPM as an assessment of occupational performance for older adults who have a

physical disability?

Critiquing an EBP Question

Identify the PICO components of the following question:

Are self management strategies more effective than medical care alone for improving health status, quality of life

and function amongst adults with coronary heart disease?

Critiquing an EBP Question

PP II CC OOPeople aged People aged over 35yrs, over 35yrs, with coronary with coronary heart diseaseheart disease

Self Self management management interventionsinterventions

Medical care Medical care alonealone

Health Health Status, Status, quality of life, quality of life, occupational occupational performance/performance/functionfunction

Activity: writing a review questionWork in groups of 2 or 3, from the following

scenario: Identify a clinical question Formulate a review question (using PICO)

“You have been running a garden therapy group for people with eating disorders, as a part of their

inpatient program at a mental health hospital. The group has been really successful, however, you need some extra evidence for its benefits in your

proposal to have the group continued. You decide to conduct an EBP review.”

Step 2: Searching the literature to find the evidence

Need to use an organised and systematic approach

Develop search strategies before you start, including:

○ Databases you will use○ Key terms to search under○ Set limits of your search

Databases to Use

Need to consider: Is your focus medical or broader? Is your focus OT specific? Do you want literature from a particular

country or area? (eg. Australia or Asia) Is there a specific research method you

want to focus on? (eg. systematic review)

Key Terms and Search Limits

Pull out the key terms from your review questionGenerally the problem, intervention and

outcomeConsider alternative or related terms (eg.

Occupation and activity)

Set limits for your search, includingLanguage of the articleResearch designDate of publication

Step 3: Critically Analysing the Evidence

Assess the value and trustworthiness of the evidence

No research is without its flaws, need to ask:

“Do the flaws make me question the conclusion?”

3 broad areas to analyse:The rigor of the researchSignificance of the resultsImpact upon your OT practice

Levels of Evidence

Consider the type of research conducted: (hierarchical list)

Systematic reviews, meta analysis Randomised controlled trials (RCTs) Non-randomised controlled trials Case controlled trials Cohort studies Descriptive studies Qualitative studies Expert opinion

Questions for Critiquing Evidence

Some general questions to ask include: What is the question? What is the purpose of the research? Did the research design allow the question to be

answered? What were the results? Were the researchers interpretations valid? Are the results relevant and useable in practice?

Useful critical appraisal checklist and guidelines are available at:

www-fhs.mcmaster.ca/rehab/ebp

Step 4: Implementing the evidence

Examples of strategies to implement evidence into practice include:

Apply the results to one or a group of clients

Reconsider treatment plans/goals Develop handouts on topics (with other

professionals)

Considerations when implementing evidence

Who is the right therapist to be implementing the evidence?

What does the evidence say the “right” thing to do is?

What is the right way to implement the intervention?

What is the right place for the implementation?

What is the right time to implement?

Step 5: Evaluating the impact of the evidence

When evaluating the impact, consider:

The client’s outcomes Cost effectiveness Client satisfaction Therapist satisfaction

Barriers to EBPSome barriers to EBP that have been discussed in

literature include: Access and availability to information Limited time Lack of EBP skills Confidence in the value of the evidence Support from management Conflict with client centered philosophy of OT

HOWEVER, BARRIERS CAN ALWAYS BE OVERCOME

Becoming an Evidence Based Practitioner

Strategies include: Regularly ask clinical reflective

questions Take time to track down the best

evidence to support your therapy Use the evidence in your therapy Evaluate the impact of this evidence on

your therapy

Useful Resources

Databases: AMED- rehab and therapy for allied health

professions, accessed through www.silverplatter.com/catalog/amed.htm

CINAHL- mainly nursing literature but some allied health, www.cinahl.com/

Cochrane Library- RCTs and Systematic Reviews, www.cochrane.co.uk/

OT Seeker- Systematic Reviews and RCTs relating to OT, www.otseeker.com/

Useful Resources

Websites: HealthWeb: tutorials and guides to searching

literature- www.healthweb.org/browse.cfm?subjectid=39

British medical journals: articles relating to EBP- http://bmj.bmjjournals.com/collections/

Canadian Centre for Health Evidence: description of EBP www.cche.net/usersguides/main.asp

Useful Resources

Websites Continued: OT EBP research group: article analysis

guidelines- www-fhs.mcmaster.ca/rehab/ebp

Joanna Briggs Institute: International Research Collaboration, centres incl. Thailand and Australia www.joannabriggs.edu.au/about/home.php

For more useful internet resources see:www.library.unisa.edu.au/resources/subject/ebmed.asp

References: Alison Lane- Evidence Based Practice

Presentation, Pt Pirie Mary Russell- Evidence Based Practice

Presentation, UniSA Taylor, MC 2002, ‘Evidence Based Practice

for Occupational Therapists,’ Blackwell Science Ltd, USA

Holm MB 2000, The 2000 Elanor Clarke Slagle Lecture: Our Mandate for the New Millenium: Evidence-Based Practice, American Journal of Occupational Therapy, vol.54, no.6, pp.575-85