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EVIDENCE BASED PRACTICE

EVIDENCE BASED PRACTICE. Amy Baker and Melissa Edwards 4 th year Occupational Therapy Students University of South Australia. 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.

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EVIDENCE BASED PRACTICE

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  1. EVIDENCE BASED PRACTICE Amy Baker and Melissa Edwards 4th year Occupational Therapy Students University of South Australia

  2. 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

  3. 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)

  4. 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

  5. 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

  6. 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

  7. ANY QUESTIONS?

  8. How to use EBP Overview Five 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

  9. 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

  10. 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)”

  11. 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

  12. 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?

  13. 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?

  14. Critiquing an EBP Question

  15. Activity: writing a review question Work 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.”

  16. 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

  17. 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)

  18. Key Terms and Search Limits • Pull out the key terms from your review question • Generally the problem, intervention and outcome • Consider alternative or related terms (eg. Occupation and activity) • Set limits for your search, including • Language of the article • Research design • Date of publication

  19. 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 research • Significance of the results • Impact upon your OT practice

  20. 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

  21. 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

  22. 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)

  23. 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?

  24. Step 5: Evaluating the impact of the evidence When evaluating the impact, consider: • The client’s outcomes • Cost effectiveness • Client satisfaction • Therapist satisfaction

  25. Barriers to EBP Some 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

  26. 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

  27. 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/

  28. 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

  29. 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

  30. ANY QUESTIONS?

  31. 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

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