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Evidence-Based Practice Strategies for Busy Clinicians

Evidence-Based Practice Strategies for Busy Clinicians. Yvonne Swinth, PhD, OTR/L, FAOTA Associate Professor University of Puget Sound. “How do you know that what you do and how you do it really works?” Holm, 2000. Common Definition.

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Evidence-Based Practice Strategies for Busy Clinicians

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  1. Evidence-Based Practice Strategies for Busy Clinicians Yvonne Swinth, PhD, OTR/L, FAOTA Associate Professor University of Puget Sound

  2. “How do you know that what you do and how you do it really works?” • Holm, 2000

  3. 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

  4. 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

  5. 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

  6. Types of Evidence • Peer reviewed journals • Book Chapters • Case Studies • Clinical Data • Online Resources • Clinical Experience • Expert Opinion • Peer reviewed • Non-peer reviewed

  7. 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.

  8. 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

  9. 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

  10. 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

  11. Articulate your Hypothesis • Ask questions like: • What are the strengths/concerns? • What intervention are you considering? • What are some potential contraindications?

  12. 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

  13. 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/

  14. 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

  15. 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)

  16. 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

  17. 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?

  18. Implement Intervention • “NIKE moment” – Just DO IT

  19. Evaluate the Effectiveness of Your Intervention • Use your data to determine if the intervention is taking you where you want to go….

  20. 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

  21. 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

  22. 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)

  23. 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

  24. The Process Illustrated

  25. 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

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