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 The Evidence-Based
Practitioner: Applying Research
to Meet Client Needs

4366_FM_i-xxii.indd i 27/10/16 2:13 pm

4366_FM_i-xxii.indd ii 27/10/16 2:13 pm
 The Evidence-Based
Practitioner: Applying
Research to Meet Client Needs
Catana Brown, PhD, OTR/L, FAOTA
Midwestern University
Department of Occupational Therapy
Glendale, Arizona

4366_FM_i-xxii.indd iii 27/10/16 2:13 pm

 F. A. Davis Company
1915 Arch Street
Philadelphia, PA 19103
www.fadavis.com

Copyright © 2017 by F. A. Davis Company

Copyright © 2017 by F. A. Davis Company. All rights reserved. This product is protected by copyright. No part of it may be reproduced, stored
in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written
permission from the publisher.

Printed in the United States of America

Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1

Senior Acquisitions Editor: Christa A. Fratantoro

Director of Content Development: George W. Lang
Developmental Editor: Nancy J. Peterson
Content Project Manager: Julie Chase
Art and Design Manager: Carolyn O’Brien

As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes.
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of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and
make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader
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any drug. Caution is especially urged when using new or infrequently ordered drugs.

Library of Congress Cataloging-in-Publication Data

Names: Brown, Catana, author.

Title: The evidence-based practitioner : applying research to meet client
needs / Catana Brown.
Description: Philadelphia : F.A. Davis Company, [2017] | Includes
bibliographical references and index.
Identifiers: LCCN 2016046032 | ISBN 9780803643666 (pbk. : alk. paper)
Subjects: | MESH: Occupational Therapy | Evidence-Based Practice | Physical
Therapy Modalities | Speech Therapy | Language Therapy | Problems and
Exercises
Classification: LCC RM735.3 | NLM WB 18.2 | DDC 615.8/515—dc23 LC record available at https://lccn.loc.gov/2016046032

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4366_FM_i-xxii.indd iv 27/10/16 2:13 pm

 For Lauren—

You’re an astonishing teacher, despite the fact that you won’t read this book.

But then I probably won’t read your opera book, either.

CB

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4366_FM_i-xxii.indd vi 27/10/16 2:13 pm
 Foreword

The introduction of evidence-based medicine by David the details of a particular assessment. Although it does
Sackett and other researchers in the 1990s (Sackett, require learning about research methods and design,
1997) initiated a radical shift in the approach to in- measurement, and statistics, this knowledge is mastered
struction in research methods and the application of in the context of appraising evidence in relation to a
research findings to health-care practice. Until then, particular clinical question regarding a particular clini-
practitioners learned about research through standard cal scenario. The EBP process involves a specific set of
academic research methods courses in which they were steps to formulate an answerable question, and then to
taught to read and critique journal articles using the search, select, appraise, and apply the evidence to an-
well-established criteria of reliability and validity. They swer the clinical decision at hand. Ideally, students will
were then expected to use those skills to “keep up” with have multiple opportunities to practice these steps so
the research literature relevant to their area of practice that ultimately the process can be initiated and carried
and apply the results to patient care. Unfortunately, for out smoothly and efficiently in occupational therapy
the most part, they didn’t. practice.
Sackett and his colleagues determined that the tra- One of the valuable features of this text is that it is
ditional approach to applying research to practice was designed to be used with team-based learning. This ap-
ineffective, and they proposed a radically different proach supports another important element of Sackett’s
approach—what we now recognize as evidence-based (Sackett, 1997) and others’ original recommendations for
practice. What was so different? Sackett and colleagues how to conduct EBP: that is, the importance of distrib-
recognized that research was relevant and useful to the uting the work and learning from one another’s insights.
Team-based learning models a method that can be carried
practitioner only to the extent that it addressed a clinical
forward into the “real world” to continue to implement
question of importance to practice and provided a useful
EBP in practice.
guide to clinical decision-making. From this perspec-
Here’s what this can look like: Each of the five practi-
tive, reading journal articles just to “keep current” and
tioners in a group prepares and shares an appraisal of one
without a particular question in mind was unfocused and
key study that addresses a clinical question of importance
unproductive.
to the group. In less than an hour of discussion, the group
The alternative method they proposed taught practi- synthesizes the findings and reaches a decision on the best
tioners to use research evidence as one of three integral answer (known as the “clinical bottom line” in EBP) to a
components of clinical reasoning and decision-making. clinical question at hand. One busy practitioner working
This method is reflected in the now-familiar definition of alone might find that amount of work daunting. In addi-
evidence-based practice: integration of the clinician’s exper- tion, he or she would miss the crucial insights that other
tise and the best available scientific evidence with the cli- group participants provide.
ent’s preferences and values to determine an appropriate There’s another important advantage to team-based
course of action in a clinical encounter. EBP: it’s much more fun. Group members energize one
To support the use of evidence-based practice as an another, and examining the evidence becomes an inter-
integral part of clinical reasoning, a different method of esting exploration and lively discussion of how best to
instruction was developed, which is exemplified in The balance strengths and limitations, clinical relevance and
Evidence-Based Practitioner: Applying Research to Meet feasibility, and similarities and differences in the evidence.
Client Needs. Evidence-based practice (EBP) is a pro- The outcome of that lively discussion will help ensure
cess to be learned, not a content area to be mastered that your clinical decisions are guided by the best evi-
the way we learn to identify the bones of the body or dence available to help your clients.

vii

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 viii Foreword

In The Evidence-Based Practitioner: Applying Research to I hope that you will approach learning EBP as a great
Meet Client Needs, Catana Brown provides occupational adventure and that you and your fellow students make
therapy, physical therapy, and speech-language pathology exciting discoveries.
students with a clear and concise overview of research de-
signs, methodology, use of statistical analysis, and levels Wendy Coster, PhD, OTR/L FAOTA
of evidence, as well as the tools with which to evaluate Professor and Chair, Department of Occupational Therapy
and apply evidence. Interesting and engaging features Director, Behavior and Health Program
such as From the Evidence lead the readers through the Boston University
steps to becoming effective consumers of evidence. Exer- Boston, Massachusetts, USA
cises and Critical Thinking Questions motivate learners Sackett, D. L. (1997). Evidence-based medicine: How to
to explore how this knowledge can be applied to their practice and teach EBM. New York/Edinburgh: Churchill
clinical practice. Livingstone.

4366_FM_i-xxii.indd viii 27/10/16 2:13 pm

 Preface

Evidence-based practice is no longer a new idea: it’s The text contains 11 chapters and is intended to fit
a mandate from third-party payers, accrediting bod- within a single entry-level course in a health-care pro-
ies, health-care institutions, and clients. Although the gram. It will fit ideally into programs offering a course on
majority of therapists will become practitioners and evidence-based practice, and can also be used to support a
consumers of research rather than academic research- traditional research methods text in research courses that
ers, good consumers of research must still understand cover evidence-based practice.
how a study is put together and how to analyze the re- The content of the initial chapters focuses on explain-
sults. Occupational therapists, physical therapists, and ing basic research concepts, including describing qualita-
speech-language pathologists are expected to use evi- tive and quantitative approaches. A separate chapter on
dence when discussing intervention options with clients statistics is included in this introductory material. Subse-
and their families, and when making clinical decisions. quent chapters explain the different designs used in health-
The skills required to be an effective evidence-based care research, including separate chapters for each of the
practitioner are complex; for many therapists, finding following types of research: intervention, assessment,
and reviewing research is considered a daunting or descriptive/predictive, and qualitative, as well as a chapter
tedious endeavor. In addition, evidence-based practice on systematic reviews. These chapters prepare students to
is still new enough that many working therapists were match their own evidence-based questions with the cor-
not trained in the methods, and some work settings have rect type of research. In addition, students will acquire the
not yet adopted a culture of evidence-based practice knowledge and skills necessary to understand research arti-
that provides sufficient resources. cles, including those aspects of the research article that can
be particularly befuddling: statistics, tables, and graphs.
Importantly, the chapters provide students with an under-
GUIDING PRINCIPLE: CONSUMING standing of how to evaluate the quality of research studies.
VS. CONDUCTING RESEARCH The text ends with a chapter on integrating evidence from
multiple sources, which highlights the importance of in-
The Evidence-Based Practitioner: Applying Research to Meet volving clients and families in the decision-making process
Client Needs is designed for entry-level graduate students by sharing the evidence.
in occupational therapy, physical therapy, and speech-
language pathology, particularly those in courses that
focus on evidence-based practice versus the performance
of research. Its emphasis is on providing therapists with
A TEAM-BASED LEARNING WORKTEXT
the knowledge and tools necessary to access evidence, cri- This text uses a unique team-based learning (TBL)
tique its strength and applicability, and use evidence from approach. TBL is a specific instructional strategy that
all sources (i.e., research, the client, and clinical experience) facilitates the type of learning that helps students solve
to make well-informed clinical decisions. problems. It is a method that requires active involvement
This textbook was designed with multiple features of the student in the learning process from the outset.
that allow students and practitioners not only to ac- Ideally, students work in small teams, using methods that
quire knowledge about evidence-based practice, but also enhance accountability for both individual and team work;
to begin to apply that knowledge in the real world. this can result in a deeper level of understanding that is
Numerous examples and excerpts of published journal more relevant to real-life practice. Still, this textbook is
articles from occupational therapy, physical therapy, and useful for all types of instructional strategies and is rele-
speech-language pathology are used throughout the text. vant even with approaches that do not use a TBL format.
In addition to learning about evidence-based practice, Nevertheless, TBL provides the pedagogy for applying
students are exposed to research in their own disciplines information, and therefore one strength of this text is its
and the disciplines of their future team members. emphasis on application.

ix

4366_FM_i-xxii.indd ix 27/10/16 2:13 pm

Visit https://ebookmass.com today to explore
a vast collection of ebooks across various
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 x Preface

To facilitate application, the text is presented as a advanced skills needed for assessing the strength and
worktext that interweaves narrative with exercises, crit- applicability of evidence, and apply the material to prac-
ical thinking questions, and other means of engaging tice. The Evidence-Based Practitioner: Applying Research to
students and helping them comprehend the informa- Meet Client Needs includes several special features.
tion. When appropriate, answers to these questions are
included at the end of the chapter. An advantage of the
Key Terms
worktext approach is that it gets students engaged with
the material from the beginning. In courses that use a An alphabetical list of key terms appears at the beginning
TBL format, the worktext prepares students to be effec- of each chapter. These terms are also bolded where they
tive team members. are first described in the chapter and fully defined in the
end-of-book glossary.

TERMINOLOGY From the Evidence

A challenging aspect of evidence-based practice for stu-
Students often have trouble applying research concepts
dents and instructors alike is terminology. In fact, this was
to reading a research article. This key feature helps stu-
one of the greatest challenges for the author of this text.
dents make the link by providing real-world examples
In evidence-based practice, several different terms can be
from research articles in occupational therapy, physi-
used to describe the same or similar concepts. Making
cal therapy, and speech-language pathology. From the
matters more difficult, there are several issues with termi-
Evidence visually walks the student through graphic ex-
nology that can make deciphering the research literature
amples such as abstracts, tables, and figures to illustrate
perplexing. For example:
key concepts explained in the chapter. Arrows and text
• Different terms are used to describe the same or sim- boxes are used to point out and elucidate the concept
ilar concepts. of interest.
• There are disagreements among experts as to the proper From the Evidence features are included in each
use of some terms. chapter. Each has at least one corresponding question to
• Terms are used incorrectly, even in peer-reviewed ensure that the student fully understands the material.
articles. Answers to these questions are provided at the end of
• Labels and terms are sometimes omitted from research each chapter.
articles.
Because deciphering research terminology is chal- Exercises
lenging, a significant effort was directed toward using
Exercises are distributed throughout the chapters to help
the most common terms that are likely to appear in the
students learn to apply information in context. In TBL
literature. When multiple terms are routinely used, this
courses, the exercises are intended to prepare students for
is explained in the text. For example, what some call a
the in-class team assignments; similarly, in flipped class-
nonrandomized controlled trial may be described by oth-
rooms, students would complete the exercises at home
ers as a quasi-experimental study.
and arrive at class prepared for discussions and activities.
Due to the challenges with terminology, students
Each exercise is tied directly to a Learning Outcome and
need to read actual articles and excerpts of articles during
includes questions requiring students to apply the knowl-
the learning process so that these terminology issues can
edge acquired in the chapter. There is space in the text for
become transparent. When students have a more thor-
the student to complete the exercise, and the answers are
ough understanding of a concept and the terms involved,
provided at the end of the chapter.
they can better interpret the idiosyncrasies of individual
articles.
Fortunately many journals are creating standard for- Understanding Statistics
mats for reporting research, and with time some termi-
After Chapter 4, “Understanding Statistics: What They
nology issues will be resolved, although differences in
Tell You and How to Apply Them in Practice,” the
opinion and disciplines (e.g., school-based practice vs.
Understanding Statistics feature is included in chapters
medicine) will likely continue to exist.
in which specific statistical procedures are described.
Understanding Statistics boxes provide an example of a
statistic with additional explanation to reinforce informa-
SPECIAL FEATURES tion that is typically challenging. The feature also helps
The special features developed for this text will enable put the information in context for students by associating
students to better understand content, develop the the statistic with a specific research design.

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 Preface xi

Evidence in the Real World as prompts for students to evaluate their comprehension
of the chapter concepts.
The Evidence in the Real World feature uses a story-
telling or case scenario approach to demonstrate how
theoretical research concepts apply to real-life practice. CLOSING THOUGHTS
It serves as another method of demystifying research
concepts—such as how the concept of standard devia- In today’s health-care environment, occupational ther-
tions can be used to understand the autism spectrum— apists, physical therapists, and speech-language pathol-
and showing students the relevance/practical application ogists must be proficient in accessing, critiquing, and
of what they are learning. applying research in order to be effective evidence-based
practitioners. With solid foundational information and
engaging application exercises, this text provides the
Critical Thinking Questions framework for developing the evidence-based practice
Each chapter ends with Critical Thinking Questions. skills that allow practitioners to best meet their clients’
These questions require higher-level thinking and serve needs.

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4366_FM_i-xxii.indd xii 27/10/16 2:13 pm
 Acknowledgment

Although it is now widely valued, evidence-based practice rough drafts of the text and provided invaluable feedback,
is not the favorite topic of most rehabilitation therapy stu- resulting in the addition, clarification, and improvement
dents. When I began this process, I knew that I wanted a of the content. I would especially like to thank Morgan
very different sort of textbook that would require students Lloyd, who helped me with some of the content that was
to actively engage with the material; hence, the use of a the most difficult to explain.
team-based learning format. However, doing something Larry Michaelsen, who developed the team-based
different required a lot of help along the way. learning approach, inspired me to try a new way of teach-
First, I would like to acknowledge the fantastic edito- ing, which ultimately led to my insight that a new type of
rial support provided by F.A. Davis. In particular I would textbook was needed. Furthermore, I would like to thank
like to thank Christa Fratantoro, the acquisitions editor, Bill Roberson and Larry Michaelsen for contributing a
who grasped my vision for a new evidence-based textbook marvelous team-based learning primer as part of the in-
and believed in my ability to pull it off. I appreciate her structor resources.
friendship and backing. Nancy Peterson, developmental Finally, a big thanks to those who offered support, both
editor extraordinaire, was with me through every step of professional and personal, providing me with the time,
the process. All the things that are good about this text are space, and encouragement to make this text a reality. This
better because of Nancy. In addition, Nancy is my sound- includes my chair, Chris Merchant; my husband, Alan
ing board, my counselor, motivator, and guide. Berman; and my friend, Bob Gravel.
I owe a debt of gratitude to the occupational therapy
and physical therapy students at Midwestern University– Catana Brown, PhD, OTR/L, FAOTA
Glendale in Arizona, who used different variations of the

xiii

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4366_FM_i-xxii.indd xiv 27/10/16 2:13 pm
 Reviewers

Evelyn Andersson, PhD, OTR/L Sharon Gutman, PhD, OTR, FAOTA

Associate Professor Associate Professor
School of Occupational Therapy Programs in Occupational Therapy
Midwestern University Columbia University
Glendale, AZ New York, NY

Suzanne R. Brown, PhD, MPH, PT Elisabeth L. Koch, MOT, OTR/L

Educational Consultant Faculty and Clinical Coordinator
Mesa, AZ Occupational Therapy Assistant Program
Metropolitan Community College of Kansas City–Penn
April Catherine Cowan, OTR, OTD, CHT Valley, Health Science Institute
Assistant Professor Kansas City, MO
Occupational Therapy
The University of Texas Medical Branch Teresa Plummer, PhD, OTR/L, CAPS, ATP
Galveston, TX Assistant Professor
School of Occupational Therapy
Denise K. Donica, DHS, OTR/L, BCP Belmont University
Associate Professor, Graduate Program Director Nashville, TN
Occupational Therapy
East Carolina University Patricia J. Scott, PhD, MPH, OT, FAOTA
Greenville, NC Associate Professor
Occupational Therapy
Marc E. Fey, PhD, CCC-SLP Indiana University
Professor Indianapolis, IN
Department of Hearing and Speech
University of Kansas Medical Center
Kansas City, KS

Thomas F. Fisher, PhD, OTR, CCM, FAOTA

Professor and Chair
Occupational Therapy
Indiana University
Indianapolis, IN

xv

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4366_FM_i-xxii.indd xvi 27/10/16 2:13 pm
 Contents in Brief

Chapter 1 Chapter 7
Evidence-Based Practice: Why Do Using the Evidence to Evaluate
Practitioners Need to Understand Measurement Studies and Select
Research? 1 Appropriate Tests 127

Chapter 2 Chapter 8
Finding and Reading Evidence: Descriptive and Predictive Research
The First Steps in Evidence-Based Designs: Understanding Conditions
Practice 21 and Making Clinical Predictions 145

Chapter 3 Chapter 9
Research Methods and Variables: Qualitative Designs and Methods:
Creating a Foundation for Evaluating Exploring the Lived Experience 163
Research 39
Chapter 10
Chapter 4 Tools for Practitioners That Synthesize
Understanding Statistics: What They the Results of Multiple Studies:
Tell You and How to Apply Them in Systematic Reviews and Practice
Practice 59 Guidelines 183

Chapter 5 Chapter 11
Validity: What Makes a Study Strong? 81 Integrating Evidence From Multiple
Sources: Involving Clients and
Chapter 6 Families in Decision-Making 203
Choosing Interventions for Glossary 217
Practice: Designs to Answer Efficacy
Questions 103 Index 225

xvii

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4366_FM_i-xxii.indd xviii 27/10/16 2:13 pm
 Contents

Chapter 1 Chapter 2
Evidence-Based Practice: Why Do Finding and Reading Evidence: The First
Practitioners Need to Understand Steps in Evidence-Based Practice 21
Research? 1 INTRODUCTION 22
INTRODUCTION 2 IDENTIFYING DATABASES 22
WHAT IS EVIDENCE-BASED PRACTICE? 2 PubMed 24
External Scientific Evidence 3 Cumulative Index of Nursing and Allied Health
Practitioner Experience 3 Literature 25
Client Situation and Values 5 Cochrane Database of Systematic Reviews 25
WHY EVIDENCE-BASED PRACTICE? 6 EMPLOYING SEARCH STRATEGIES 25
THE PROCESS OF EVIDENCE-BASED PRACTICE 7 Selecting Key Words and Search Terms 26
Combining Terms and Using Advanced Search 26
Formulate a Question Based on a Clinical
Using Limits and Filters 27
Problem 7
Expanding Your Search 29
Identify the Relevant Evidence 7
Evaluate the Evidence 7 ACCESSING THE EVIDENCE 29
Implement Useful Findings 8 The Research Librarian 30
Evaluate the Outcomes 8 Professional Organizations 31
WRITING AN EVIDENCE-BASED QUESTION 9 DETERMINING THE CREDIBILITY OF A SOURCE
Questions on Efficacy of an Intervention 9 OF EVIDENCE 31
Research Designs for Efficacy Questions Websites 32
and Levels of Evidence 10 The Public Press/News Media 32
Questions for Usefulness of an Assessment 13 Scholarly Publications 33
Research Designs Used in Assessment Impact Factor 33
Studies 13 The Peer-Review Process 33
Questions for Description of a Condition 14 Research Funding Bias 34
Research Designs Used in Descriptive Studies 14 Publication Bias 34
Questions for Prediction of an Outcome 14 Duplicate Publication 34
Research Designs Used in Predictive Studies 14 READING A RESEARCH ARTICLE 35
Questions About the Client’s Lived
Title 35
Experience 15
Authorship 35
Research Designs Addressing the Client’s Lived
Abstract 35
Experience 16
Introduction 35
CRITICAL THINKING QUESTIONS 16 Methods 35
ANSWERS 17 Results 36
REFERENCES 18 Discussion 37

xix

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abgerundet. 6–9. Wege, Schutt, gemein
Weg-M., M. neglécta Wallroth
— Frstiele abstehend od. aufrecht; Blblätt. 3–4mal so lang als der
Kelch; Bltn größer als bei vor., hellpurpurn, dunkler gestreift. 7–9.
Wie vor., häufig
Wilde M., M. silvéstris L.
In Gärten und daraus verwild. M. mauritiána L., die sich von M. silvéstris durch den
kräftigen Wuchs und den aufrechten, fast kahlen Stengel unterscheidet.

2. Althǣa L., Eibisch. XVI.

1. Stengel filzig-zottig; Blätt. beiderseits sammetart. filzig; Bltn
büschelig gehäuft. 7. 8. Feuchte Orte, sehr zerstr.
Echter E., A. officinális L.
— Stengel rauhhaarig, aber nicht filzig; Bltn einzeln,
blattachselständig
2
2. Blätt. 5–7eckig; Bltn groß, verschiedenfarbig. 7. 8. Häufige Zierpfl.
Stockrose, A. rósea Cavanilles
— Blätt. rundl., nierenf., 5lappig, obere tief 3–5spalt.; Bltn rosenrot.
7. 8. Äcker, Weinberge, selten
Rauher E., A. hirsúta L.

3. Lavatéra L., Malve. XVI.

Unt. Blätt. eckig gelappt, obere 3lappig; Bltn blaßrosenrot. 7. 8.
Wege, Weinberge, sehr zerstr.
Thüringer M., L. thuringíaca L.

39. Familie. Geraniáceae, Storchschnabelgewächse.

Blätt. handf. gespalten od. 3–5zählig zusammengesetzt (Fig. 460 bis
462); Stbblätt. 10, meist alle mit Stbbeuteln; Grannen der Fr.
innen kahl, bei der Reife bogenf. aufwärts gekrümmt
Geránium 155
Blätt. gefied.; Stbblätt. 10, nur 5 mit Stbbeuteln; Grannen der Fr.
innen behaart, bei der Reife in der unt. Hälfte spiralig gedreht
Eródium 156

1. Geránium L., Storchschnabel. XVI.

1. Blkr. meist klein (bis 1½ cm br.), meist wenig länger, höchstens
doppelt so lang als der Kelch. Pfl. ohne unterirdischen Stengel,
nur mit dünner, einfacher Wurzel, 1jährig
7
— Blkr. groß (1½-4 cm br.), meist doppelt so lang als der Kelch. Pfl.
mit dickem, unterirdischem Stengel, ausdauernd
2
2. Die blattachselst. Bltnstiele sind 1blütig; Blätt. tief 7teilig, mit
gespaltenen, linealischen Zipfeln; Bltn blutrot. 6–8. Waldwiesen,
 sehr zerstr.
Blutroter St., G. sanguíneum L.
— Bltnstiele 2blütig
3
3. Bltn schwarzviolett, selten rotbraun; Blblätter flach ausgebreitet,
rundl.-verkehrt-eiförm., etwas länger als der Kelch; Früchtch.
behaart, querrunzlig. 5. 6. Gebirgstäler, selten, auch in Gärten
und daraus verwildert
Brauner St., G. phaeum L.
— Bltn blau, violett od. purpurn; Blblätt. doppelt so lang als der
Kelch; Früchtchen glatt
4
4. Blblätt. tief 2spalt.; Blätt. im Umriß nierenf., mit abgerundeten
Zipfeln. 5–10. Waldwiesen. Mittel- und Süddeutschl., auch
verschleppt
Anger-St., G. pyrenáicum L.
— Blblätt. ungeteilt od. seicht ausgerandet; Blattzipfel zugespitzt
5
5. Stengel und Bltnstiele rauhhaarig, drüsenlos; Samen längsstreifig;
Bltn rot. 6–8. Feuchte Orte, zerstr.
Sumpf-St., G. palústre L.
— Stengel u. Bltnstiele drüsig behaart; Samen punktiert
6
6. Stbfäden am Grunde breit eif., plötzlich verschmälert (Fig. 458);
Blblätt. über dem Nagel gewimpert, violettblau; Bltnstiele nach
dem Verblühen herabgeschlagen (zur Frzeit oft wieder aufrecht);
Blattzipfel schmal fiederspaltig. 6–8. Wiesen, Grasplätze, zerstr.
(in Nordwestdeutschl. u. Holstein nicht einheimisch)
Wiesen-St., G. praténse L.
 Fig.
458.

— Stbfäden lanzettlich, allmählich verschmälert (Fig. 459); Blblätt.

über dem Nagel bärtig, rötl. violett; Bltnstiele nach dem
Verblühen aufrecht; Blattzipfel eingeschnitten gesägt. 6. 7.
Bergige Laubwälder, meist sehr zerstr.
Wald-St., G. silváticum L.

Fig. 459.

7. (1.) Blätt. aus 3–5 gestielten, fiederspalt. Blättch.

zusammengesetzt (Fig. 460); Stengel rot; Bltn rosa, mit 3 weißl.
Streifen. 6–10. Gebüsche, gemein
Ruprechtskraut, G. robertiánum L.

Fig. 460.

— Blätt. 5–9teilig, nicht aus gestielten Blättchen zusammengesetzt

8
8. Blblätt. an der Spitze ausgerandet od. eingeschnitten
10
— Blblätt. nicht ausgerandet, an der Spitze abgerundet
9
9. Stengel, Blätt. und Fr. behaart; Blblätt. verkehrt eif. 6–10. Äcker,
sehr selten
Rundblättr. St., G. rotundifólium L.
— Pfl. fast ganz kahl; Stengel meist rot, zerbrechlich; Blätt.
glänzend; Blblätt. längl.-keilf. 5–8. Gebirgswälder, selten
Glänzender St., G. lúcidum L.

Fig. 461.

10. Blätt. fast bis auf den Grund geteilt, mit tief fiederspalt. Blättch.
(Fig. 461)
15
— Blätt. etwa bis zur Mitte eingeschnitten (Fig. 462)
11

Fig. 462.
11. Blätt. im Umriß rundl.; Kelchblätt. kurz bespitzt
13
— Blätt. eckig; Kelchblätt. begrannt
12
12. Bltn blau; Stbfäden zottig; Kelchblätt. nebst den glatten Fr.
drüsenhaarig. 6. 7. Sehr selten (Oberlausitz, Böhmen)
Böhmischer St., G. bohémicum L.
— Bltn rosa; Stbfäden kahl; Kelchblätt. nebst den querrunzl. Fr.
kurzhaarig[26]. 7. 8. Weinberge, selten in Mitteldeutschl.
Ausgebreiteter St., G. divaricátum Ehrh.
13. Blblätt. so lang als der Kelch, schwach ausgerandet, ca. 4 mm
lang; Fr. glatt, behaart (Fig. 463); Bltn blaßviolett. 5–8. Schutt,
häufig
Kleiner St., G. pusíllum L.
— Blblätt. länger als der Kelch, ca. 5–8 mm lang, tief
eingeschnitten
14
14. Fr. kahl, querrunzlig (Fig. 464); Stengel kurzhaarig
Fig. 463. und zugleich von langen Haaren zottig; Bltn rosa. 5–
10. Grasplätze, Wege, häufig.
Weicher St., G. molle L.
— Fr. behaart, glatt; Stengel weichhaarig; Bltnstiele drüsig behaart;
Bltn violett, selten weiß
G. pyrenáicum L. (S. No. 4.)
15. (10.) Bltnstiele viel länger als die sie stützenden Blätt.;
Fr. kahl, mit drüsenlos behaart. Schnabel. 5–10. Hügel,
steinige Orte, zerstr.
Stein-St., G. columbínum L.

Fig. 464.
— Bltnstiele meist kürzer als die Blätt.; Fr. drüsenhaarig. 5–10. Äcker,
Wegränder, meist häufig
Schlitzblättriger St., G. disséctum L.

2. Eródium L'Héritier, Reiherschnabel. XVI.

Bltn in Dolden, purpurn, zuweilen gefleckt. 4–10. Bebauter Boden,
sandige Triften, häufig
E. cicutárium L'Héritier

40. Familie. Oxalidáceae, Sauerkleegewächse.

1. Óxalis L., Sauerklee. X.
1. Bltn weiß od. rötlich; Blätt. u. Bltnstiele grundst. 4. 5. Laubwälder,
häufig
Hain-S., O. acetosélla L.
— Bltn gelb
2
2. Blattstiel am Grunde mit 2 sehr kleinen, angewachsenen
Nebenblätt. (Fig. 465); Stengel niederliegend. 6–8. Bebauter
Boden, sehr zerstr.
Gehörnter S., O. corniculáta L.
— Blattstiel am Grunde ohne Nebenblätt.; Stengel aufrecht. Wie vor.,
nicht selt.
Steifer S., O. stricta L.
Tropǣolum majus L., Kapuzinerkresse, mit langgestielten, kreisf. Blätt. und
orangefarbenen bis roten Bltn, ist oft in Gärten angepfl.
 Fig. 465.

41. Familie. Balsamináceae, Balsaminengewächse.

1. Impátiens L., Springkraut. V.
Bltn groß, hängend, mit gekrümmtem Sporn. 7. 8. Feuchte Wälder
und Gebüsche, nicht selten
Echtes Sp., I. noli tángere L.
Bltn klein, aufrecht, mit geradem Sporn. 7. 8. Verwildert
Kleines Sp., I. parviflóra DC.

42. Familie. Lináceae, Leingewächse.

1. Linum L., Lein. V.
1. Blätt. gegenst.; Stengel gabelästig; Bltn klein, weiß; Kelchblätt.
schwach drüsig gewimpert. 6–8. Wiesen, Triften, häufig
Wiesen-L., L. cathárticum L.
— Blätt. wechselst.; Bltn ansehnlich, sehr selten weiß
2
2. Bltn blau, selten weiß
5
— Bltn gelb od. rötlich
3
3. Bltn gelb; Stengel oben scharfkant.; Blätt. kahl. 7. 8. Bergwiesen,
sehr selten (Südostdeutschl.)
Gelber L., L. flavum L.
— Bltn rötlich; Blätt. zottig od. am Rande gewimpert
4
4. Blätt. lanzettl. (4–9 mm br.); Stengel von abstehend. Haaren
zottig. 6. 7. Wiesen, Heiden, sehr selten in Süddeutschl.
Klebriger L., L. viscósum L.
— Blätt. sehr schmal (ca. 1½ mm br.), kahl, am Rande wimperig-
rauh. 6. 7. Kalkhügel, sehr zerstr.
Zarter L., L. tenuifólium L.
5. Stengel einzeln; Kelchblätt. am Rande fein gewimpert. 6. 7.
Gebaut
Echter L., Flachs, L. usitatíssimum L.
— Stengel zu mehreren; Kelchblätt. kahl
6
6. Bltnstiele nach dem Verblühen bogig überhängend. 6. Unbebaute
Orte (Lothringen). Zuweilen verschleppt
Österreichischer L., L. austríacum L.
— Bltnstiele und Frstiele steif aufrecht. 6. 7. Sonnige Hügel, sehr
selten, auch angepflanzt und verwildert
Ausdauernder L., L. perénne L.

2. Radíola Roth, Zwerglein. IV.

Feuchte, sandige Orte, zerstr. 7. 8.
R. linoídes Roth

43. Familie. Polygaláceae, Kreuzblumengewächse.

1. Polýgala L., Kreuzblume. XVII.
1. Bltn gelb; vord. Blumenblatt 4lappig; Stengel holzig; Blätt.
lederart. 4–6. Heiden u. Wälder Mitteldeutschl., sehr selten
Zwergbuchs, P. chamaebúxus L.
— Bltn weiß, rötlich od. bläulich; vord. Blblatt vielsp. (Fig. 53);
Stengel und Blätt. krautig
2
2. Seitennerven der flügelf. Kelchblätt. an der Spitze mit dem
Mittelnerven nicht verbunden, spärlich verzweigt, nicht netzig
verbunden (Fig. 466b); untere Blätt. viel größer als die oberen,
rosettig. 5. 6. Sumpfwiesen, Kalkberge, zerstr. (Ändert mehrfach ab,
z. B. unterste Blätt. sehr groß; Flügel oft kürzer als die Kapsel = P. amarélla
Crantz.)
Bittere K., P. amára L.
— Seitennerven der flügelf. Kelchblätt. an der Spitze durch eine
schräge Ader mit dem Mittelnerven verbunden, nach dem Rande
hin netzig verzweigt (Fig. 466a)
3
3. Traube 3–5blütig, zuletzt seitenst.; Stengel niederliegend, fädlich;
Blätt. lanzettl., gedrängt, unt. elliptisch, fast gegenst. 5–9.
Heiden, Moore, sehr zerstr.
Niederliegende K., P. depréssa Wenderoth
— Traube vielblütig; Blätt. wechselst.
4
4. Mittl. Deckblätt. länger als die Bltnstiele, vor dem Aufblühen die
Bltnknospen überragend und die Traube daher schopfig. 5. 6.
Wiesen, Grasplätze, zerstr., fehlt im nordwestl. Gebiet
Schopfige K., P. comósa Schkuhr
— Deckblättch. der einzelnen Bltn kürzer als die Bltnstiele od. nur
das mittl. etwa so lang; Traube vor dem Aufblühen nicht schopfig
5
 Fig. 466.

5. Die unt., verkehrt-eif. Blätt. länger als die oberen, linealisch-

lanzettl.; Mittelnerv der Flügel etwa von der Mitte an verzweigt.
5. 6. Kalkberge, sehr selten
Kalk-K., P. calcárea F. Schultz
— Die unteren, elliptischen Blätt. kürzer als die oberen, schmal
lanzettl. 5–8. Wiesen, Waldränder, Grasplätze, häufig. (Ändert ab:
a) var. elliáta Lebel, Deckblätt., Bltnstiele und Kelchblätt. bewimpert; b) var.
oxýptera Rchb., Flügel spitz, schmäler als die Kapsel).
Wiesen-K., P. vulgáris L.

44. Familie. Hippocastanáceae,

Roßkastaniengewächse.
1. Aesculus L., Roßkastanie. VII.
Bltn weiß, rot- und gelbgefleckt. 5. 6. Angepflanzt
A. hippocástanum L.
Pávia rubra Lmk. mit purpurnen Bltn findet sich zuweilen angepflanzt, ebenso P. flava
DC. mit gelben Blüten.

45. Familie. Aceráceae, Ahorngewächse.

1. Acer L., Ahorn. VIII.
1. Bltntrauben aufrecht; Stbblätt. so lang als die Blkr.
3
— Bltntrauben hängend; Stbblätt. doppelt so lang als die Blkr.
2

Fig. 467.

2. Blätt. 3lappig, mit stumpfen, ganzrand. Lappen (Fig. 467), klein.

4. Felsabhänge am Rhein
Felsen-A., A. monspessulánum L.
— Blätt. 5lapp., mit zugespitzten, ungleich gesägt. Lappen (Fig.
468). 5. 6. Bergwälder
Berg-A., A. pseudoplatánus L.

Fig. 468.

3. Blätt. 5–7lapp., mit lang zugespitzten, grob gezähnten Lappen

(Fig. 469); Bltn mit den Blätt. erscheinend. 4. 5. Wälder, fehlt in
Nordwestdeutschl.
Spitz-A., A. platanoídes L.
 Fig. 469.

— Blätt. 5lappig, mit stumpfen, ganzrand. od. eingeschnittenen

Lappen, der mittl. stets 3lappig (Fig. 470); Bltn kurz nach den
Blätt. erscheinend. 5. Wie vor.
Feld-A., A. campéstre L.

Fig. 470.
Alle Arten finden sich auch angepflanzt. Außerdem noch häufig: A. rubrum L., mit roten
Bltn; A. dasycárpum Ehrh., mit gelblichgrünen Bltn ohne Blblätt. und A. tatáricum L., mit
ungeteilt, herzeif. Blätt.

2. Negúndo Moench, Eschenahorn. XXII.

Blätt. gefied., zuw. weißgefleckt. Zierbaum aus Nordamerika. 5. (Acer
negundo L.)
N. fraxinifólia Moench

46. Familie. Rutáceae, Rautengewächse.

Blblätt. 4, nur bei der Endblüte meist 5
Ruta 160
Blblätt. 5, etwas ungleich
Dictámnus 160

1. Ruta L., Raute. VIII.

Blblätt. am Rande fransig-ausgefressen, fast schuhf. (Fig. 471), gelb.
6–7. Weinberge, sehr selten, häufiger angebaut
R. gravéolens L.

2. Dictámnus L., Diptam. X.

Bltn rosa, dunkler geadert, selten weiß; Pfl. stark gewürzhaft
riechend. 5. 6. Kalkfelsen, Bergwälder, in Mittel- und Süddeutschl.
D. albus L.
Verwandt ist Ailánthus glandulósa Desfontaines, Götterbaum. In Anlagen.

Fig. 471.

47. Familie. Vitáceae, Weinrebengewächse.

1. Vitis L., Weinstock. V.
Bltn gelblichgrün. 6. 7. Angepflanzt und verwild.
V. vinífera L.

2. Ampelópsis Michaux, Zaunrebe, wilder Wein. V.

Bltn grünlich. 7. 8. Zierstrauch
A. quinquefólia Michaux
 48. Familie. Celastráceae, Spindelbaumgewächse.
1. Evónymus L., Spindelbaum. V.
1. Äste 4kantig, glatt; Blblätt. längl., grün; Kapseln rosenrot,
stumpfkantig, flügellos. 5. Hecken, Gebüsche
Pfaffenhütlein, E. europǣus L.
— Äste stielrund od. etwas zusammengedrückt; Blblätt. rundl.
2
2. Blblätt. grün, rot punktiert; Äste warzig, stielrund; Kapsel
stumpfkantig. 5. 6. Ostdeutschland, selten, auch angepflanzt
Warzen-Sp., E. verrucósus Scopoli
— Blblätt. grünlich, mit roten Rändern; Äste glatt, etwas
zusammengedrückt; Kapsel geflügelt-kantig. 5. 6. Gebirgswälder
Süddeutschl., selten angepflanzt
Alpen-Sp., E. latifólius Scopoli

2. Staphylǣa L., Klappernuß. V.

Blätt. 5–7zählig gefied.; Bltn in oberwärts traubigen Rispen, weißlich.
5. 6. Felsige Wälder Schlesiens, öfters angepfl.
St. pinnáta L.

49. Familie. Rhamnáceae, Kreuzdorngewächse.

1. Rhamnus L., Kreuzdorn. V.
Blattstiel bis 3mal länger als die hinfälligen Nebenblätt.; Blätt. rundl.-
eif.; Bltn grünlich, wie bei der folgenden. H. 1–3 m. 5. 6.
Gebüsche, verbreitet
Echter K., R. cathártica L.
Blattstiel etwa so lang als die Nebenblätt.; Blätt. elliptisch od.
lanzettlich, kleiner und heller als bei vor. H. ⅓-1 m. 5. Felsige,
 sonnige Orte Süddeutschl.
Felsen-K., R. saxátilis L.

2. Frángula L., Faulbaum. V. Gebüsche, Wälder, häufig. 5. 6.

F. alnus Miller

50. Familie. Aquifoliáceae, Stechpalmengewächse.

1. Ilex L., Stechpalme. IV.
Blätt. dornig gezähnt (Fig. 472); Bltn weiß; Fr. eine rote Beere. 5. 6.
Wälder, gesellig, aber nicht überall
I. aquifólium L.

Fig. 472.

51. Familie. Anacardiáceae, Sumachgewächse.

1. Rhus L., Sumach. V.
Blätt. einfach, ganzrand. 6. 7. In Anlag.
Perückenbaum, R. cótinus L.
Blätt. gefied. Wie vor.
Essigbaum, R. týphina L.
Seltener angepflanzt findet sich R. toxicodéndron L. mit 3zähl. Blätt.
 52. Familie. Crassuláceae, Dickblattgewächse.
1. Blblätt., Stbblätt. u. Frkn. 3–4; Blätt. gegenst., linealisch. Winzige,
3–5 cm hohe Pflänzchen mit kleinen, weißen od. rötl. Bltn in den
Blattachseln. Feuchte Orte
Tillǣa 161
— Blblätt. u. Frkn. 4–20; Stbblätt. 5–40; Blätt. meist wechselst.; Bltn
meist gelb od. rot, seltener weiß
2
2. Frkn. 6–20; Stbblätt. 12–40; Kelch- u. Blblätt. 6–20; Blätt. meist
rosettig
Sempervívum 163
— Frkn. 4–5; Stbblätt. 5, 8 od. 10 (selten 12); Kelch u. Blblätt. 4–5;
Blätt. wechselst., seltener gegenst.
3
3. Bltn entweder mit 8 Stbblätt. od. mit 4 Frkn., rötlichgelb, gehäuft;
Blätt. gedrängt
Rhodíola 161
— Jede Blüte enthält Stbblätt. und Stempel
4
4. Stbblätt. 5; Bltn weiß, rotgekielt; Äste drüsig
Crássula 162

Fig. 473.

— Stbblätt. 10, seltener mehr (Fig. 473)

Sedum 162
 1. Tillǣa Micheli, Tilläe. IV.
Blätt. eif., genähert; Blblätt. 3–4; Kapseln 2samig; Stengel meist
liegend, mit aufstrebenden Ästchen. 5. 6. Feuchte Sandfelder,
sehr selten (Westfalen, Rheinprovinz)
Moosartige T., T. muscósa L.
Blätt. linealisch, entfernt; Blblätt. stets 4; Kapseln 1samig; Stengel
niederliegend od. (im Wasser) aufrecht. 8. 9. Sandige Ufer, selten
(Bulliárda aquática DC.)
Wasser-T., T. aquática L.

2. Rhodiola L., Rosenwurz. XXII.

Blätt. längl.-keilf., vorn gesägt. 6. 7. Felsenspalten der höheren
Gebirge
Rh. rósea L.

3. Crássula L., Dickblatt. V.

Bltn einseitswendig, einzeln. 5. 6. Äcker, sehr selten (Trier, Elsaß,
Baden).
C. rubens L.

4. Sedum L., Fetthenne. X.

1. Blätt. stielrund od. halbstielrund.
5
— Blätt. flach und breit
2
2. Bltn grünlich gelb; Blätt. gegenst. od. zu 3 quirlst., unt. sitzend,
obere stengelumfassend. 8. Anhöhen, Felsen, Wälder, häufig
Große F.,
S. máximum Suter
— Bltn rot
3
3. Blätt. ganzrand., gegenst. od. zu 3 od. 4 quirlst., obere linealisch-
keilf.; Stengel oberwärts drüsig. 6. 7. Schattige Orte. Nur bei Baar
im Elsaß u. zuweilen verw.
Rispige F., S. cepǣa L.
— Blätt. an der Spitze gesägt od. gezähnt
4
4. Blätt. mit keilf. Grunde in den Blattstiel verschmälert, wechselst.;
innere Stbblätt. ⅓ über dem Grunde der Blkr. eingefügt. 6.
Felsen, selten
Berg-F., S. fabária Koch
— Unt. Blätt. kurzgestielt, obere mit abgerund. Grunde sitzend, oft
gegenst.; innere Stbblätt. ⅙ über dem Grunde der Blkr.
eingefügt. 7. Wälder, unbebaute Orte, zerstr.
Rote F., S. purpúreum Link
5. (1.) Bltn gelb
8
— Bltn rot od. weiß
6
6. Blätt. und Bltnstiele kahl oder letztere sehr zerstreut drüsig-
behaart; Blblätt. weiß, 3–4mal so lang als der Kelch. 6. 7. Felsen,
fehlt im Norden, zuw. verw.
Weiße F., S. album L.
— Bltnstiele und zuweilen auch die Blätt. drüsig weichhaarig
7
7. Blätt. beiderseits buckelig gewölbt, blaugrün, elliptisch-eif.; Bltn
weiß bis rosa. 6. 7. Felsen Süddeutschl., sonst nur angepfl.
Buckel-F., S. dasyphýllum L.
— Blätt. oberseits flach, drüsig, weichhaarig, über 2mal so lang als
dick; Bltn rosenrot. 7. 8. Torfwiesen, zerstr., fehlt im Nordwesten
Zottige F., S. villósum L.
8. (5.) Pfl. nur blühende Stengel treibend; Äste verlängert,
schlängelig. 6–8. Felsen, Mauern, nur im südl. Gebiete
Sommer-F., S. ánnuum L.
— Pfl. außer den blühenden Stengeln auch mit nichtblühenden
(Blättertriebe)
9

Fig.
474.

9. Blätt. mit Stachelspitze (Fig. 476)

12
— Blätt. stumpf, ohne Stachelspitze (Fig. 474–475)
10
10. Blätt. linealisch-walzl., am Grunde deutlich in einen stumpfen
Sporn ausgezogen (Fig. 474), fast geschmacklos, an den
Blättertrieben nur oberwärts locker 6zeilig angeordnet. 6. 7.
Sandfelder, trockene Orte (S. boloniénse Loiseleur)
Sporn-F., S. mite Gilibert

Fig.
475.

— Blätt. am Grunde nicht od. kaum gespornt (Fig. 475)

11
11. Blätt. dick, eif., an den Blättertrieben dicht dachig in 6
Längsreihen angeordnet, scharf schmeckend; Blblätt. abstehend,
etwas größer und dunkler gelb als bei vor. 6. 7. Felsen, sonnige
Hügel, Mauern, meist häufig
Mauerpfeffer, S. acre L.
— Blätt. linealisch, oft rot überlaufen, nicht deutlich in Reihen
gestellt; Blblätt. aufrecht, blaßgelb. 6. Felsritzen höherer Gebirge,
sehr selten
Gebirgs-F., S. alpéstre Villars
12. (9.) Bltn weißlich schwefelgelb; Kelchzipfel aus breitem Grunde
lanzettl., spitz. 6. 7. Hausberge bei Jena
Blasse F., S. albéscens Haworth
— Bltn goldgelb
13
13. Kelchblätt. spitz; Blätt. am Grunde mit kurzem Sporn (Fig. 476),
entweder grasgrün (var. víride Koch) od. blaugrün (S. rupéstre L.).
7. 8. Die 1. Var. unter dem Namen »Trippmadam« angepfl., die 2.
zerstr. an Felsen und in Nadelwäldern.
Zurückgekrümmte F., S. refléxum L.
— Kelchblätt. stumpf; Blätt. blaugrün, beiderseits flach, am Grunde
kaum gespornt; Blättertriebe kugelig.
(Ändert ab: Blättertriebe verkehrt-kegelf.; Blätt. unterseits gewölbt, purpurrot
od. dunkelgrün, am Grunde mit spitzem Sporn = S. āūreum Wirtgen). 7. 8.
Felsen und Mauern bei Metz und Sierk, die Var. mehrfach in der
Rheingegend.
Gold-F., S. élegans Lejeune

5. Sempervívum L., Hauswurz. XI.

Blblätt. 10–20, rosenrot, sternf. ausgebreitet. 7. 8. Felsen der
Rheingegend, häufig an Mauern und Dächern angepfl.
Echte H., S. tectórum L.
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