SEMINAR

PRESENTATION

BY: PRIYADARSHINI ROUT

MOT 1ST YEAR
INTRODUCTION • The link between research and
practice.

• Evidence is anything that can be used

to prove something.

• Practice is an application, use,

implementation, and execution.

• Evidence Based Practice is a Proof

Based Application.
 EVIDENCE BASED MEDICINE

In,1990 the evidence- It is a systemic approach

based medicine model to analyze published
was developed at MC research as basis of
Master University. clinical decision making.

“The conscientious,
explicit and judicious use
Sackett et al(1996) have
of current best evidence
defined evidence-based
in making decisions about
medicine as-
the care of individual
patients.”
 Evidence Based Practice evolved from Evidence
Based Medicine

Evidence based The evidence-based Now “Evidence Based

medicine is still a process has broadened Practice” is seen as a
commonly used term. and evolved. more appropriate term.
 WHAT IS EVIDENCE BASED
PRACTICE?
• The science of finding, evaluating and implementing the result of medical
(occupational therapy) research can, and often does, make patient care
more objective, more logical, and more cost effective”. – Greenhalgh(1997)

• It means integrating individual clinical expertise with the best available

external clinical evidence from systematic research” Haynes et al (2002) -
Sackett's colleague.
• EBP occurs when a practitioner combines his or her
clinical expertise with the best available research
evidence and the values of the client [Sackett,
Straus, Richardson, Rosenberg, & Haynes, 2000].
 RESEARCH VS EVIDENCE BASED
PRACTICE

Research= systematic EBP= the

EBP is not about process of gathering
conducting research conscientious, explicit
and synthesizing and judicious use of
it is about USING empirical data to
RESEARCH. best current evidence
generate knowledge in making decisions
about a given topic. about care for clients.
EVIDENCE-BASED PRACTICE
IN OCCUPATIONAL THERAPY
Systematic OT practice (SOTP)- A model that synthesizes and builds
on evidence-based approaches to professional practice.

It is defined as “the integration of critical, analytic, scientific thinking

and action processes throughout all phases and domains of
occupational therapy practice”.

(PEDRETTI’S-7Thedition)
WHAT IS THE DIFFERENCE BETWEEN
THINKING AND ACTION PROCESSES?
ACTION PROCESSES

• These are the specific behaviours

involved in implementing thinking

THINKING These are OT practitioner processes.

composed of plans the steps
PROCESSES reasoning necessary to • In SOTP, these steps are founded on
sequence and assess problems,
logic. evaluate
treatment specify
logical inquiry such that any claim is
desired
outcomes, and
supported with empirically derived
plan a research
strategy.
information from variety of sources.
 OT process (Clinical SOTP (Evidence Based
Relationship Decision Making) OT Practice)
between OT
Referral to OT Initial problem statement
process and
SOTP: Systematic assessment of client’s Need statement
occupational profile and analysis
of occupational performance

Intervention goals and objectives Goals and objectives

Regular progress monitoring and Reflexive intervention

revision of intervention in
response

Final assessment of client Outcome assessment

progress
WHY IS EVIDENCE BASED PRACTICE NEEDED?

For providing an
For providing
evidentiary basis for
efficient and cost- 01
clinical thinking and
effective healthcare.
action.

02

For providing a
basis for discussion
with other members
of health care teams.
THE PROCESS OF EVIDENCE BASED
PRACTICE

1. Formulate the questions

2.Find best evidence to answer the question

3.Critical appraisal

4.Apply to Practice

5.Conduct Self-Assessment
 1. Formulate the questions

ASKING THE QUESTION RELATED TO :

PATIENTS CONCERNS /ISSUES

HARM OR ETIOLOGY
DIAGNOSIS
TREATMENT
PROGNOSIS
QUALITY OF CARE AND HEALTH ECONOMICS.
FOR EXAMPLE:

• A therapist is working in an acute psychiatric ward, where many of the

patients are admitted with depression.

• Therapist is developing a program for these depressed patients and is

searching effective interventions to reduce depression.

• One of the interventions he is wondering about is physical exercise.

Relevant questions arising from this
example :

Example of question Requires evidence about

What assessments would be useful for measuring mood/ Diagnosis

motivation levels in patients with depression?

Is inability to manage work stress the most likely cause Harm or Etiology
of depression in this patient?

What should be included in a ward programmed to lift Effects of intervention

mood and enable depressed patients to continue with
their daily activities including return to work?

What are the strongest predictors of return to previous prognosis

occupations in patients with depression?
• SACKETT et. Al.(1997) pointed out that the
identification of information for answering a
particular clinical question may be facilitated
by breaking the question into components.
• Develop a PICO question
1. P: Represents patient characteristics and
interests.
2. I: Represents the intervention, which is used
in the patient’s rehabilitation program.
3. C: Represents comparison intervention.
4. O: Represents the outcome measures.
 Is exercise compared with traditional ward program
effective for improving mood and enabling adults
with depression to return to their previous
occupations?

Patient Adult with depression

Intervention Exercise

Comparison Traditional ward programme

Outcome Improving mood and enabling return to previous

occupations
 2.Find best evidence to answer the question
• Search current best evidence.

• EBP does not recommend searching traditional textbooks.

• Different types of research provide ‘best’ answers for different types of questions: It may
be of :Primary and secondary publications.

• Primary refers to original analytical research.

• Secondary refers to integrative studies that summarize and draw a conclusion from
primary research or from previously published or unpublished studies (McKibbon 1999)
 RCT

COHORT STUDIEs
PRIMARY
PUBLICATION CASE CONTROL &
CASE REPORT

EXPERT OPINION
SECONDARY PUBLICATION

META ANALYSIS SYSTEMATIC REVIEW

OF ARTCLES
 PRIMARY
& SECONDARY
PUBLICATIONS
EVIDENCE
HIERARCHIES
SEARCH AND SORT EVIDENCE:

• Use of specialist database/ journals/ websites of pre-appraised research:

Example:
• The Cochrane Library
• OT seeker (www.otseeker.com)
• Evidence Based Medicine Journal series
• Use of traditional databases, example :
1.CINAHL (Cumulative Index to nursing and allied health literature)
2.MEDLINE
3.PUBMED
4.PSYCinfo, Healthstar
 3. Critically appraise the evidence

The third step is critical appraisal or formal evaluation of the

evidence is to determine the soundness,magnitude and
usefulness to practice.

Level of evidence & grading guidelines vary reflecting the

complexity of research design used during the investigation.

It requires selecting the most consistent result of studies, to

find the best possible answer.
 4.Apply to Practice.

The 4th step is application of The systematic integration of

scientific research findings to the evidence with client factor,
practice. institution factors and staff
expertise results in either
This is the culmination of the rejection or integration of the
search process . research findings into practice.
 5.Conduct self-assessment

• It is an appraisal of the procedures undertaken and reflection on the way the

OTist conducted the steps.

• Once one starts using EBP, the explosion and formidable amount of
information can be overwhelming. Hence, Managers & staff members must
share this methodology with one another for support & validation.

• Effects of intervention are monitored through documentation.

 HISTORY OF LEVEL OF EVIDENCE:

There are 3 types of level There are 5 types of level

of evidence present: of evidence present.
I-Large RCTs with clear cut
I- RCT results
2.
1. II-(1)- Controlled trail II-Small RCTs with unclear
The levels of evidence results
The levels of evidence without randomisation were further described
were originally described (2) Cohort or case control and expanded by III-Cohort and case-control
by the Canadian Task studies studies
Sackett in an article on
Force on the Periodic (3) Time series studies levels of evidence for IV-Historical cohort or case-
Health Examination in antithrombotic agents in control studies
1979. 1989
III- Expert opinion V-Case series or studies
with no controls
Grades of
Recommendation

Reference : Karunarathna, Indunil, et al. "Understanding Evidence Levels in

Evidence-Based Medicine: A Guide for Healthcare Professionals." Uva
Clinical Lab. Retrieved from ResearchGate (2024).
GOALS OF EBP:-

To improve the quality of care and life for the client.

Clinical decision can be clearly explained to clients and their families.

Demonstrated interventions are clinically cost effective to colleagues,

managers and administration.

Maintaining and improving therapists knowledge base and the evidence

base of OT for the future.
ADVANTAGES OF EBP:

Improves therapist knowledge

Helps therapist to remain updated with OT practices

Increase confidence in decision making

Provide client focused care

Better patient outcome

Provide guideline for further research

 It takes lot of time for the OT practitioner to
access and appraise individual research studies.

Lack of time and skills to locate relevant

evidence.

Lack of knowledge in computer application.

DISADVANTAGES
OF EBP:
Lack of exposure and awareness towards evidence
based practice in OT in developing countries.

Research reports not easily available.

CONCLUSION :

The ultimate goal of OT is to improve OT practice so that the services

we provide, help the clients to achieve the best possible outcomes.

This goal is achieved by familiarity with research process that helps to

engage EBP with clients.

It gives best interventions to clients, interventions that are based on

relevant, valid, and reliable evidence.
 • Crepeau, Elizabeth Blesedell Evidence-Based Practice “Using
Available Evidence to Inform Practice ”WILLARD &
SPACKMAN'S Occupational Therapy, 10th Edition, and 11th Edition

• Lorraine Williams Pedretti Evidence-Based Practice Occupational

Therapy Practice Skills for Physical Dysfunction, 7 th Edition.

REFERENCE: • Bennett Sally et al “The process of evidence-based practice in

occupational therapy: Informing clinical decisions” Australian
Occupational Therapy Journal (2000), 47, 171-180

• The Occupational Therapy Manager,4th edition.

• REHABILITATION RESEARCH: PRINCIPLES AND

APPLICATIONS, Fourth Edition
 • The Occupational Therapy Manager,4th edition.

Contd. • REHABILITATION RESEARCH: PRINCIPLES

AND APPLICATIONS, Fourth Edition
 THANK
YOU