Describe an evidence based practice………………
Evidence based practice is the integration of clinical expertise, patient values, and the best research evidence into the decision making process of patient’s care. Evidence-based practice can also be defined as the systematic process of finding, analyzing, and using the best available, scientifically
sound research to guide therapists in decision making so that clients may be treated with the most powerful, effective, and safe interventions (Dysart , 60).
The primary goal of scientific health professions is to translate research into clinical practice and this is the idea behind evidence based practice. The reason for occupational therapy research is to validate occupational therapy as a profession and to aid in the clinician’s decision making process. The goals for this research include theory development, evaluation of tests and measurement, identification of treatment intervention effects, increasing professional knowledge base for clinical reasoning and contributing to society’s understanding of occupation (MacEwan et al, 276)
Before EBP, clinicians tended to rely on other forms of evidence such as the voice of an expert, uncritical acceptance of the findings of a single published study or a published manual and the reliance of our own previous experienced and of the experiences around us. This did not always yield the best treatment plan or strategy so SBP came into use.
The various ways to obtain evidence include;
- Obtaining evidence from clinically relevant research that has been conducted using sound methodology
- The patient bringing his or her own personal and unique concerns, expectations and values
- Clinical expertise i.e. the clinician’s experience (Stillwell et al, 42)
The steps for implementing EBP are as follows ;( MacEwan et al, 276)
- Formulating a clinical question
- Searching for relevant literature
- Analysing results for validity, reliability and usefulness
- Implementing result
- Evaluating the evidence-based assessment and intervention procedures as they are implemented and revise
Clinical questions are identified which reflect the information needed to make clinical decisions which also take into account the type of client or client groups being treated as well as the context in which treatment occurs. A literature search is then undertaken to identify research evidence available to answer the question.
When seeing a client, new information is required in order to solve a clinical problem and make treatment decisions. These questions may relate to specific clients. The types of questions asked reflect the core clinical tasks of occupational therapy practice. These may be questions concerning diagnosis, treatment or prevention and diagnosis.
The main challenge of EBP is asking the questions to the clients but the following questions may be asked;
- Do these results apply to my client?
- Does the treatment fit with my client’s values and preferences?
- Are the resources available to implement treatment?
Where possible, the client should be involved in the decision making (Lee, 19) and the best evidence should be used and the client should be advised on the biases or the limitations of the research. Where research evidence is lacking, expert clinical opinion should be greatly used.
The framework of evidence based practice presents evidence based practice as a process that follows a cycle stemming from clinical decisions that need to be made in all staged of the occupational therapy treatment process.
Research evidence is often found in peer-viewed journals as this is where results are first published and where enough detail in methodology exists to make informed judgements on the validity and clinical relevance of the findings.
There is a variety of research designs which will depend on the type of question that was asked to the client. These designs are as follows:
It is an efficient method of gathering information on issues that exist in particular groups in the community e.g. may help occupational therapists to gain information from parents of children with disabilities about the effectiveness of their service (Occupational Therapy Services, 3)
Qualitative research methods
These are used to predict the cause and effect relationship between variables, qualitative methods. They are more useful to describe the experiences of people in particular settings and understand their perspectives.
This design is concerned with the effectiveness of interventions or treatments. These are the few of the many research designs used in EBP.
Systematic reviews use rigorous method to locate asses and summarize the results of many studies. Appropriate systemic reviews provide the best evidence e.g. Randomized controlled trials (RCT) minimize likelihood of bias in the conclusions of studies addressing treatment effectiveness.
Hierarchies of evidence provide information on the ability of various methodologies to reduce bias and thus provide the best evidence for EBP (Occupational Therapy Services, 6). There are a variety of databases available that provide the sites for particular evidences and these include EMBASE, MEDLINE, PUBMED, AMED, ERIC and ASSIA and the choice on which database to use depend on the type of question being asked by the clinician.
For clinicians, they may benefit from the examples of reasoning, strategies and resources in order for them to successfully integrate evidence (Lin et al, 164). Evidence Based Practice requires that the clinician has new skills that include efficient literature searching and the application of formal rules of evidence in evaluating the clinical literature.
The article conducted research on a specific area of practice i.e. in Autism treatment. It conducted research on finding out the problems exhibited by people with Autism Spectrum Disorder (ASD) and the range of intervention approaches that can be used by the occupational therapy practitioners.
The research protocol
First a research question was formulated that guided in selection of research studies for the review and interpretation of the findings. This question was: What is the evidence for the effect of interventions used in or of relevance to occupational therapy in children and adolescents with autism spectrum disorder?
The search strategies for the evidence in ASD included occupation and engagement in addition to performance based interventions. The behaviour, self-regulation, family and the role of the family were also some of the things that were included in the search (Dysart, 61).
To identify the research report for the review, databases and sites used included Medline, CINAHL,ERIC, PsycINFO, Social Sciences Abstracts, Sociological Abstracts, Linguistics and Language Behaviour Abstracts, Rehab data, Latin American and Caribbean Health Sciences Literature and EBSCOHost and other databases that were developed by the authors and reviewed by the advisory group. Articles were later included in the review if they provided evidence for an intervention approach used with children with ASD, had been peer reviewed, were published between 1986 and 2007 and addressed performance area or intervention approach within the domain of occupational therapy (Perri, 34). Only studies determined to be level I to level III evidence were included. Research reports were excluded if they were published before 1986, level IV or V, used qualitative methods excluding quantitative methods, not peer reviewed or had serious design limitations (Susan et al, 32).
The 217 articles that appeared to have relevance to occupational therapy were selected to determine whether they fit the criteria with the first author, the AOTA consultant and the AOTA staff making the final selection of the studies using the established criteria. The first author analysed 49 studies describing the study level, study design, number of participants, types of interventions and the outcome measures, summary of results, study limitations and implications of the study for occupational therapy. Guidelines for reviewing quantitative studies were based on those developed by law. An evidence table that included interpretation of findings for occupational therapists was created and reviewed by the authors (Case-Smith 417).
The research conclusions that were found during the research can be used in formulating a treatment plan for ASD children. Once the results of the research are identified, the treatment plans can be obtained from these results and used practically.
The interventions that were found included sensory based interventions e.g. therapeutic touch (massage) which can be used to reduce hypersensitivity reduce stereotypic behaviours and improve attention, relationship-based interactive interventions that are used to enhance the child’s play and social participation. Developmental skill-based programs are also one of the treatments found. These programs are play based, use peers, focus on strengths of the child and involve professionals from multiple disciplines (Case-Smith, 149)
The treatment plan that will be formulated from the results include such things as self-care of the children, educating all the parties concerned with the health of the children, recommending play activities, leisure, social participation, communicating with the children, behaviour training, helping the children in the transition to work and the community. The interventions that were more likely to be used by the occupational therapists were highlighted suggesting their importance to clinical practice. These are the interventions that are used in treatment of the children with ASD (Amber, 6).
Once evidences are found, they are grouped according to the best evidence and systemic reviews such as RCTs are used in order to conclude the treatment plan (Lee and Miller, 23).
Evidence Based practice is an integral part in the health sector. Since medical practitioners cannot only rely on their own knowledge and skills to treat a patient, there must be an aide that will guide in the treatment. Like many other systems, EBP also has some advantages and disadvantages. Some of the concerns in using EBP include limited information about the research question, little or no research applicability to a certain situation, limited time to find the information required or no access to the required information. Despite the substantial barriers to EBP, it is important to implement an evidence based practice since a client deserves the best treatment (Jane, 7).
The process of Evidence Based Practice is not an easy task to perform and the clinicians have a very hard task to undertake. In addition to their ever busy schedules, they also have to find evidence from various sources and perform other duties related to EBP. This requires tolerance, a heart of giving and empathy on the part of the clinicians.
Amber MacEwan, Georges Tomlin. Factors related to Evidence Based Practice among U.S
Occupational Therapy Clinicians. American Journal of Occupational Therapy. 2011. Print.
Dysart, A. M., & Tomlin, G. S. Factors related to evidence-based practice among U.S.
occupational therapy clinicians. American Journal of Occupational Therapy, 2002. Print.
Susan Linn, Susan Murphy & J.C, Robinson. Facilitating Evidence Based Practice: process,
strategies and resources. American Journal of Occupational Therapy,2010. Print.
Perri Stern. A holistic approach to teaching Evidence Based Practice. American Journal of
Occupational Therapy. 2005. Print.
Lee and Miller. Evidence Based Practice. American Journal of Occupational Therapy. 2003.
Susan Stillwell, Ellen Fineout, Mazurek Meinyk, Kathleen Willliamson. Evidence Based
Practice. American Journal of Nursing. 2010. Print.
Occupational Therapy Services. Occupational Therapists; Evidence Based Practice.2012. web.
30 April. 2012.
Jane Case-Smith, Marian Arbesman. Evidence-based interventions for Autism used in or of
relevance to occupational therapy. American Journal of Occupational Therapy.2008. Print.
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