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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

EVIDENCE BASED PRACTICE

Amy Baker and Melissa Edwards

4th year Occupational Therapy Students

University of South Australia

aims of the session
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
what is evidence based practice
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)

what is ebp
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
research vs ebp
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
why is ebp important
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
how to use ebp
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
step 1 formulate a review question
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
clinical vs review questions
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)”

how to write a review question
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

example of pico question
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?

critiquing an ebp question
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?

activity writing a review question
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.”

step 2 searching the literature to find the evidence
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
databases to use
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)
key terms and search limits
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
step 3 critically analysing the evidence
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
levels of evidence
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
questions for critiquing evidence
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

step 4 implementing the evidence
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)
considerations when implementing evidence
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?
step 5 evaluating the impact of the evidence
Step 5: Evaluating the impact of the evidence

When evaluating the impact, consider:

  • The client’s outcomes
  • Cost effectiveness
  • Client satisfaction
  • Therapist satisfaction
barriers to ebp
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

becoming an evidence based practitioner
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
useful resources
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/
useful resources28
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
useful resources29
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

references
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