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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

Evidence-Based Practice Strategies for Busy Clinicians

Yvonne Swinth, PhD, OTR/L, FAOTA

Associate Professor

University of Puget Sound

common definition
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
3 prongs to ebp
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
levels of evidence
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
types of evidence
Types of Evidence
  • Peer reviewed journals
  • Book Chapters
  • Case Studies
  • Clinical Data
  • Online Resources
  • Clinical Experience
  • Expert Opinion
    • Peer reviewed
    • Non-peer reviewed
ebp is guided by as well as guides clinical reasoning
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.
an ebp orientation includes
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
how do we do evidence based practice
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
application to occupational therapy services
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
articulate your hypothesis
Articulate your Hypothesis
  • Ask questions like:
    • What are the strengths/concerns?
    • What intervention are you considering?
    • What are some potential contraindications?
ask a target question
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
complete a search
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/
how to complete search
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
analyze the evidence
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)
websites that can help with analyzing the evidence
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
draw conclusions
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?
implement intervention
Implement Intervention
  • “NIKE moment” – Just DO IT
evaluate the effectiveness of your intervention
Evaluate the Effectiveness of Your Intervention
  • Use your data to determine if the intervention is taking you where you want to go….
other resources of evidence reviews
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
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
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)
implications for occupational therapists
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
presentation adapted from
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