Transcript EBP Strategies for Busy Clinicians

Evidence-Based Practice
Strategies for Busy Clinicians
Yvonne Swinth, PhD, OTR/L, FAOTA
Associate Professor
University of Puget Sound
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“How do you know that
what you do and how
you do it really works?”
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Holm, 2000
Common Definition
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“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”
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Sackett et al, 1996
3-Prongs to EBP
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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.
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Sackett et al, 1996
Levels of Evidence
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Several different approaches/models
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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
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Peer reviewed journals
Book Chapters
Case Studies
Clinical Data
Online Resources
Clinical Experience
Expert Opinion
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Peer reviewed
Non-peer reviewed
EBP is guided by, as well as
guides, clinical reasoning
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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:
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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?
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“Health care is an
imperfect science that
requires both overarching
clinical guidelines and
individual judgment in
equal parts”
Application to Occupational
Therapy Services
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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
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Ask questions like:
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What are the strengths/concerns?
What intervention are you considering?
What are some potential contraindications?
Ask a Target Question
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PICO Model
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Patient
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Intervention
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strategy or approach you are considering applying
Comparison Intervention
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relevant characteristics of child/student or population
may or may not use this – strategy or approach you
want to compare with “I”
Outcome
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anticipated benefit from the intervention
Complete a Search
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Access to university? Access to the internet?
Websites to consider
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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
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If unfamiliar with search strategies,
consider an online tutorial to learn
strategies such as:
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Choosing appropriate key words
Narrowing/widening search strategies
Combining words (use of “and”, “or”, etc..)
Online tutorial site:
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Centre for Evidence-Based Medicine
www.cebm.net/searching.asp
Analyze the Evidence
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Critically appraise the validity and
usefulness of information found
Interpret for applicability to the specific
client
Consider the three-pronged approach,
include:
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the therapist’s clinical reasoning
the client’s perspective(s)
Websites that can Help with
Analyzing the Evidence
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http://www.cebm.utoronto.ca/practise/c
a/therapyst/
http://www.cebm.net/levels_of_evidenc
e.asp
http://www.pedro.fhs.usyd.edu.au/tutor
ial.html#part_one
http://www.psychstat.smsu.edu/sbk00.
htm
Draw Conclusions
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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
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“NIKE moment” – Just DO IT
Evaluate the Effectiveness of
Your Intervention
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Use your data to determine if
the intervention is taking you
where you want to go….
Other Resources of Evidence
Reviews
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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
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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)
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Implications for
Occupational Therapists….
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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
The Process
Illustrated
Presentation Adapted From:
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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