Slide 1 Leaping into Evidence-Based Practice Susan Jeantete, OTR, OTD Megan Flores, PT, MPT
Slide 2 Course Objectives By the end of the session, the learner will be able to: 1. Describe evidence-based practice as it relates to occupational therapy practice. 2. Create a clinical question in PICO format. 3. Discuss a method to appraise evidence gathered from online sources. 4. Explore free full text and open-access databases to gather the best available evidence to answer a clinical question.
Slide 3 Evidence-Based Practice (EBP) in Occupational Therapy
Slide 4 History of EBP First emerged during Post-World War II Era 1950 s there was a push to begin examining the efficacy of medical interventions The term evidence-based medicine first published in JAMA-1991 Adopted by other health professions as evidence-based practice (Hinojosa, 2013)
Slide 5 Evolution of EBP in OT 1997- Evidence-Based Practice and Occupational Therapy by Walter Lloyd-Smith was published July 2000- AOTA included EBP in accreditation standards for entry-level occupational therapy education (AOTA, n.d.; AOTA, 1999) 2007- AOTA included EBP to AOTA s Centennial Vision 2008- Introduced term in 2 nd ed. of the OTPF: Domain and Process
Slide 6 First steps first Coming to a common definition What is your definition of evidence based practice? It depends
Slide 7 Did you graduate before 2000? PRE-2000 GRADUATES Emphasis on teaching of experts Graduated before Internet was introduced (1995) or widely used May never have had formal training in EBP methods Most experienced may actually be least skilled in utilizing evidence POST-2000 GRADUATES Increased use of relevant data from research Proficient with technology used for EBP EBP was part of the entrylevel education Least experienced may be the most skilled in locating best available evidence (Anders & Evans, 2010; Jette et al., 2003; Leiner et al., 2009; Lu, 2011; Thomas & Law, 2013)
Slide 8 Regardless of Experience Obstacles to implementing EBP must be overcome for profession to progress owhat barriers do you experience in your practice? owhat can we do to promote EBP in clinical settings? (Bennett & Bennett, 2000; Dijkers et al., 2012; Hinojosa, 2013; Maher et al., 2004; McClusky & Cusick, 2002; Thomas & Law, 2013)
Slide 9 Definition of Evidence-Based Practice: Clinical decision making which incorporates the evidence triad of clinical expertise, current research and the client s preferences. (Crausaz, Kelly, & Lee, 2011, p. 11)
Slide 10 Clinical Expertise EBP Best Research Evidence Patient values and preference (Bennett & Bennett, 2000; Dijkers et al., 2012)
Slide 11 Implementing Evidence-Based Practice (EBP) in Occupational Therapy
Slide 12 Steps to Implementing EBP 1. Develop a clinical question 2. Locate the best available evidence 3. Appraise the evidence 4. Integrate the evidence with clinical expertise and patient preferences 5. Evaluate the outcomes of implementation 6. Share the results (Adapted from Melnyk, Fineout-Overholt, Stillwell, & Williamson, 2010)
Slide 13 Step 1: Develop a Clinical Question LET S GET STARTED!
Slide 14 Taking the first step Conducting an online search can feel overwhelming given the vast amount of information out there. However a little practice and a list of tools can help make that process much easier.
Slide 15 Where to begin? What is your clinical question and why are you asking it? Is it to get more information about a diagnosis? Is it to get more information on a treatment protocol? Is it related to finding out the results or associated difficulties of a treatment method? Is it to compare two treatment methods? (Bennett & Bennett, 2000, p. 173)
Slide 16 Refining your question The more explicit your question, the more focused your search The type of question can help you determine the best search strategy The type of question can also determine the type of evidence needed for making clinical inferences (Bennett & Bennett, 2000, p. 174-175)
Slide 17 PICO Strategy Common strategy to assist in online searches Consists of: Patient population/problem Intervention Comparison (if applicable) Outcome (Schardt, Adams, Owens, Keitz, & Fontelo, 2007)
Slide 18 Example Scenario using PICO You have been referred a new pediatric patient who is 2-years old and has a diagnosis of Erb s palsy. You have used e-stim before with a similar patient some years ago, but you remember a colleague used kinesiotape with some success for another child with Erb s palsy to increase supination. Before you evaluate the child, you decide you want to investigate the current evidence.
Slide 19 So from that example Patient population: Children diagnosed with Erb s palsy Intervention: Kineseiotaping Comparison (if applicable): E-Stim Outcome: Improved supination
Slide 20 Step 2: Locating the best available evidence YOU HAVE YOUR CLINICAL QUESTION NOW WHAT?
Slide 21 Beginning the search Your clinical question helps determine the search engine to use Search engines can be specific to the type of publications Think: What category does the question fall under
Slide 22 Common EBP Search Engines Google Scholar (www.googlescholar.com) Free search tool Searches internet for scholarly articles, not all free full-text PubMed (www.pubmed.com) Free equivalent to MedLine 25 million citations, not all free full-text MeSH Headings Tutorials available
Slide 23 Comparing Search Engines Adapted from Anders and Evans, 2010 GOOGLE SCHOLAR Search engine for various academic fields Searches include scholarly publications (i.e. theses, books, peerreviewed journal articles, etc.) Simple to use Familiar format Advanced search options are limited Searches are less refined PUBMED From National Library of Congress Focus on biomedical journal literature Powerful search filters can be complex for users Includes Clinical Queries to identify studies by design Uses MeSH strategy Searches are more focused due to the search strategies available
Slide 24 Example PUBMED
Slide 25 Let s go back to the earlier example Patient population: Children diagnosed with Erb s palsy Intervention: Kineseiotaping Comparison (if applicable): E-Stim Outcome: Improved supination
Slide 26 Our PICO search may be: Erb s palsy AND electrical stimulation AND kinesiotape AND supination Results in PubMed: 0 Modified search to see if either treatment has research: Erb s palsy AND electrical stimulation OR kinesiotape AND supination Results in PubMed: 109
Slide 27 Example GOOGLE SCHOLAR
Slide 28 Our PICO search may be: Erb s palsy AND electrical stimulation AND kinesiotape AND supination Results in Google Scholar: 5 Modified search to see if either treatment has research: Erb s palsy AND electrical stimulation OR kinesiotape AND supination Results in Google Scholar: 605
Slide 29 Modifying the Search If at first you don t succeed, try again: Use a different search engine Use a different database Use a synonym for one of your search terms Use more specific terms (if too many items are returned) Make terms more broad (if too few items are returned) Change the order of the of the PICO terms
Slide 30 Step 3: Appraising the Evidence HOW DO YOU KNOW IF YOUR EVIDENCE IS ANY GOOD?
Slide 31 Appraising the Evidence Questions to Consider when Appraising Evidence Did the study investigate your specific intervention with the same population as yours? Is the source of the study credible? Are the results of the study consistent with the results of other studies investigating similar treatments or populations? Is the study more than 5 years old? Were the sample sizes adequate to determine a benefit? (Davies & Logan, 2011)
Slide 32 Types of Evidence Meta- Analyses, Systematic Reviews Randomized Control Studies Cohort Studies Case Controlled Studies, Case Series, Case Reports
Slide 33 Exploring Additional Online Resources TO SUPPORT EVIDENCE-BASED PRACTICE IN OCCUPATIONAL THERAPY
Slide 34 Beyond PubMed PubMed and beyond: A survey of web tools for searching biomedical literature. Reviews 28 systems and compares to PubMed Systems divided into 4 categories: Rank search results by various means Clustering results by topic Displaying relationships and semantics of results Improving interface and experience (Lu, 2011)
Slide 35 Online Databases Cochrane Library (www.cochranelibrary.com) Open access systematic reviews and other resources PEDro (www.pedro.fhs.usyd.edu.au) Open access to 32,000+ items Physiotherapist focus PsychBite (www.psycbite.com) Focus on acquired brain impairments Open access to cognitive, behavioral, and psychological topics Digital Commons Network (http://network.bepress.com/) Open access publications from universities
Slide 36 Occupational Therapy Databases and Resources OT Research (www.nbcot.org/otresearch) Member benefit for NBCOT OT Search (http://www1.aota.org/otsearch/) Subscription service Occupational Therapy Focus OT Seeker (www.otseeker.com) Open access to 10,000+ items Occupational therapy focus Evidence Exchange (http://www.aota.org/practice/researchers/evidence- Exchange.aspx) Open access to completed CAP reviews
Slide 37 Physical Therapy Databases and Resources PT Now (www.ptnow.org/default.aspx) Open access to 4,500+ items Physical therapy focus Hooked On Evidence (http://www.hookedonevidence.org/captcha.cfm) Physical therapy focus Members only benefit of APTA
Slide 38 Speech and Language Databases and Resources Speech Bite (http://speechbite.com/) Open access for topics related to speech pathology ASHA Compendium (http://www.asha.org/members/ebp/compendium/) Systematic reviews on practice topics Members only
Slide 39 Other EBP Resources (Open Access or Subscription) PMC (http://www.ncbi.nlm.nih.gov/pmc/) Free full-text archive Medline Plus (www.medlineplus.gov) For patients and practitioners ProQuest CINAHL Database/EBSCO Health And many more
Slide 40 Open Access Online Journals www.freemedicaljournals.com Taylor and Frances SAGE Publications BMC Medical JAMA British Medical Journal Biomed Central And many more
Slide 41 Tutorials on Locating Evidence Duke University Medical Center and Library http://guides.mclibrary.duke.edu/c.php?g=15820 1&p=1036002 PubMed: US National Library of Medicine https://www.nlm.nih.gov/bsd/disted/pubmedtutori al/cover.html
Slide 42 Steps to Implementing EBP 1. Develop a clinical question 2. Locate the best available evidence 3. Appraise the evidence 4. Integrate the evidence with clinical expertise and patient preferences 5. Evaluate the outcomes of implementation 6. Share the results (Adapted from Melnyk, Fineout-Overholt, Stillwell, & Williamson, 2010)
Slide 43 Any Questions?
Slide 44 References American Occupational Therapy Association. (n.d.). History of AOTA accreditation. Retrieved from http://www.aota.org/education- Careers/Accreditation/Overview/History.aspx Anders, M. E., & Evans, D. P. (2010). Comparison of PubMed and Google Scholar literature searches. Respiratory Care, 55(5), 578 583. doi:10.1111/j.1471-1842.2012.00992.x Bennett, S., & Bennett, J. W. (2000). The process of evidence-based practice in occupational therapy: Informing clinical decisions. Australian Occupational Therapy Journal, 47(4), 171 180. doi:10.1046/j.1440-1630.2000.00237.x Crausaz, J., Kelly, M., & Lee, S. (2011). Three educational approaches to enhance the evidence-based practice behaviour of Irish occupational therapists. World Federation of Occupational Therapists Bulletin, 64(1), 11-17. Davies, B. & Logan, J. (2011). Reading research: A user-friendly guide for health professionals (5th ed.). Toronto, ON: Elsevier Science Health Science Division
Slide 45 References Continued Dijkers, M. P., Murphy, S. L., & Krellman, J. (2012). Evidence-based practice for rehabilitation professionals: Concepts and controversies. Archives of Physical Medicine and Rehabilitation, 93(8, Supplement), S164 S176. doi:10.1016/j.apmr.2011.12.014 Hinojosa, J. (2013). The evidence-based paradox. American Journal of Occupational Therapy, 67(2), e18-e23. doi:10.5014/ajot.2013.005587 Jette, D. U., Bacon, K., Batty, C., Carlson, M., Ferland, A., Hemingway, R. D., Volk, D. (2003). Evidence-based practice: Beliefs, attitudes, knowledge, and behaviors of physical therapists. Physical Therapy, 83(9), 786 805. Leiner, B. M., Cerf, V. G., Clark, D. D., Kahn, R. E., Kleinrock, L., Lynch, D. C.,... & Wolff, S. (2009). A brief history of the Internet. ACM SIGCOMM Computer Communication Review, 39(5), 22-31. Lloyd-Smith, W. (1997). Evidence-based practice and occupational therapy. British Journal of Occupational Therapy, 60(11), 474-478.
Slide 46 References Continued Lu, Z. (2011). PubMed and beyond: A survey of web tools for searching biomedical literature. Database, 2011, 1-13. doi.org/10.1093/database/baq036 Maher, C. G., Sherrington, C., Elkins, M., Herbert, R. D., & Moseley, A. M. (2004). Challenges for evidence-based physical therapy: Accessing and interpreting high-quality evidence on therapy. Physical Therapy, 84(7), 644 654. McCluskey, A., and Cusick, A. (2002). Strategies for introducing evidencebased practice and changing clinician behaviours: A manager s toolbox. Australian Occupational Therapy Journal, 49, 63-70. doi:10.1046/j.1440-1630.2002.00272.x Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2010). Evidence-based practice, step by step: The seven steps of evidencebased practice. The American Journal of Nursing, 110(1), 51 53. doi:10.1097/01.naj.0000366056.06605.d2
Slide 47 References Continued Schardt, C., Adams, M. B., Owens, T., Keitz, S., & Fontelo, P. (2007). Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Medical Informatics and Decision Making, 7(1), 16. doi: 10.1186/1472-6947-7-16 Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Evidence-based practice, step by step: Asking the clinical question: A key step in evidence-based practice. The American Journal of Nursing, 110(3), 58 61. doi:10.1097/01.naj.0000368959.11129.79 Thomas, A., & Law, M. (2013). Research utilization and evidence-based practice in occupational therapy: A scoping study. American Journal of Occupational Therapy, 67(4), e55 e65. doi:10.5014/ajot.2013.006395 Upton, D., Stephens, D., Williams, B., & Scurlock-Evans, L. (2014). Occupational therapists' attitudes, knowledge, and implementation of evidence-based practice: A systematic review of published research. British Journal of Occupational Therapy, 77(1), 24-38 15p. doi:10.4276/030802214x13887685335544 Frog image: <a href="https://www.freevector.com/happy-frog-character">freevector.com</a>