Associate Dean, Faculty of Social Sciences
University of Hong Kong
Lecturer, Faculty of Health Sciences
University of Sydney
Introduction to evidence-based occupational therapy
What is evidence-based OT?
The purposes of this paper are twofold. Firstly, we discuss what is special about evidence-based practice for occupational therapy and what the key issues of evidence-based practice are for occupational therapy both for individual practitioners and the profession. Secondly, we provide an annotated bibliography and some important resources for readers to expand their understanding of the topic and retrieve useful references to effect their practice.
Evidence-based practice is about asking questions and “finding, appraising, and using contemporaneous research findings as the basis for clinical decisions” (Rosenberg & Donald, 1995, p.1122). Law and Baum add that “An evidence-based occupational therapy practice uses research evidence together with clinical knowledge and reasoning to make decisions about interventions that are effective for a specific client(s)” (1998, p.131).
It is argued that the decisions made in the process of addressing client’s occupational needs (such as, some form of intervention to assist in the ability to return to work; to look after oneself at home; to engage in activity that gives satisfaction to the person and is within the person’s abilities) differ from those of diagnosis, treatment and prognosis which are considered in evidence-based medicine. Following this line of argument, it may imply that the statistical approach of researching the evidence may not be always applicable for the clinical issues dealt with by occupational therapists. “To best determine how best to address occupational performance issues, the therapist must carefully consider the unique mix of task, environment and person that form an occupation. Adequate understanding of these three factors requires that the therapist considers both client-generated evidence as well as findings from relevant population based research evidence” (Egan, Dubouloz, Zweck & Vallerand, 1998, p.139).
There are several concerns raised in the literature regarding evidence-based practice in occupational therapy. For most practitioners lack of time and skills to frame the question, access research evidence, and integrate research information into practice is one of the major barriers to the evidence-based practice. (Conroy, 1997; Eakin, 1997; Law & Baum, 1998; Lloyd-Smith, 1997). Lack of support from management or employers for clinicians to engage in evidence-based practice whilst still managing a caseload does not assist occupational therapists to explore the possibilities of evidence based practice. Additionally, lack of libraries or library services around a small country such as in New Zealand that hold occupational therapy journals can be seen as another barrier to exploring and utilising evidence-based practice to guide clinical decisions. More recently, access to information sources such as the Cochrane Library via the World Wide Web or CD-ROM will assist therapists to retrieve the research findings, or even to be more active in contributing to the collation of data such as the Cochrane Review process as described by Hayes and McGrath (1998). The Cochrane Library comprises the Cochrane Database of Systematic Reviews (CDSR), the York Database of Abstracts of Reviews of Effectiveness (DARE), the Cochrane Review Methodology Database (CRMD).
Although at a professional level, occupational therapy is a relative beginner in the field of evidence-based practice (Culshaw, 1995; Mountain, 1997), there is growing interest. Two major publications have dedicated one whole issue to articles on evidence based practice (e.g., the Canadian Journal of Occupational Therapy, 1998 June issue; British Journal of Occupational Therapy, 1997 November issue). One might think another challenge to evidence-based practice approach for occupational therapy is the lack of research evidence about the effectiveness of occupational therapy interventions. Several authors (e.g., Bannigan, 1997; Eakin ,1997; Hayes & McGrath, 1998; Law & Baum, 1998) have argued that evidence is emerging in some fields of practice such as: neuro-developmental therapy, living skills training for people with severe mental disabilities, client centred practice approach for occupational therapy, structured activities program versus standard ward program in acute psychiatric care facilities, sensory integration, prevention of fall among elderly, use of standardised self-care assessment. Increasingly, occupational therapists are undertaking randomised controlled trials (e.g., the work by Jackson, Carlson, Mandel, Zemke & Clark, 1998 on the well elderly program; the work by Logan, Ahern, Gladman & Lincoln, 1997 on community occupational therapy for people with stroke) and meta-analyses (e.g., the work by Carlson, Fanchiang, Zemke & Clark on occupational therapy for older persons; Ottenbacher & Petersen, 1985 on applied vestibular stimulation) of occupational therapy interventions have also been performed.
In summary, occupational therapy research focused on the effectiveness of occupational therapy interventions using randomised control studies is in its infancy. The challenge for our profession is to continue to define what it is that we do, while demonstrating that what we do is effective!
Other resources for evidence-based occupational therapy
Tickle-Degnen, L. (1998), Using research evidence in planning treatment for the individual client. Canadian Journal of Occupational Therapy, 65(3), 152-159.
- Provides a step-by-step guide of how to ask the questions and search for evidence to guide the practice
- Shows how the evidence is evaluated and how the conclusion is arrived in relation to the case scenario described in the article
- Demonstrates how the client can be involved in the final decision about the intervention option after considering the evidence
Law, M., & Baum, C. (1998). Evidence-based occupational therapy. Canadian Journal of Occupational Therapy, 65(3), 131-135.
- Gives the background to the evidence-based practice in occupational therapy
- Good expansion on the challenges and threats to the evidence-based practice in occupational therapy
Bannigan, K. (1997). Clinical effectiveness: Systematic reviews and evidence-based practice in occupational therapy. British Journal of Occupational Therapy, 60(11), 479-483.
- Discusses the relevance of systematic reviews to the clinical practice of occupational therapy
- Outlines how to access systematic reviews through the Cochrane Library or Databases of Abstracts of Reviews of Effectiveness
- Briefly critiques two systematic reviews on sensory integration, and preventing falls and subsequent injury in older people
Hayes, L.R., & McGrath, J.J. (1998). Evidence-based practice: The Cochrane Collaboration, and occupational therapy. Canadian Journal of Occupational Therapy, 65(3), 131-135.
- Describes how occupational therapists can become involved in the Cochrane Collaboration
- Describes how occupational therapists can use the Cochrane Collaboration to become better informed about best practice, to evaluated research in their area of interest and to learn skills related to conducting randomised controlled trials, systematic reviews, and meta-analyses
Carlson, M., Fanchiang, S., Zemke, R., & Clark, F. (1996). A meta-analysis of effectiveness of occupational therapy for older persons. American Journal of Occupational Therapy, 50(2), 89-98.
- Describes a study designed to determine the effectiveness of occupational therapy interventions for older persons using meta-analysis of outcome literature
- Describes the process through which the authors were able to determine that occupational therapy in general is effective for older persons
Useful world wide websites
This web page will provide you with:
- the contacts with your nearest Cochrane centre
- the contacts with the Cochrane Collaboration groups (e.g., schizophrenia group, stroke group) which may be reviewing a field of practice which is of your interest
- Abstracts of Cochrane reviews