Canadian Association of Occupational Therapists

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CJOT Abstracts
Volume 65 • Number 3
June 1998

National perspective
Evidence-based occupational therapy
Mary Law, Caroline Baum


The client-centred evidence-based practice of occupational therapy
Mary Egan, Claire-Jehanne Dubouloz, Claudia von Zweck, Josée Vallerand

Evidence-based practice has its roots in evidence-based medicine. This term refers to the formulation of treatment decision using the best available research evidence. While the concept has gained increased attention among health care workers in the recent past, practice based on scientific evidence has been recommended for over 300 years. However, all health-related professions continue to report difficulties adopting evidence-based practice. Notably, practitioners are often concerned that results of population-based research may not be relevant for their specific patients.

This may be of particular concern for occupational therapists who aim to provide client-centred intervention, taking into consideration individual characteristics of the client, the environment and the occupation. As well, those wishing to practice evidence-based occupational therapy must determine which decisions are made during the course of therapy and what evidence may impact on these decisions. The Occupational Performance Process Model (Fearing, Law & Clark, 1997) outlines the occupational therapy problem solving process and assists therapists to integrate knowledge from both client and therapist. A framework for evidence-based occupational therapy is presented, based on this model.

Keywords:
Decision making, clinical, evidence-based practice, models of practice, occupational performance


Evidence-based practice: The Cochrane Collaboration and occupational therapy
Robyn Hayes, John McGrath

This paper describes how occupational therapists can become involved in the Cochrane Collaboration - a well-developed tool for facilitating the involvement of health professionals and lay people in evidence-based practice. The Cochrane Collaboration is a growing international project intended to systematically locate, conduct systematic reviews (including meta-analyses) of, and disseminate information on all available randomised controlled trials of interventions in any area of health. In particular, occupational therapists can use the Cochrane Collaboration to become better informed about best practice and evaluate research in their areas of interest, and learn skills related to conducting randomised controlled trials, systematic reviews, and meta-analyses.

Keywords:
Evidence-based practice, research, occupational therapy, resource databases


Using research evidence in planning treatment for the individual client
Linda Tickle-Degnen

The purpose of this paper is to describe strategies for retrieving and using evidence published in the research literature for application to treatment planning with a particular client. Suggestions are given for how to develop clinical questions about a particular client for use in guiding literature retrieval, how to retrieve the most relevant research studies in a timely manner, how to interpret results of these studies for use with a single client, and how to communicate the results of these studies with clients and families in order to engage in collaborative treatment planning.

Keywords:
Decision making, clinical, evaluation research, evidence-based practice, research, occupational therapy


Economic evaluation of occupational therapy: Where are we at?
Diane Watson Landry, Maria Mathews

Policy makers, health administrators, and practitioners are under pressure to justify resource allocation decisions through an analysis of need, value, and choice. Economic evaluations are increasingly being used to assess the value of health programmes and services. A search of three literature databases revealed that whereas assessments of outcomes and effectiveness are common in the rehabilitation disciplines, comparatively few studies attempt to link costs with outcomes. The purpose of this paper is to familiarize practitioners with the basic concepts and methods used to conduct economic evaluations by describing the different types of analysis, and critiquing research publications to illustrate how this approach has been used to assess the value of various domains of health service relevant to most occupational therapists. By participating in outcomes research to link the costs and consequences of services, occupational therapists will be better able to demonstrate the value of their contribution to the health of Canadians. It is hoped that this paper will stimulate evaluative efforts and enhance the practice of evidence-based decision making in resource allocations.

Keywords:
Costs and cost analysis, outcome and process assessment (health care)


Reflections On…
The Cochrane Collaboration
Nancy Pollock

One of the elements of best practice is the use of evidence in decision-making with clients. It is often very difficult for clinicians to access the latest research evidence, to synthesize the findings and to apply the evidence to the practice situation. A recent innovation, The Cochrane Collaboration represents an important step forward in making evidence available in a usable form for busy clinicians. This paper describes the Cochrane Collaboration and suggests ways that occupational therapists can both benefit from and contribute to the Collaboration.

Keywords:
Evaluation research, evidence-based practice, libraries, electronic, resource databases

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