Evidence-based practice
Wait, cue the music, anchor the ship, we are back! What a journey it has been! Welcome to the evidence-based practice island of occupation.
When I looked down memory lane, I realised that the little choices processed through value and its intricacies laid the foundation of who I am today. A wise man once said, “May your choices reflect your hopes, not your fears.” That is exactly what we are all about today: decisions. Decisions are driven by factual evidence and collaborative and dynamic interaction with diverse sources of information. A decision can be defined as an internal, adventurous process of considering the facts laid out in front of you. My question to you is: if we are the decision-makers, what kind of life do we perceive our clients to live?
You may ask, "What is evidence-based practice?" It is characterized as fundamentally a clinical decision-making framework that motivates clinicians to integrate information from elevated quantitative and qualitative research with the clinician's clinical expertise and the client's history, preferences, and values. It is the complexity of incorporating the value, experience, and educational use one gain over time as a health practitioner. Furthermore, the compromise of viewing the client holistically, including their context and values, promotes a client-centred approach and proficiency in clinical reasoning. For more information read on:
It's about integrating individual clinical expertise and the best external evidence Evidence based medicine, whose philosophical origins ex
The OT process consists of evaluation to build an occupational profile. We can enquire about relevant information through deliberate discourse with the client, clinical presentations, textbooks, or scholarly research to address the client's needs through prioritized assessments and interventions to promote the effectiveness of therapy through evidence-based practice. The principles of what we do and why we do it are facilitated by evidence-based practice. This week, I seized the ability to experience hand therapy. I was assisting two young men identified as X and K who both had the same diagnoses. I researched the pathology to apply broad therapy concepts, but what distinguished my approach from the two men was their diverse contextual backgrounds. The inefficiency of implementing the city-based home program for Mr K due to his peri-urban lifestyle of different religious and societal constructs will be meaningless. Evidence-based practice acts as a liaison between pathology and client-specific therapeutic needs.
Occupational therapists thrive on finding the "fit" between person, context, and environment. The evidence-based practice provides the opportunity to dive deeper through research to fit the different puzzle pieces together to do the puzzle through a collaborative approach to attain a shared goal. For instance, Mr K needed orthopaedic care to drain the abscess from his hand, nurses to dress his wound, and occupational therapy to return hand function so he could engage in his everyday activities and reintegrate with ease back home and work. This can be achieved through will of exposure and learning from our interactions.
According to Bennett and Bennett (2000), evidence-based practice is a framework and a process based on clinical considerations that must be made at all phases of the occupational therapy treatment process. Clinical questions that represent the information required to make clinical judgments and consider the specific client or group of clients being treated and the context in which therapy occurs are identified.
I know that is an amalgamation of information one is bombarded with, but I am the solution. Do not fear, OT enthusiasts; different reliable sources are available for an OT to refer to and learn from through the hierarchy of research Sackett's method of ranking evidence, such as the AOTA, AOTF, NIH, and SciElo. Please take a look below to read more about available resources.
This resource on evidence based practice in occupational therapy includes places to obtain evidence for therapy interventions.
We move to the “how,” which incorporates first asking questions related to assessment, treatment planning, and context. to be in search of evidence using a variety of sources to locate data relevant to the client. Then follows the appraisal of evidence to implement evidence-based data into practice in intervention planning.
This guide includes links to key sources of health evidence, and guides users through systematic searching strategies.
We may not follow the same process of reviewing evidence, but when I saw the TB spine client, I entered the therapy session with a presumption of how he would present and began asking questions to better understand the pathology and establish his hypothesized prognosis. I consulted with the hospital OTs to attain a better understanding and learn from their experiences as practising OTs. I consolidated the information through online articles to guide my intervention planning. I would have followed up with the evidence presented to clinical reason out the therapeutic aims and goals I have for the client, which I would then implement into practice. This process may not work for the next person or client, but we change and adapt to use ourselves as therapeutic tools within and outside of therapy.
This guide includes links to key sources of health evidence, and guides users through systematic searching strategies.
As we approach the final stops of our OT journey, when I look into the mirror, I fall in love with the person I see. The four-week-ago version of myself would have been proud of my tenacity, determination, and willingness to always learn, even in situations when I was on the verge of tears. How I managed my client's horrific experience of a situation we had no control over shifted my perception of myself and the importance of collaborative care. The continuous support from my supervisor allowed space for tranquillity and being okay with shortcomings, but also the importance of accountability, being equally yoked with my group, and wearing the shoe on the other foot. Sometimes we need to jump the fence and learn from those who have walked the path further than we have. Albert Einstein emphasized not to stop learning; allow yourself to explore and learn to be the therapist that is client-centred through EBP.
OT enthusiasts, if you ask me how my week was, no words can describe the physical and mental strain I was under. The academic pressure closed in on me, but through the guidance of my supervisor, "still I rise." She sharpened my observational skills during my session and explained their importance. What I learned was to be thorough and not superficial in going back to EBP to consider and apply the available resources to ensure intervention planning is evolving and therapeutic. She planted the purpose of precision and evidentiality from initial contact to treatment to guide and reason your session to attain therapeutic objectives through research, articles, observing experiences from seniors, and consolidating through interactive learning such as the NDT techniques tutorial.
My take-home message is that we as students forget the power element we instil within the sessions with the clients, and the role we play within the multidisciplinary team requires knowledge in order to clinically reason our therapeutic process. Remember, a decision is not a choice because “a good decision is based on knowledge and not on numbers.” – Plato
Onto our final stop...