First of all, take a deep breath. Ah! Now that is more like it . . . The description you provided, 'wheelchair transfers for bilateral amputees' does not give me a lot to go on; uppers, lowers, at the knee, trans-humeral? What specific transfers are important to the person with whom you are dealing? Are the transfers related to basic self cares, or possibly to instrumental ADLs such as access to driving, community transportation or maybe into a boat so that the person could spend time with persons that are important in their life? I am left guessing. But that is not my concern for you at this point.
I know little of what you were asked to produce by your instructor. In respect to your assignment I would ask that you investigate other sources (Cochrane was not built with the OT in mind) for your information and consider how you frame your search. (www.aotf.org) and OT Search may offer some help, and direct your search to your specific question related to your subject of interest. It is an issue that likely only OTs and PTs address, so related journals would be a good place to start. Also, talk to skilled clinicians and look over rehabilitation books. Last but certainly first, talk to persons who have experienced the amputations, what have they been doing? Given the existence of this group, any with particulars, please reply. It is my feeling that there has been a huge surge to incorporate medicine's values for evidenced-based practice into occupational therapy. Clearly this has been evidenced by AOTA (AJOT) devoting a section in each journal to this topic. OT education programs have been called to assert their commitment, with 'Thankyou' possibly being explicit evidence of this occurrence. I am not an educator, and cannot speak to the pressures placed upon them. But I am concerned with the question that has been posed. I must say that I am all for a practitioner having a sense of personal responsibility and duty to their client so as to continually search for the best options for the client's care. However, the notion of evidence-based medicine, which was meant to foster best practices for medicine, may not translate directly to the OT practitioner. The paucity of randomized controlled trials (RCT) of occupational therapy treatment approaches leaves OT with little in the way of a solid evidence for treatment efficacy. The nature of OT practice, at least how I have experienced it, calls for the judgment of the practitioner supporting the goals relevant to the client. If the practitioner and client are able to bolster the therapeutic approach with evidence garnered by either of the participants, then all the better. RCT speak to the generalities of therapeutic intervention, and enough of them provide bright illumination for the OT in designing a treatment approach. Unfortunately, RTC are few and far between in OT. There are other levels of evidence that may help direct the practitioner (e.g., quazi-experimental, case study, qualitative designs, practitioner experience, etc). It may be that these levels of evidence provide greater insight for the OT practitioner. Case studies may address the specific needs of a particular client addressed in a particular way; a practitioner could generalize from this study to their present client. We must acknowledge the compassion and intellect of our OTs. It is not unreasonable to believe that after hearing of how one person dealt with a difficult situation that others might take the same approach. OT's are not blind as they assert a claim to assist persons in regaining or establishing meaningful occupations or occupational routines in their life. It is a useful practice for the profession to explore what practices result in what benefits for which clients. I know this exploration is of importance to the profession and efforts are being made. But there are many, many issues related to meaningful occupational engagement in life that may have many, many different meanings to many, many different people. Evidence-based medicine is not the model occupational therapy should whole-heartedly adopt to support best practice. Yes, RCT's are needed in occupational therapy, as are other research approaches which will assert the importance of our practice and legitimize its place in today's society. But OT's must not loose touch with the most vital resource for guiding practice, the client. It is the client, and their intimate social network, that should play the strongest role in how we approach our best practice. Just listen . . . Aaron Eakman -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of [EMAIL PROTECTED] Sent: Tuesday, March 09, 2004 8:55 AM To: [EMAIL PROTECTED] Subject: [OTnow] comparison between wheelchair transfers for bilateralamputees Help I have to do an evidence based practice for my 2nd year placement, but am having great trouble finding any research on wheel chair transfers for bilateral amputees. It would be great if anyone is aware of any studies that I can access. I do have access to cochrane etc but do not seem to get any hits. Thankyou _______________________________________________ To unsubscribe, visit: http://otnow.com/mailman/listinfo/otlist_otnow.com The OTnow Mail Archive: www.mail-archive.com/[EMAIL PROTECTED] =============================================== _______________________________________________ To unsubscribe, visit: http://otnow.com/mailman/listinfo/otlist_otnow.com The OTnow Mail Archive: www.mail-archive.com/[EMAIL PROTECTED] ==============================================
