Hi Sue, Ron and all: I have been reading these posts with great interest. Sue, I am working on my Ph D and leaning toward choosing for my dissertation topic the evolution of clinical reasoning in established therapists. In other words, how do we move people out of the mode of only doing what they saw during FW or learned in school toward a more dynamic occupation based, as well as, evidence based practice. One thing I learned that has helped me over the years feel less intimidated is to not just equate EBP with research alone. In my doctoral work, I have been taught that there are several componets to EBP: best available research, clinical expertise and the preferences of the clients. Though they are not all equally weighted, the weaving of these three variables is what should guide our clinical reasoning. An EBP practitioner should be able to answer the question "why did you decide to do that?" in regard to any OT intervention. Of course it would be great if we could pull out excellent examples of randomized control trials (RCT) that upheld OT interventions as effective, but we are not there yet, nor is it likley that the types of questions generated by OT will fit the RCT . However, there is increasingly more literature out there that does support what we do if we look for it. 'OT Seeker' is an excellent resource for a good place to start looking for reserach around various topics. The clinical expertise piece comes in when we don't just do what we've always done (often mistaken for "expertise"), but rather, collect our own data within our own practice settings. This doesn't have to be a huge formal undertaking, it can be as simple as tracking informally what ever it is you want to evaluate over time (which can be a baby step toward collaborating on a more formal research program in the future). For example, years ago when I worked in rehab, I began tracking Allen Cognitive Level scores on patients who had been admitted after hip surgery. It didn't take long to see a trend in the scores of people who had surgery as a result of a fall (lower) versus those who had elected the surgery (higher). This information informed my "expertise", and helped direct my inteventions. The protocal at the hospital back then was to put every hip patient on the same clinical pathway of teaching use of dressing equipment and compensation, strategies which were often to hard for the fairly cogntively impaired patient. I focused instead on caregiver education and environmental modification to support engagement in occupation. Back then, many of my fellow OTs however simply did the same things over and over with every hip patient, then got frustrated when some didn't learn or couldn't remember what they had been taught. Regarding patient/client preferences, this isn't to imply that we only do what clients want ( I have had many a home care client ask me to give them a back massage because the PT's I worked with did that-very appropriately- but its not OT so I don't offer that intervention). Rather, what we need to do is always take into account the clients preferences whenever possible. I give as many choices as I can within the intervention I select and let the client direct. EBP is an evolving process. I agree that there have been many changes in entry level OT education, and the goal is to graduate practitioners who can go into a practice setting and make use of the best available information in real time (not just what they learned in school) because they know where to look for/ how to evaluate the literature, and who can also contribute both formally and informally to the gathering of "evidence" as defined by the three compnents I described above. Terrianne Jones, MA, OTR/L Faculty University of Minnesota Program in Occupational Therapy
--- On Mon, 9/8/08, Sue O <[EMAIL PROTECTED]> wrote: From: Sue O <[EMAIL PROTECTED]> Subject: Re: [OTlist] expertise To: [email protected] Date: Monday, September 8, 2008, 9:32 PM Just did a huge lit review on this topic for my dissertation - the literature documents a very interesting phenomenon, where all kinds of health professionals (MDs, nurses, OT, PT, SLP, and numerous others), when asked, typically express a positive attitude towards research and evidence-based practice (think it's necessary, think it will advance their profession, improve client care, etc), but other than in certain pockets, the vast majority do not use evidence based practice, even when there is evidence available. In the literature, EBP is described as including things like searching for evidence, reading and appraising the literature, applying research findings to practice, conducting any kind of research on one's own practice, and/or being involved in clinical studies. This is not only consistent across the health professions, it is consistent across time, going back from the 1980s to the present. Hopefully as more contemporary students, who are being taught more EBP skills, enter the work force, this may change, but there is also some intriguing evidence that suggests that health professionals say what they think they are supposed to say about EBP, but really don't think that using and/or creating research evidence is important, or an integral part of their role... Ron, at least you are being honest about it! What do others think? Sue Ordinetz *********** REPLY SEPARATOR *********** On 9/7/2008 at 7:14 PM Ron Carson wrote: > >At this point, I must confess a small secret. I do not like research; >I don't like doing it or reading it. I KNOW it's important but I am >just NOT a research man. As such, I tend to never focus on the >research question(s) that you mention, but maybe I should. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
