5 Strategies to be an Evidence-Based OT Practitioner
If your OT school was anything like mine, the importance of occupation-based and evidence-based practice was drilled into your head on a near-daily basis. While a variety of interventions were discussed, ones that had hard data to support their efficacy were exalted, whereas other, older interventions may have fallen out of favor.
So when I had my first day of fieldwork at a SNF, it came as a little bit of a shock to see almost every OT patient on an arm bike, pedaling away with little to no input from their treating therapist.Or when I started practicing in outpatient pediatrics and found that many therapists were still using therapeutic brushing.
It seemed to be in direct opposition to all of the discussion of evidence-based practice (EBP) that my professors had spent significant time instilling the importance of to me.
Now after having practiced a few years, I believe that almost every intervention has a time and place where it can be appropriate and effective, but I still try to think of the evidence behind something with every intervention choice I make.
While productivity requirements and ever-changing demands from payor sources make it challenging to consistently pick perfectly, it’s important to attempt to keep treatment evidence-based and meaningful to our clients.
Here are 5 resources I use to be an evidence-based OT:
If you’re currently in grad school or recently out, you’re probably already familiar with the wide variety of academic databases available to use. A database is simply a collection of scientific articles, usually from journals or other scholarly publications. Most databases include a search engine that helps you to find specific articles based on keywords or other categories.
While there are many databases available, three that are especially applicable to occupational therapy are MEDLINE, PubMed, and CINAHL as these are medicine/healthcare-specific databases. Using a database to find evidence for occupational therapy interventions is a fairly simple process, though it can be time-consuming to do it thoroughly.
I would recommend choosing one intervention or condition at a time to research, and spend some time inputting various keywords that may pull up different results.
Cost: Varies. Some databases are entirely free, others are free to search but have a fee attached to reading an article, and others still require paid subscriptions to even access the database. However, there are many ways to get access for free or low cost.
If you are still in school, you may already know that most universities give their students access to a variety of databases for free. But did you know that this perk often extends to alumni? If you’re not sure, email staff at your school to find out what the policy is.
If this isn’t available to you, you can also check with your local public library to see if this is a service they provide. Sometimes this requires going into a library in person, but often you are able to login to a database from anywhere once you’ve created an account with your library login.
Lastly, if you find an article title you’d like to read but there is a cost associated, you can always email the study’s authors to ask for a copy. Many people don’t realize that authors are allowed to send copies of their work for free, and are often excited to do so!
2. Google Scholar
This is technically another database/search engine, but I wanted to highlight it specifically since many do not realize it exists. One of my favorite things to do when I am in the preliminary steps of learning about something is to simply google it. However, when attempting to do more serious research, this can lead to issues.
When anyone can put anything on the internet, you’ll get some interesting results, including many that are not high quality. And while this can still be a way to find out info about a topic (as long as you take everything you read with a heavy dose of salt), there is a way to ask Google to only show scientific results. Enter Google Scholar.
Like most databases, it allows you to search topics of interest and include other relevant criteria, like only searching for articles in the last 5 years. It also allows you to create an alert for new articles that get published in your areas of interest.
For example, if you are working with older adult patients post-CVA and would like to keep up-to-date on best treatment practices, simply enter terms like “CVA occupational therapy” or “post-stroke occupational therapy” to get emailed every time an article is posted that meets these keywords.
I like Google Scholar because it’s a pretty low barrier-of-entry when research seems overwhelming – it’s already built into what is likely a natural routine for you (googling something).
Cost: Free to search, with the potential to find free articles as well. You can always use the options previously discussed to obtain an article for free once you locate it.
3. AOTA and AJOT
The American Occupational Therapy Association and its related publication, the American Journal of Occupational Therapy are both great resources to find the latest evidence that is specific to OT. AOTA has resources from position papers to parent handouts to practice guidelines on many areas of OT, whereas AJOT is a traditional scientific journal that only contains articles for and by occupational therapists.
Another great resource by AOTA is the annual conference, where OTs present their cutting-edge research. AOTA also sponsors several smaller conferences and events related to more specific practice areas, such as children & youth.
Cost: Varies. Many resources on AOTA.com are available for free, though most require an AOTA membership, which currently costs between $65 to $225 a year based on license type and other factors. This membership also gives you access to AJOT and other benefits like discounts on CEU courses or books.
4. CEU Courses
CEU courses are a great way to expand your knowledge base and discover new interventions to add to your toolbox. MedBridge is one my favorite all-time source for evidence-based CEU courses. Read more about MedBridge in the article titled Why MedBridge is the Best Continuing Education Investment You Can Make.
However, not every CEU course is created equally. When deciding to spend money on a course to further your education, there are a couple of important steps to take.
One, find out if the course is approved by your state board and/or AOTA. While this is not a necessity for taking a course, it is typically required if you’d like the course to count towards continuing education requirements when renewing your license or registration. It also helps to weed out courses that may be of lower quality.
Two, look up the evidence behind a course before signing up for it. This can sometimes be found in the information page for the course itself, though you can also do a database search to find all available info. Be wary of courses that claim to be evidence-based but only refer back to their own studies done in-house. While not necessarily a red flag, the highest level of evidence comes from unbiased studies done by third parties.
If a course does not have any specific evidence behind it, or only has their own research, it doesn’t necessarily mean that it’s not a course worth taking – but it does mean that you should approach it with a little bit of skepticism.
Cost: Varies. Many courses can be found for free, but most have at least some cost. Be the wariest of courses that cost hundreds to thousands of dollars but have limited supporting evidence.
5. Taking your own data
So what is there to do when you’ve researched an intervention but you’re coming up dry?
Like I’ve said previously, I think that almost every intervention has the possibility to be successful for at least some clients some of the time. So if you hear about an intervention that you want to try out that doesn’t have any “hard” evidence behind it, it doesn’t mean you have to ignore it entirely.
Being an evidence-based occupational therapy practitioner also involves evaluating those interventions which do not yet have many research studies behind them (and believe me, you will encounter a ton) and deciding whether they are appropriate.
While it can be intimidating to take your own data, this process does not have to be actually setting up and conducting a research study (though I heavily encourage that if you are interested, as we always need more research!). It can be as simple as keeping a record of how long a student sits and attends to an activity when wearing a weighted vest vs without, or measuring grip strength and task performance after trying a new exercise program with a patient.
The only word of caution I advise with situations like these is to make sure that the intervention you choose is low-risk. For example, therapeutic brushing, while having very limited documentation of positive effects, has not been shown to have overarching negative effects either, so if you’ve exhausted your other, more evidence-based tools, it is probably okay to try with a patient. However, craniosacral therapy, another treatment with limited research to support its efficacy, has been found to kill an infant patient in at least one case, so it should be utilized with extreme caution.
Cost: Free! It only takes an investment of your time.
While it can be daunting to be an evidence-based occupational therapy practitioner, it is so necessary to be the best therapist we can be for our patients as well as ensure the growth and respect of our field.
I hope these strategies help you think of ways you can include evidence in your practice. My last piece of advice is to start small – it can be overwhelming to attempt to be completely evidence-based in everything you do overnight, but making a change like reading one journal article a week is a way you can begin to build these habits into your routines.
What are some ways you work towards being an evidence-based OT? We’d love to hear your strategies in the comments!