The Importance of Evidence-Based Practice in Occupational Therapy

How many times have you heard the phrase evidence-based practice over the last few years? Applying the latest research to your treatment sessions does seem to make sense, doesn’t it?

But how do you know when the evidence supports the practice of occupational therapy?

This article will explain what evidence-based practice is, why it is important for OTs, and how you can tell when evidence has a basis in occupation.

Evidence-Based Practice, Defined

What we now know as evidence-based practice started in the early 1990s as evidence-based medicine. This term, developed by David L. Sackett, et. al. (1996) from McMaster University in Ontario, Canada, referred to the combination of the best evidence from research, clinical expertise, and patient values to achieve the best outcomes.

The American Occupational Therapy Association (AOTA) has applied this definition to our own practice by explaining evidence-based practice as “the integration of critically appraised research results with the clinical expertise, and the client’s preferences, beliefs and values.”

This definition shows that evidence-based practice isn’t just reading a research article and deciding that you want to try the technique described. Rather, it’s a careful analysis of evaluation and treatment methods addressed in the body of recent research and how those methods can be applied to the care you provide to your patients on a case by case basis.

Why is Evidence-Based Practice Important?

1. More Effective Treatment Techniques

Evidence-based practice ensures that your treatment techniques are effective. Analyzing the best and most pertinent research ensures that the treatments that you use with your patients actually work.

A good example from the world of pediatrics is the use of weighted vests with children who have sensory processing disorders. Weighted vests have been used by occupational therapists to provide deep pressure input to children with autism and attention-deficit and hyperactivity disorder (ADHD) for many years.

When questioned about why the vests work, however, the evidence supporting the use of these vests was found to be lacking. The research supporting the use of weighted vests consisted mostly of case studies or small, convenience samples with no controls. Researchers have worked to fill in the gaps in the research regarding the use of weighted vests, including their use with adults, which includes systematic reviews like this one from 2018.

2. Better Cooperation From Patients

Evidence-based practice allows you to help your patients make informed choices for their occupational therapy programs. Following evidence-based practice allows you to easily answer that question that patients always ask: “Why do I have to do this?”

Patients who are aware of their situation and who want to be in control of their own health care will be more compliant with your interventions and will be more satisfied overall with your services when they know that there is evidence showing that those programs lead to results. The evidence behind your treatment techniques will help you to show your patients that there is a point to your treatment.

3. Defending Services To Third Party Payers

Evidence-based practice helps you to show third party payers that you are using treatments supported by research. Medicare, Medicaid, and many insurance companies want assurance that the treatment you provide to your patients is based on the latest research before they will pay for your services.

Following the principles of evidence-based research helps you to easily provide this information to third party payers. AOTA now provides evidence-based practice resources to help you do this through the Evidence-Based Practice Project.

4. EBP Keeps Your OT Skills Current

Evidence-based practice ensures that your clinical skills are up to date. If you are a brand-new OT or COTA, you probably don’t have to worry about this too much. If you graduated years ago, however, the practice of occupational therapy has changed significantly since you were in school and the techniques you are using might not be the ones supported by the current research. Using evidence-based practice helps you to keep your clinical skills current.

Ensuring that Evidence is Occupation-Based

In your quest for research that supports or refutes your treatment practices, you will want to keep in mind that any evidence you choose to use should have a basis in occupation. Promoting occupation for our patients is what we do, after all.

So how do you know that the evidence you’re looking at is occupation-based?

It’s not as complicated as it sounds. Here are a few methods that you can use to locate and analyze occupation-based evidence:

• Do a keyword search. Evidence that focuses specifically on a treatment’s basis in occupation will include keywords such as “occupation-based” or “occupational engagement.” This dissertation from 2015 provides an example of a research study that directly analyzes the occupation of bathing within groups of older adults who live in the community. Notice the keyword “occupation-based” in the title, making it easy to locate in a search.
• Look for occupations as a part of the research design. This literature review completed by the AOTA Evidence-Based Practice Project provides evidence that correlates occupational therapy treatment techniques, re-engagement in daily activities, and return to work. The incorporation of daily activities and return to work in the design of the review ensures that this study is occupation-based.
• Search for research related to specific occupations. If you want to know the most effective method for addressing dressing skills in stroke patients, include the keywords “occupational therapy”, “dressing skills” and “stroke”. This case study included in AOTA’s Evidence-Based Practice Project was located using these keywords, plus the date range 2015-2021.

Best practice in occupational therapy strongly encourages the application of any treatment technique to occupation, so make sure to look for occupation-based references in the research that you read.

If an article on the use of neuromuscular stimulation correlates to an increase in muscle strength but does not apply that strength to a functional activity such as lifting a box as a part of a job or carrying dishes across a kitchen, its usefulness in your actual research base for treatment will be limited.

The use of evidence-based practice has become increasingly important in the field of occupational therapy and it is critical that you begin considering the evidence as you provide your interventions to your patients.

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All this information might sound daunting at first, especially if you have not yet incorporated evidence-based practice into your clinical treatment. This literature review by Thomas and Law discusses some of the pertinent factors involved in the use of evidence-based practice by occupational therapists. It may help you to start incorporating these principles into your practice.

*If you’re looking for evidence-based continuing education but aren’t sure where to start, be sure to check out MedBridge Continuing Education for unlimited online CEUs that are backed by current evidence. You can get $175 off of their standard price by using this link or the promo code MYOTSPOT.

Disclosure: I am an affiliate for MedBridge and I may receive a small commission for purchases made through this link at no extra cost to you. This goes directly back into the operating costs of My OT Spot. 

References

Evidence-Based Practice and Research (2018). American Occupational Therapy Association,
https://www.aota.org/Practice/Researchers.aspx

Nilsen, D., Gillen, G., Arbesman, M., & Lieberman, D. (2015, September 01). Occupational Therapy Interventions for Adults With Stroke. American Journal of Occupational Therapy, September 2015, Vol. 69, 6905395010p1-6905395010p3. doi:10.5014/ajot.2015.695002 

Paquette, S., OTD, OTR/L, CPE, D-ABVE. (2016). Critically Appraised Topic: Evidence for the Effectiveness of Exercise and Work-Related Interventions. https://www.aota.org/Practice/Rehabilitation-Disability/Evidence-Based/CAT-Musculo-Work.aspx

Reynolds, S., Lane,S.J., & Mullen,B.(2015). Brief Report—Effects of deep pressure stimulation on physiological arousal. American Journal of Occupational Therapy, 69, 6903350010. http://dx.doi.org/10.5014/ajot.2015.015560, http://www.terapeutas-ocupacionales.es/assets/files/COPTOA/Bibliotecavirtual/AJOT/Mayo-Junio-15/6903350010p1.pdf.

Sackett, D. L., Rosenberg, W. M., Gray, M., Haynes, B., & Richardson, S. (1996, January 13). Evidence based medicine: What it is and what it isn’t. BMJ: 312:71. https://www.bmj.com/content/312/7023/71

Thomas, A., & Law, M. (2013). Research utilization and evidence-based practice in occupational therapy: A scoping study. American Journal of Occupational Therapy, 67, e55–e65. http://dx.doi.org/10.5014/ajot.2013.006395.https://www.researchgate.net/publication/241691629_Research_Utilization_and_Evidence-Based_Practice_in_Occupational_Therapy_A_Scoping_Study