Why Evidence-Based Practice is not Straightforward.
Evidence-based practice is really 3 things in one which includes...
The actual research articles
The experiences of a therapist
The clients values and context
As occupational therapy practitioners, it is important to include all three steps to get the most clinically relevant decision.(1)
Everyone’s clinical questions are different
If you’ve ever made tie dye t-shirt there’s a well known fact that no two shirts will look the same, no matter how hard you try. Similarly, when you arrive at a site like Google Scholar to look up a new article for a question you have for treating a client, it will never be the same experience. Each time you look up something you have a different Person, Intervention, and Outcome in mind. Sometimes we are Comparing one intervention with another. Hence why we need to use a PlCO question.(2)
P: Person
I: Intervention
C: Comparison or control
O: Outcome
There are other versions of PICO depending on what you are looking for but since we work in rehabilitation settings, often we are looking for if a certain intervention works.
Who actually participated in the study
If you read through who was actually included in the study and they are very different from you client in age, gender, socioeconomic status, level of disability, etc. then that’s really important to take into consideration. The success of the intervention might look different if you try it with that client.
For example, if you are working with a 30 year old but the majority of the sample is, on average, 80 years old, you might want to adjust how you use that information or whether you implement it.
Implementing a new idea can come with a financial cost
Some of the studies require a cost when trying to start using the intervention. It might require a 3D printer, a new assessment tool, or a manual to purchase. Advocating for these tools, especially if it is something that would benefit a large number of clients you work with, is part of supporting our clients and providing evidence-based care.
The level of change expected varies depending on your client and their context
As you are reading through an article, your key takeaways could be vastly different from another therapist. For example, if you see an article that has a small clinical effect on the impact of using Constraint induced movement therapy for fine motor skills for an adult with cerebral palsy, that small clinical effect might actually be really meaningful for the adult in an outpatient setting. If you take the same study to a client that is in an inpatient rehabilitation hospital and recovering from a stroke, using constraint for only a small clinical effect would not be as helpful as large changes are expected. As we like to say in OT all too often, it really depends on the client, their context and what the goals are.
To be honest, this was not the blog post I hoped I would be writing ...
I went into this fall semester thinking I was going to get a step by step checklist of how to find evidence and apply it to my caseload and support others in learning how to do this more efficiently too. I was frustrated when that was turning out not to be the case. I found, over time, as therapists we cannot solely rely on evidence but it is so important not to forget our clinical experience and patient values. That is in fact where we shine since we are trained to think about the whole picture, not just one piece of it.
“Reflective practitioners capitalize on the tension that exists between research findings and clinical experience to expand their knowledge.” (Brown, 2016, p. 3)
1. Brown, C. (2016). The evidence-based practitioner: Applying research to meet client needs. FA Davis.
2. Richardson, W. S., Wilson, M. C., Nishikawa, J., & Hayward, R. S. (1995). The well-built clinical question: a key to evidence-based decisions. Acp j club, 123(3), A12-3.