Ebp lec ppt june 2012

Maria Anya Paola P. Sanchez, OTRPPrime Movers Review Center

Define evidence-based practice (EBP).

Identify the levels of research evidence.

Describe the process of finding and appraising evidence that can be applied in practice.

Compare and contrast quantitative and qualitative studies.

Define basic terms used in descriptive statistics as applied in clinical research.

Define intellectual property and plagiarism.

Describe the American Psychological Association (APA) style for writing reference lists and in-text citations.

Distinguish established interventions from non-validated treatments.

Validated

Experimental (some are plausible, some are not)

Quackery

Cure claims

Practitioner specialization

Questionable research

Intensity

Economic harmPermanent injuryTemporary injuryDeathPsychological harm

NCAHF, 1996

Boredom

Low professional esteem

Paranormal tendencies/beliefs enroachment

Paranoia

Reality shock

Profit motive

Prophet motive

Psychopathic tendencies

Conversion phenomenon

Proven practices may be difficult.

Unproven practices make them feel valuable.

People believe only the research that supports their values.

Professionals do not read literature.

They want to offer people hope.

Lack of suspicionBelief in magicOverconfidenceDesperationAlienation

The disease may have run its course.

Many diseases are cyclical.

Placebo effect may be responsible.

Original diagnosis/prognosis is wrong.

Improvements credited to the wrong intervention.

Mood improvement can be confused with cure.

Psychological needs can distort what people perceive and do.

“We envision Occupational Therapy as a powerful, widely-recognized,

science-driven, and evidence-based profession with a globally connected and diverse workforce meeting society’s occupational

needs.”

(AOTA, 2006)

“…the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” (Sackett, 1996)

Sackett, 1996; Law, 2011

Limited timeInformation overloadLack of skills in interpreting research findings

Lack of research evidenceResistance to change

MAIN AIM: To improve patient outcomes.

To use intervention strategies that are scientifically valid.

To have accountability.To improve clinicians’ knowledge.To stimulate clinically relevant research. Bailey, 2003;

Bennett, 2011

SCIENTIFIC DUBIOUS

Improvements in everyday functioning

Cures; vague but important-sounding benefits

SCIENTIFIC DUBIOUSControlled studies with measurable results

Uncontrolled studies; measures are not reliable.

SCIENTIFIC DUBIOUSConsistency with other knowledge

“Natural” intervention; attempts to remediate a core deficit.

Bailey, 2003; Bennett, 2011; Bennett & Bennett, 2000

Types of clinical questions:

What is the most appropriate assessment?

What is the prognosis of the disease/disability?

Which intervention strategies are most effective?

How cost-effective are these intervention strategies?

What are the patient’s experiences/concerns?

How do you form a clinical question?

P – patient/problem/populationI – interventionC – comparison intervention (if relevant)

O – outcomes of interest

“PICO”

Example 1: Does therapeutic practice (I) improve handwriting legibility and speed (O) for children with autism (P) better than sensorimotor-based interventions (C)?

Example 2: Do tongue exercises (I) improve swallowing patterns (O) for patients with CVA (P) better than food modification techniques (C)?

Give an example of a clinical question.

Identify the P, I, C and O.

Do a literature search.

Attend conferences and workshops.

Join professional organizations.

Assess the similarities between your client and the participants

Check if the researcher controlled for outside influences.

Examine the psychometric properties of the assessment tools that were used.

Research use – apply research findings.

EBP – tailored, client-centered use of best research evidence and clinical expertise.

Why does clinical expertise play a role in EBP?

How efficient and effective were you in following the EBP process?

What were the results of the interventions used?

How does the intervention compare with others?

Clearly and concisely explain to the patient and the family how research supports a particular intervention.

Communicate the findings to your colleagues.

Dickson, 2005; Humphris, 2005

Systematic Reviews – brings together and appraises ALL research findings

Meta-Analysis – uses a statistical approach

Randomized Controlled Trial (RCT) – one group receives an intervention, one group does not; participants are randomly assigned.

Case control – one group does not have the condition, the other group has the condition.

Cohort – participants are studied over a long period of time; prospective or restrospective.

Before and after

Pre-test and Post-test

Descriptive studies with analyses of outcomes for a particular individual

Examples: case series, single-subject

Single-Subject Designs:

AB

ABAB

Multiple Baseline

Case reports

Expert Opinion

A. Case-Controlled Studies

B. Randomized Controlled Trials

C. Cohort Studies

D. Case Series

Bailey, 2003

Front material – title, authors and their affiliations, key words and an abstract

Problem – the major issue that the researcher wishes to address in the study

Background/Literature review - findings from different studies.

Results – in a quantitative study, the statistical analysis is briefly described; descriptive statistics are used.

References – the final portion which presents all publications and other materials that are cited in the text.

Purpose – what the authors hope to accomplish in the study.

Hypotheses/Research Questions

Method – sources of data, participant selection, sample size, procedures and instruments used.

Castaldy, 2008; Jeanfreau & Jack, 2010

Phenomenology – “phenomenon”; how one perceives personal experience.

Ethnomethodology – “ethno-”; culture – practices, beliefs, roles and values.

Participatory Action Research – “participate”; subjects research on their own experiences.

Grounded Theory – theory based on data.

Heuristic – researcher participates in the experience.

Case study – a single sbject or group of subjects is studied in an in-depth manner.

Interviews

Focus Groups

Participant Observation

Purposeful/Purposive – based on the purpose of the study.

Nominated – people volunteer other people.

Volunteer – people volunteered but the researchers do not know them.

Total population – subjects are in one area.

Did the qualitative research describe an important problem related to health practice?

Does the study have clear research questions?

Was the qualitative approach appropriate?

How were the participants selected?

What were the researchers’ roles in the study? Was this taken into account?

What methods did the researchers use for gathering data? Were they described in appropriate detail?

Castaldy, 2008; Law, 2011; Polgar & Thomas, 2010

True Experimental – two groups; randomization.

Quasi-Experimental – no randomization; used when it is unethical to withhold treatment.

Non-Experimental/Correlational – impossible to have randomization or manipulation of variables.

Properties that vary.

Can be numerical or categorical.

Dependent – item observed and measured; cannot be manipulated.

Independent – assumed to have caused effects; manipulated.

Reliability – consistency of measurements

2 Types:Inter-rater – between two ratersTest-retest (intra-rater)– after a time interval,

usually 2 weeks

Measured by a correlation coefficient from -1 to +1

Good reliability: 0.8 and above

Validity – the extent to which a tool measures what it intends to measure.

3 Types:Construct-relatedContent-relatedCriterion-related

Construct-related validity – the extent to which a tool discriminates among different groups of individuals.

Example: The Sensory Profile is able to differentiate kids with sensory processing disorders from typically developing children because of its acceptable level of construct-related validity.

Content-related validity – the extent to which items on a test accurately sample a particular behavior domain.

Example: The Barthel Index has a comprehensive set of items (content-related validity) pertaining to self-care tasks in order to measure the client’s performance in ADL.

Criterion-related validity – the extent to which a tool predicts the client’s performance in other related tests or activities.

2 Types of Criterion-Related Validity

Concurrent Predictive

Concurrent – measures current performance

Example: There is a high correlation between the Sensory Profile and the School Function Assessment (SFA) in items that address hand use.

Predictive – predicts one’s performance in the future when another test is used.

Example:

The Test of Infant Motor Performance (TIMP) was administered shortly after birth. It was able to accurately predict which infants would be classified as delayed by the Alberta Infant Motor Scale after 12 months.

HistoryMaturationTestingInstrumentationSelection or assignment errors

Nominal – naming; categorizationExample: Male & Female; Blood Types A, B, O, AB

Ordinal – rank orderingExample: Good, fair, poor; minimal, moderate, maximal

Interval – no absolute zero; identifies intervals or distances between any 2 values.Examples: Celsius, Fahrenheit

Ratio – has a zero-point.Examples: Height, weight, ROM measurements

Sensitivity – people with conditions are correctly identified as having such problems; detects “true positive”.

Specificity – people without conditions are identified as NOT having such problems; detects “true negative”.

Type I – “false positive”

Type II – “false negative”; more dangerous

Sample bias

Intervention bias

Measurement bias

Rosenthal Effect – researcher expectation influenced the results.

Hawthorne Effect – subjects’ performance improved through being observed and/or social contact; an example of placebo effect.

Statistical Significance – the probability that the differences in the outcomes were NOT caused by chance.

P- value – probability that an event occurred by chance; used to measure statistical significance.

P > 0.05 – result is not statistcally significant.

P < 0.05 – result is significant.P < 0.01 – result is highly significantP < 0.001 – result is very highly significant

CENTRAL TENDENCY

Mean – averageMedian – middleMode – most common

Internal Validity – results are due to the treatment/independent variable

External Validity – results can be generalized to the population

Republic Act No. 8293 – Intellectual Property Code of the Philippines

Intellectual Property Rights – the exclusive right given to a creator over the use of his creation within a period of time.

Turning in someone else’s work as your own.

Copying words or ideas from someone else without giving credit.

Failing to put quotation marks.

Changing words but not changing the sentence structures without giving credit.

Copying so many words that they constitute the bulk of your work.

References are cited both in the text and in the reference list.

In-text citation: surname and year of publication

Reference List: Author’s last name, initials (year in parenthesis), title of article or book, title of publication (if journal) or city, state and publication house (if book)

To be questioning

To see more than one side of the argument

To be objective rather than subjective

To weigh evidence

To judge whether a statement is based on logic or emotion

To look at the meaning behind the facts

To identify issues regarding the facts

To recognize when further evidence is needed

Role modelling

Reflection in action

Action learning groups

Research awareness groups

Ending

The Neutral Zone

The New Beginning

American Occupational Therapy Association. (2006). AOTA’s Centennial Vision. Retrieved May 5, 2011 from http://www.aota.org/News/Centennial/Background/36516.aspx.

Bailey, D.M. (2003). Research: Discovering Knowledge through Systematic Investigation. In E.B. Crepeau, et. al (Eds.), Willard & Spackman’s Occupational Therapy (pp. 963-974). Philadelphia: Lippincott, William & Wilkins.

Bennett, S. (2011). Evidence-Based Practice in Occupational Therapy: An Introduction. Retrieved May 5, 2011 from http://www.otevidence.info/images/Introduction.pdf.

Bennett, S. & Bennet J.W. (2000). The process of evidence-based occupational therapy: Informing clinical decisions. Australian Occupational Therapy Journal, 47, 171.80.

Cabatan (2006). Referencing. Manila: University of the Philippines, College of Allied Medical Professions.

Castaldy, R. P. F. (2008). Professional responsibilities and service management. In R.P.F. Castaldy (Ed.), National Occupational Therapy Certification Exam: Review & Study Guide. Illinois: International Educational Resources.

Dickson, R. (2005). Types of evidence. In S. Hamer & G. Collinson (Eds.), Achieving Evidence-Based Practice (pp. 15-40). Philadelphia: Elsevier, Limited.

Humphris, D. (2005). Types of evidence. In S. Hamer & G. Collinson (Eds.), Achieving Evidence-Based Practice (pp. 15-40). Philadelphia: Elsevier, Limited.

Jeanfreau, S.G. & Jack, L. (2010). Appraising qualitative research in health education: Guidelines for public health educators. Health Promotion Practice, 11, 612-617.

Law, M. (2011).Evidence-based practice: Finding and critically reviewing the evidence. Retrieved May 5, 2011 from http://www.otevidence.info/images/FindingReviewing.pdf.

Lin, S.H., Murphy, S.L., & Robinson, J.C. (2010). The Issue is --- Facilitating evidence-based practice: Process, strategies and resources. American Journal of Occupational Therapy, 64, 164-171.

Polgar, J.M. (2003). Critiquing Assessments. In E.B. Crepeau, et. al (Eds.), Willard & Spackman’s Occupational Therapy 10th Edition (pp. 299-313). Philadelphia: Lippincott, William & Wilkins.

Polgar, S. & Thomas, S.A. (2010). Introduction to Research in the Health Sciences. Singapore: Elsevier, Limited.

Richardson, P.K. (2010). Use of Standardized Tests in Pediatric Practice. In J. Case-Smith & J. Clifford O’Brien (Edzs.) Occupational Therapy for Children 6th Edition (pp.216-243). Missouri: Mosby Elsevier.

Rappolt, S. (2003). The role of professional expertise in evidence-based occupational therapy. American Journal of Occupational Therapy, 57, 589-593.

Sackett, D.L., et.al.(1996). Evidence based medicine: What it is and what it isn’t. British Medical Journal. Retrieved May 5, 2011 from http://www.bmj.com/content/312/7023/71.long.

Tomlin, G. & Borgetto, B. (2011). Research Pyramid: A new evidence-based practice model for occupational therapy. American Journal of Occupational Therapy, 65, 189-196.

What is Plagiarism? Retrieved May 5, 2011 from http://www.plagiarism.org/plag_article_what_is_plagiarism.html.