Evidence-based Practice in Occupational Therapy

Abstract

Evidence-based practice (EBP) was introduced to the occupational therapy (OT) profession to aid in the development of clinical services and to substantiate daily OT practices. It refers to the conscientious, explicit and judicious use of the current best evidence in making decisions about the care of individual clients. In this article, a systematic and critical review of published randomized controlled trials in OT was performed in order to critically appraise the current level of evidence provided with respect to EBP and provide recommendations accordingly. Searches of MEDLINE EXPRESS and the Cochrane Collaboration Library databases of the English-language literature with keywords “randomized clinical trial”, “controlled clinical trial” and “clinical trial” for publication type, and “occupational therapy” in any field were made. Forty-six randomized, controlled trial publications of OT treatment were identified, and two independent reviewers assessed their quality according to a preset protocol. Among the 46 trials, 29 were classified as average or above. The remaining 17 trials were graded as poor quality. About 50% of the trials studied geriatric, paediatric or stroke patients. These areas had higher evidence grades. In terms of the quality of design, most studies adequately described the measurement methods, duration of therapy and group assignment, but handling of blinding method and sample size calculation were poorly described. In this systematic and critical review, I conclud that there were far too few randomized, controlled OT trials. The quality of one third of the trials was low and there were insufficiencies in their reporting as well. Therefore, more properly designed and conducted randomized controlled clinical trials of OT treatment with proper reporting based on reference to the CONSORT statement are necessary.