Evidence-based Occupational Therapy Research Articles

Spirituality unplugged: a review of commonalities and contentions, and a resolution.

Spirituality is an important and essential component of occupational therapy, but recent publications in occupational therapy literature also raise questions about the adequacy of the Canadian Association of Occupational Therapists' definition of spirituality and the relationship of spirituality to occupational performance. Re-examination of spirituality and occupation is needed to better understand the role of occupational therapists with respect to spirituality. In this paper, the authors examine the common themes that are inherent in definitions of spirituality from diverse professional perspectives. The commonalities and contentions inherent in these definitions are then contrasted with the perspectives of occupational therapists. This discussion is followed by a challenge for re-examination of spirituality in the Canadian Model of Occupational Performance, and an argument that occupational identity rather than spirituality should have a central position. The implications of spirituality and occupational identity for evidence-based occupational therapy are considered.

Recent professional developments

Having recently returned from the most successful 21st National Conference of Occupational Therapists in Brisbane, we feel stimulated by the launch of the Accredited Occupational Therapist Program (AccOT) and by the theme of evidence-based practice (EBP), which emerged during the scientific program and in Anne Cusick’s Sylvia Docker lecture. These developments have been in train for several years, as indicated by the long-term planning for the AccOT Program and by the recent issue of the Australian Occupational Therapy Journal featuring EBP (December 2000). The AccOT Program has been developed to assist and encourage occupational therapists to maintain currency of knowledge and skills. It also aims to promote occupational therapy skills to consumers, employers, government agencies and authorities; these groups will now have a means for identifying those practitioners who are continually working to update their professional skills. This program is comprehensive, covering standards of practice, occupational therapy training programs, appropriate mechanisms for handling of any concerns or complaints, and guidelines for mentoring and supervision. The core theme of the AccOT Program is continuing professional development, which links effectively with EBP. The International Symposium on Evidence-Based Occupational Therapy, organised by the Department of Occupational Therapy at the University of Queensland and held prior to the Conference, provided an exciting forum for Australian and international occupational therapists to participate in identifying issues, themes and future directions for EBP. We were fortunate to have leading Australian and New Zealand representatives and eminent international occupational therapy speakers. The links between Australia, New Zealand, Canada, the UK and the USA, and the World Federation of Occupational Therapists, which were strengthened at the symposium, will provide a valuable base for future collaboration. A further recommendation from the symposium related to the publication in our Journal of critically appraised papers (CAP) relevant to occupational therapy. This would involve location of suitable papers, preparation of a structured abstract, and a written commentary on the paper by an expert from the relevant field. Publishing a variety of CAP in a journal enables the subscribers to access a wider range of scientific papers relevant to their professional interests. This proposal will be discussed at our next Editorial Board meeting. It is important to understand that EBP is the combination and integration of best available research evidence, clinical experience and patient values (Sackett et al., 1996), with Taylor (2000) stressing that EBP should be seen as ‘just one of the tools of clinical reasoning and reflective practice’ (p. 3). Best evidence can range from expert discussion to systematic reviews and meta-analysis of randomised controlled trials, with qualitative research now being seen as acceptable and appropriate evidence (Taylor). Evidence-based practice in the health sector is a universal concept, which according to Sackett et al. (1996), will be integral to all practice by the year 2005. The AccOT Program will provide an effective tool for occupational therapists to achieve this goal. The continuing professional development tool of the AccOT Program will provide an effective framework for occupational therapists to develop their practice through access to the latest research, developing skills in understanding and interpreting the research literature, and by accessing systematic reviews and critically appraised papers from journals and the Internet. These themes from the Conference can be interpreted as demonstrating the continuing growth of our profession, and signify the strength of the foundations of our practice.

The promotion of evidence-based occupational therapy practice in Canada.

Occupational therapists must utilize evidence in decision making in order to define approaches for occupational therapy service which attain optimal client outcomes, promote consistency, continuity and cost containment, and validate the role of occupational therapy to clients, payers and other health professionals. CAOT has undertaken many initiatives to teach the skills, provide the tools and facilitate the generation and dissemination of evidence required for evidence-based occupational therapy. CAOT recognizes the importance of working in partnership with other stakeholders involved in occupational therapy practice in Canada in order to successfully break down barriers to the integration of evidence in occupational therapy practice.

Research utilization models: frameworks for implementing evidence‐based occupational therapy practice

AbstractEvidence‐based practice is an important step in the professional evolution of occupational therapy and also provides the means for state‐of‐the‐art innovative clinical service for clients. An essential step in incorporating innovations and developments into clinical practice is through research utilization. Nine models of research utilization developed in the literature are reviewed and critiqued. These are: (1) the Conduct and Utilization of Research in Nursing (CURN) Project; (2) the Stetler‐Marram Model; (3) the University of North Carolina Approach; (4) the Innovation Diffusion Process Model; (5) Killeen's Matrix of Research Activity; (6) the Iowa Model of Research In Practice; (7) the Western Interstate Commission for Higher Education In Nursing Project; (8) the Nursing Child Assessment Satellite Training Project; and (9) the Linkage Model. Research utilization models provide a framework for collaboration and the necessary conditions for research utilization activities to be successful. Copyright © 1999 Whurr Publishers Ltd.

The Client-Centred Evidence-Based Practice of Occupational Therapy

Evidence-based practice has its roots in evidence-based medicine. This term refers to the formulation of treatment decision using the best available research evidence. While the concept has gained increased attention among health care workers in the recent past, practice based on scientific evidence has been recommended for over 300 years. However, all health-related professions continue to report difficulties adopting evidence-based practice. Notably, practitioners are often concerned that results of population-based research may not be relevant for their specific patients. This may be of particular concern for occupational therapists who aim to provide client-centred intervention, taking into consideration individual characteristics of the client, the environment and the occupation. As well, those wishing to practice evidence-based occupational therapy must determine which decisions are made during the course of therapy and what evidence may impact on these decisions. The Occupational Performance Process Model (Fearing, Law & Clark, 1997) outlines the occupational therapy problem solving process and assists therapists to integrate knowledge from both client and therapist. A framework for evidence-based occupational therapy is presented, based on this model.