Re: Re[2]: Questions on evidenced-based practice

[DairBerner]

Wow, CR, this issue seems to push some big negative buttons for you.  What is it about therapists having access to and making use of evidence of effective treatment techniques and approaches that you have such difficulty with?  Have you done any reading on evidence based practice?  The Well Elderly Study that is acclaimed by much of the OT community is one example of evidence that can be accessed by OTs when treatment planning.  The following is taken from a web site developed by some OT students at:  http://ot.curtin.edu.au/home/html/ebp/Default.html

"Evidence-Based Practice in Occupational Therapy What Is Evidence-Based Practice?

Evidence-based practice (EBP) is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual clients. EBP means integrating individual clinical expertise with the best available external clinical evidence from systematic reviews.

Good practitioners use both individual clinical expertise and the best available external evidence and neither alone is enough. Without clinical expertise, practice risks becoming tyrannised by external evidence because even excellent external evidence may be inapplicable to or appropriate for an individual client. Without current best external evidence, practice risks becoming rapidly out of date, to the detriment of clients.

A Framework for EBP - 5 steps
EBP is a process of life-long, self-directed learning in which caring for our own clients creates the need for clinically important information about assessment, prognosis, therapy and other health care issues and in which we:
� Convert these information needs into answerable questions
� Track down, with maximum efficiency the best evidence with which to answer them (eg clinical examination, diagnostic tests, assessments, research evidence or other sources).
� Critically appraise that evidence for its validity (closeness to the truth) and usefulness (clinical applicability).
� Apply the results of this appraisal in our clinical practice
� Evaluate our performance.

What Evidence-Based Practice Is Not

� EBP is not a top down "cook book" practice and cannot result in slavish, cook book approaches to client care. Why? Because it is essential that it adopts a bottom-up approach that integrates the best external evidence with individual clinical expertise and client choice. Individual clinical expertise decides whether the clinical evidence applies to the client at all, and if so, how it should be integrated into a clinical decision.
� EBP is not restricted to randomised control trials and meta-analyses. It involves tracking down the best external evidence with which to answer our clinical questions"

Ann