OTHY100 Week 8

Evidence-based health care promotes the collection, interpretation and integration of valid, important and applicable patient-reported, clinician-observed, and research-based evidence.

•Find theoretical information and research results•Evaluate whether theories and research results are consistent with occupational therapy philosophies about people, health & occupation•Evaluate the trustworthiness of research findings based on validity and reliability•Make judgements about conflicting information•Current knowledge of best-practice

•Effectively locating, understanding, evaluating information/data and applying to practice•Provide a coherent rationale for practice using theory and research results•Clinical reasoning is involved in this process of critical analysis and linking theoretical evidence with application

Clinical practice attitudes in OT need to:Ensure quality service delivery by valuing and building on theory development, the application of research findings to practice, and ensuring that practice is informed by the best available information.

•Identify the problem•Develop a plan to find the evidence•Evaluate the evidence•Develop clinical guidelines (best practice)•Implement•Review outcome

Level 1 at least 1 properly randomized controlled trial (RCT).Level II-1 well-designed controlled trials without randomization (CCT).Level II-2 well-designed cohort or case-control analytic studies, preferably from more than 1 center or research group.Level II-3 comparisons between times / places with or without intervention. Dramatic results in uncontrolled experiments may be included.Level III opinions of respected authorities, based on clinical experience, descriptive studies or reports of expert committees.

1.Knowledge (Evidence based practice)2.Reasoning ability3.Metacognition (Thinking about thinking!)

Rule-based procedural reasoningMinimal use of contextual cluesNarrative reasoning to establish social relationshipsPragmatic reasoning for job survivalRecognises overt ethical issues

•Reasoning is fast & intuitive•Has an extensive range of experiences•Highly skilful use of the occupational story

1.Used to understand nature of condition2.What are the common disabilities, impairments, ocupational performance problems that result?3.What are typical contextual (environmental factors) that affect performance?4.What theories and research guide assessment and intervention5.What intervention protocols apply?

1.Used to understand the meaning of the condition to the person.2.What is his life story?3.What is the nature of this person as an occupational being?4.How has the condition affected the person’s life story?5.What occupational activities are important to this person? What activities are meaningful to this person and useful for meeting therapy goals?

1.Used to understand the practical issues affecting clinical action2.Who referred this person and why?3.Who is paying for services and what are the expectations?4.What family/caregiver support is there?5.What are the workplace expectations?6.How much time, therapy space and equipment does the OT have for the person?7.What are the clinical competencies of the OT?

1.Used to choose morally defensible actions, given there are competing interests2.What are the benefits and risks of intervention?3.With limited time and resources, what is the fairest way to prioritise care?4.How can you balance the goals of the client with those of the family or caregivers?5.What should the OT do when other service providers are in conflict with the person’s goals?

•Therapy is an interactive process•Some interactive reasoning is conscious, others unconscious