Being an evidence-based practitioner is not a step-by-step checklist. It involves a blending of a lot of different reasoning and research searching into a beautiful mix. In this solo episode, I go into some areas to consider when providing evidence-based care and what that actually looks like with some practical examples. Also, I discuss the differences between evidence-based practice, practice-based evidence, and evidence-informed practice.
Resources mentioned in the episode:
Welcome to the OT digest podcast. I'm your host, Katie Caspero, the founder of OT, graphically.com, where I synthesize research individually appealing. On this podcast, we take research and make it more fun and interesting in order to quickly hear the most updated evidence all around the world. I interview authors, share research tips and provide practical examples that I hope we can use and incorporate into your interventions the very next day.
Thanks for listening.
Hey everybody today, we are going to be talking about a topic that is close to my heart and something I've been very passionate about lately. Uh, why evidence-based practice is not straightforward. Even the term itself evidence-based practice can be confusing because there's also practice-based evidence and evidence informed.
Practice. So all of these things together can create some confusion. So I just wanted to go ahead and clear some of that up right now, evidence-based practice is applying our translating research findings into daily patient care and clinical decision-making. So it's taking those results of the research studies that have been thoroughly tested, um, and putting them into your practice.
Evidenced informed practice is using what has already been out there in the world and studied extensively using that to inform your practice, but also adapting it so that if it doesn't quite fit your model or your context or your, um, population, you know, there are many reasons people need to adjust things and adapt, you know, we're all human and it can be complicated to put some of these.
Evidence and interventions into practice. So hence the need for both evidence-based and evidence-informed. Um, now practice-based evidence. Uh, this is something I'm learning more about. Um, but it's my understanding is it's what we do when we actually, well, we do this, but we don't always call it this, but.
Try something. Um, and it works and intervention, maybe that is not as well studied or even has never been, um, done, you know, extensively before. And we try it and it works and we document it and we show that there is progress and clinical improvements for our clients. So that is the importance of the kind of distinguishing the differences between them.
And all of them are needed at different times and all of them are important too, um, kind and patient care. So one of the things that was really helpful for me, when I was learning about evidence-based practice, kind of again, That it's not necessarily that it's just the research or it's just the clinician’s experiences.
It's all of it together. The experiences of the therapist, the actual research and the client's perspectives and values and their context. So if we took one of those away, it would not necessarily, um, be as strong. We need all three points right now. I don't know if you can't see, but I have a microphone and it has a.
Tripod. And if any, one of those parts of the tripod, like if we didn't include clients' values in their context, or if we didn't include any research, the tripod would fall. So same as with evidence-based practice. I'm specifically talking to that. So as occupational therapists, it's really important to get all three of these steps in order to make the most clinically relevant decision.
When we're talking about using evidence-based practice and being evidence-based practitioners, I want to kind of diverge a little bit because something that I have been exploring and learning more about is that there's a lot of research that's being done. That may be. Biased or is being done without the perspectives of the individuals who are being impacted by the research or the stakeholders, um, in, in that, that is like kind of what has happened, but it's changing.
A lot of people are including stakeholders earlier in the research. But it's still not perfect. So definitely something to keep in mind as you're reading through. Um, and that kind of brings me to my next point that, um, who you are looking for and your clinical questions are always going to be different.
So say if there's a study and you're looking for someone who, um, has cerebral palsy and you want to look up whether, um, constraint-induced movement therapy will help them. To, um, just typical therapy. So that's a clinical question, but I have a certain client in mind when I'm thinking of that somebody else has the same clinical question, but they are, have a different client and a different set of values and a different set of, um, experiences and ages and demographics.
So it's definitely important to think about. Who you're looking for and what you're hoping, um, to get out of the research study, uh, you're looking for, for when you're searching. So another thing that you can consider and why it makes, you know, finding the articles that have actually help guide our practice tricky is, um, If you look at the study, you know, we find one that may be is about an adult with a stroke.
That's doing constraint, but that doesn't necessarily apply to the child with cerebral palsy. So, um, that can be tricky. However, sometimes it can be helpful to look at those and to be able to clinically reason through. I could do this. The age is different, but the intervention is the same, or I'm working with a young adult.
And even though the age range is not the same, it's pretty close. So that's kind of where our expertise as clinicians, as our reasoning skills that we learn, um, that's where those can come in and you can kind of make those decisions to adapt the research to what your needs are. Um, and the other thing is.
That makes evidence-based practice really tricky. Ah, this one is always tough for me is, um, you find this great study. It's doing this awesome stuff. You look at the, you know, how they did it, what they actually did. And it's. Uh, in your budget at all. Um, so the thing you need, the fancy tech, the, um, new manual, anything that really comes, uh, new to you comes at a cost, and that can be a huge barrier to implementing evidence-based practice.
However, if you. Find the tools to help you share why this is important and why this is such a needed study. You can or need an intervention. You can really work with your administration to show, you know, this could make us different. This could, you know, financially pull us away from some of the other competitors in our area, kind of talking their language, um, advocating for those are so important.
However, it's important to talk the language of the people you're trying to, um, Get the funding from. So always thinking about that is really helpful. The next thing is, depending on your setting, you know, when you're in inpatient rehab or if you're in a school or if you were in early intervention, or if you're in a community-based, um, mental health setting, those are very different change expectations.
So. Say if there's a study of looking at the strategy training of working with individuals who have recently had a stroke, um, and seeing how much change is, is, um, expected by the end of that study, if you're an inpatient rehab working on that goal, you're going to want to see a pretty big change, like a large amount of change, because that is the expectation and that's it.
Whereas, if it's someone who has a more long-term, um, stroke and they are in community-based mental health or outpatient setting, you may not see as much change in even a small amount of change would be meaningful to that client because they are maybe five, 10 years out from having a stroke. And they're still struggling with buttons or, or being able to remember their daily routine.
You know, the goals may be a little bit different, uh, but really understanding that even if a study is. A small clinical effect that can still be very meaningful to a client who has, um, a longer term condition. So just thinking through that and, um, again, using your reasoning, you can still adapt some of the results, uh, just in different ways, depending on who that person is you're thinking of and what their situation is.
And what's important to them again, using those client values. So I have to be honest, uh, this was not what I was hoping I would be talking about. I was hoping I have a little step 10 ways to be evidence-based and it's very clean. Cut. And there's no question. It's just, this is what it is. Um, that was kinda my goal when I originally tried to set out on, uh, learning more about this, but I found as, uh, I am sure.
You know, many people already know this, but you know, the things we think are straightforward are usually not, ah, there's always a little bit of gray area and, uh, being able to. Kind of wrestle through that, um, a combination of art and science is something that I find to be really exciting, but also very challenging at times.
And I think understanding that there's tension between. These two, the clinical experience and the, um, research you find and trying to creatively adapt, which we are so good at as OTs that into our context is really, really important for us to get the best possible care to our families, clients, um, and be able to.
Really helped the world. Um, uh, one quote that I found that I find really helpful, which is basically what I just said, but this is the actual quote is reflective practitioners capitalize on the tension that exists between research, findings and clinical experience to expand their knowledge. Um, and that is from.
Book entitled the evidence-based practitioner. So if you're looking for some more information on like the how and the steps and kind of the more, um, checklist, see things like I was talking about, you know, to, to a point, you can find some things on that, but, um, definitely check out that book. I found that to be really helpful and also just something that is a great resource to go back to time and time.
Well, thank you for listening. If you're interested in learning more about this process, or just kind of walking through this together with a group of other people, um, consider joining the OT graphically library. So we meet twice a month for journal clubs. We review a topic, um, And it is either a case study or an individual article.
Uh, we go through it and we discuss it and we really do this process of trying to clinically apply it to our contexts and learn from one another in a group setting. I also obviously have a lot of infographics in that library. It's a library of them. So you can download them, use them to advocate for interventions.
You're looking for, to share with your administration, to share with your clients, to get them more empowered about their care. Um, and we also have many other resources, a community Facebook page, and yeah. A lot of different, um, infographics that help you navigate the research, uh, and make it easier and save you time to be able to provide the best care, um, and stay up to date pretty quick.
So if you're interested in that, um, I'll put it a link to it in the show notes, you can always reach out to me. Um, but I'd love to have you. I love libraries. I love how they build community. And so I hope that the OT graphically library can do the same. So thanks so much. And I can't. Yeah. Wait to hear about all the amazing things you're doing as an OT, have a great day. .