10-23-06
Using the Internet To Find Evidence To Inform Your Practice (10-23-06)
Jessica Scheer, Marian Arbesman, and Deborah Lieberman
We are pleased to introduce the first Evidence Perks, a quarterly column that will connect practitioners, students, educators, and researchers to resources and information related to the evidence-based practice (EBP) of occupational therapy. This column will address the day-to-day needs of occupational therapy professionals to use the best available evidence from the scientific literature to inform the clinical reasoning process. One of the major goals of the American Occupational Therapy Association's (AOTA's) Centennial Vision is for practitioners to be able to integrate high-quality scientific evidence with clinical expertise and the client perspective to ensure that client care follows current best practices. Each Evidence Perk will support this goal by adding to your personal EBP toolkit and will help to foster high-quality client care.
Practice Scenario
In a conversation with my supervisor during my annual performance review, the subject of EBP came up. She agreed with the results of surveys of Canadian and Australian occupational therapists that clinicians need dedicated work time to keep up with the literature and the results of systematic evidence-based reviews of the literature.1–3 She has granted me 4 hours each month to find literature and systematic reviews of the literature that are relevant to our geriatric outpatient practice and to present my findings to the occupational therapy team during monthly meetings.
It is both exciting and somewhat daunting to meet this challenge. Are there any Web sites that could help me locate recently published articles and the results of systematic reviews on topics relevant to our practice? In other words, where are the "lowest hanging fruits" that I can start to pick from the Internet?
First Step:
Links to Web Sites and Databases
AOTA's Evidence-Based Practice Project has spearheaded the development of a set of evidence-based resources that can be found on our Web site at www.aota.org. Click Evidence-Based Practice Resources and you will be connected to an introductory page containing links to the Evidence Brief Series and the EBP Resource Directory. Click Go to the Directory to find links to sites and databases that contain abstracts of published articles and systematic evidence-based reviews of the literature that are relevant to geriatric practice.
You will find that the Resource Directory contains links to (a) databases and Internet sites in occupational therapy, rehabilitation, and health outcomes; (b) tutorials for acquiring basic and intermediate-level skills to search and interpret the literature relevant to occupational therapy; and (c) national and international evidence-oriented Internet sites posted by universities, government agencies, and private organizations. AOTA members report that the Resource Directory is an invaluable gateway to the world of EBP and occupational therapy, for novices and experts alike.
Second Step:
Easy-to-Find Systematic Reviews of the Literature Related to Geriatric Practice
On the introductory page of the Resource Directory, go to the drop-down menu Resources by Topic. Under the topic Selected EBP Resources, click OT-Specific Resources. Scroll down and click Otseeker (Occupational Therapy Systematic Evaluations of Evidence). In 2002, occupational therapy educators and researchers Sally Bennett of the University of Queensland and Annie McCluskey of the University of Western Sydney led a team of occupational therapists to locate, select, and then appraise the quality of randomized controlled trials (RCTs) and systematic EBP reviews that are relevant to occupational therapy practice areas. Abstracts of the selected RCTs and published systematic reviews have been entered into a database format, along with a quality rating for each publication. The database can be easily searched using typical search terms related to the geriatric population, such as memory loss, outpatient stroke rehabilitation, fall prevention, and diabetes treatment in the geriatric population.
Third Step:
Easy-to-Find Abstracts of Published Articles Related to Geriatric Practice
Return to the introductory page of the Resource Directory and go once again to the drop-down menu under Resources by Topic. Under the topic Selected EBP Resources, click Rehabilitation-Focused EBP Resources. Scroll down and click REHABDATA Literature Database, then click Visit Web Site. REHABDATA is a feature of the National Rehabilitation Information Center (NARIC), an information clearinghouse that has been funded by the National Institute on Disability and Rehabilitation Research (NIDRR) for almost 30 years and is an excellent source of some "low-hanging EBP fruit." The NARIC Web site provides rehabilitation-oriented information organized in a variety of formats. REHABDATA features (a) reports, papers, and articles produced by projects funded by the NIDRR; (b) abstracts of articles published in rehabilitation-related periodicals; and (c) commercially published books. Some full-text articles are available for a nominal fee. Information specialists are available to assist individuals with creating customized database searches and can be contacted online (click Ask Me) or by phone (800-346-2742).
NARIC also provides REHABDATA Connection, a no-cost online information service that is useful for practitioners, students, educators, and researchers interested in EBP. Individuals may select up to five topics of interest and then sign up to receive a monthly e-mail containing abstracts of recently published articles on those topics. For example, occupational therapy practitioners who work in specialty geriatric practices or practices that include older persons could select Home Modification, Stroke, Mobility Issues, Caregiving Issues, Aging, and Deafness-Hearing impairments, among others.
In April 2006 the NARIC Web site introduced reSearch, a semimonthly collection of abstracts associated with select topics published within the previous 5 years. Each topic is related to a real-world scenario posed by rehabilitation professionals; of special interest to practitioners working with the geriatric population are (a) Evidence-Based Practice in Life Skills Training (April 2006); (b) Best Practices in Prosthetics and Orthotics (June 2006); and (c) Aphasia and Stroke Rehabilitation (July 2006). What a feast!
Fourth Step:
Easy-to-Read Summaries of Critically Appraised Articles and the Results of Focused-Question Evidence-Based Literature Reviews Return to the home page of AOTA's Web site, and once again click Evidence-Based Resources to connect to the page that contains links to the Evidence Brief Series and the Resource Directory. This time click Go to the Briefs to find the geriatric practice-relevant, easy-to-read summaries of (a) critically appraised individual articles (click Stroke, Parkinson's Disease, and Older Adults); and (b) the results of a focused-question review of the literature about stroke (click Stroke-Focused Question).
Now take a step back and remember where you started ("I feel overwhelmed by the opportunity!"), and how far you've come, having found some incredible low-hanging EBP fruit of great relevance for geriatric practice.
A Final Note:
Getting Access to University Libraries
For those of you not presently associated with a university, consider joining the alumni association of the university from which you graduated. Often, library access is a member benefit, and full-text downloads are frequently available.
If that is not practical, visit the federally funded Library of Medicine (http:// www.nlm.nih.gov). At this site you will find no-cost public access to PubMed/ MEDLINE (http://pubmed.gov), where you can search the database to see whether an article you've read about (via an abstract or a citation) has electronic full-text availability. You can initiate your own searches of the literature.
References
1. Bennett, S., Tooth, L., McKenna, K., Rodger, S., Strong, J., Ziviani, J., et al. (2003). Perceptions of evidence-based practice: A survey of Australian occupational therapists. Australian Occupational Therapy Journal, 50, 3–12.
2. Dubouloz, C., Egan, M., Vallerand, J., & von Zweck, C. (1999). Occupational therapists' perceptions of evidence-based practice. American Journal of Occupational Therapy, 53, 445–453.
3. McCluskey, A. (2003). Occupational therapists report a low level of knowledge, skill, and involvement in evidence-based practice. Australian Occupational Therapy Journal, 50, 3–12.
Jessica Scheer, PhD, is a medical anthropologist and research professor at the School of Public Health and Health Services at the George Washington University in Washington, DC. She has served as a consultant with AOTA's EBP Project since 1998.
Marian Arbesman, PhD, OTR/L, is president of ArbesIdeas, Inc., and a clinical assistant professor in the Department of Rehabilitation Science at the State University of New York at Buffalo. She has served as a consultant with AOTA's EBP Project since 1999.
Deborah Lieberman, OTR, MHSA, is program director, EBP, in the Practice Department of AOTA.
Reference Information:
Scheer, J., Arbesman, M., & Lieberman, D. (2006). Using the internet to find evidence to inform your practice. [Electronic Version]. OT Practice, 11(19), 23–24.
©Copyright 2006. The American Occupational Therapy Association. All rights reserved.
