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Occupational Therapy: Evidence-Based Practice

This guide presents a starting point for Occupational Therapy students and faculty locating health evidence in books, journal articles, databases, and the web.

Evidence Based OT

"Evidence-Based Practice in Occupational Therapy: An Introduction".
This is a powerpoint presentation made available from OTseeker (http://www.otseeker.com/) and may be used for educational purposes on the basis that it is unaltered. (Sally Bennett, Division of Occupational Therapy School of Health and Rehabilitation Sciences, The University of Queensland, Australia)

Evidence Based Resources

Evidence-Based Health Care Resources

 

Evidence-Based Medicine (EBM) is defined as: "The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients." (Sackett, Straus, Richardson, Rosenberg, & Haynes, 1996). *

Evidence-Based Nursing (EBN) is defined as: "the application of valid, relevant, research-based information in nurse decision-making... used alongside our knowledge of our patients (their symptoms, diagnoses, and expressed preferences) and the context in which the decision is taking place (including the care setting and available resources), and in processing this information we use our expertise and judgement." (Cullum, 2008) **

Evidence-Based Health Services Management is the "systematic application of the best available evidence to the evaluation of managerial strategies for improving the performance of health services organizations." (Kovner & Rundall, 2006) ***

Evidence-Based Dentistry (EBD) "is an approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient's oral and medical condition and history, with the dentist's clinical expertise and the patient's treatment needs and preferences." ****

 

TRIP Database Filtered Information Systematic Reviews Critically-Appraised Topics

 

Meta-Search Tools ("Federated" search tools)


ACCESSSS Federated Search (McMaster University)


(Free registration required) Provides current best evidence for clinical decisions. It conducts literature searches simultaneously in several different evidence-based information services (online evidence-based texts, and pre-appraised journal publications).


TRIP (Turning Research Into Practice) Database Plus

This meta-search engine simultaneously searches evidence-based sources of systematic reviews, practice guidelines, and critically-appraised topics and articles -- including most of those listed above and many more. Also searches MEDLINE’s Clinical Queries, medical image databases, e-textbooks, and patient information leaflets.

SUMSearch Combines meta-searching and contingency searching in order to automate searching for medical evidence. Simultaneously searches multiple Internet sites and collates the results into one page.

 


Filtered Resources

 

Systematic Reviews / Meta-Analyses

The Cochrane Database of Systematic Reviews
Consists of detailed, structured topic reviews of hundreds of articles. Teams of experts complete comprehensive literature reviews, evaluate the literature, and present summaries of the findings of the best studies. Published by the International Cochrane Collaboration.

Joanna Briggs Institute EBP Database This comprehensive database covers a wide range of medical, nursing, and health science specialties and includes a unique suite of information that’s been analyzed, appraised, and prepared by expert reviewers at JBI.

PROSPERO International Prospective Register of Systematic Reviews
International database of prospectively registered systematic reviews in health and social care. PROSPERO has recently opened for registration and so contains few published records; searching is therefore limited.

OT Seeker
Free site contains abstracts of systematic reviews and RCTs relevant to occupational therapy.  (Critically appraised and rated to assist you in evaluating their validity and interpretability).

PubMed Health specializes in reviews of clinical effectiveness research with easy-to-read summaries for consumers as well as full technical reports. The reviews were generally published or updated from 2003. PubMed Health provides summaries and full text of selected systematic reviews in one place. A search on PubMed Health runs simultaneously in PubMed. A filter identifies indexed scientific articles at the NLM that might be systematic reviews and includes pre-2003 articles.

Systematic Reviews and Meta-Analyses are also searchable in individual databases:

  • MEDLINE via Ovid: Enter your search query. Click on the “Limits” icon; select “Systematic Reviews” under “Subject Subsets.” OR limit your search to publication type: meta-analysis.  (Caution: the "systematic review" subset in Medline also includes literature reviews, narrative reviews, etc.)
  • MEDLINE via PubMed:In Advanced Search,  perform search, then scroll to the “Limit by Topics, Languages, and Journal Groups” choices, and select  limit by Subset: systematic reviews.   (Caution: the "systematic review" subset in Medline also includes literature reviews, narrative reviews, etc.)

OR, in Advanced Search,  perform search, then scroll to More Resources/Clinical Queries or Topic Specific Queries feature to search by:  Clinical Study Category, Find Systematic Reviews, or other Topic-Specific PubMed Queries targeted for clinicians and health services researchers.

  • PsycINFO (via Ovid): When you have performed a search by topic in PsycINFO, you may then choose to restrict your search to one or more “Methodology,” e.g. "systematic review."

Critically-Appraised Topics

American Psychiatric Association (APA) Practice Guidelines: practice guidelines provide evidence-based recommendations for the assessment and treatment of psychiatric disorders.

AHRQ Evidence Based Practice [with links to Evidence-based Practice Center (EPC) Evidence Reports] Click on a category of Completed Reports (for example, "Eye Conditions"), to view individual evidence reports and summaries.

Annual Reviews  Authoritative, analytic reviews in 37 focused disciplines within the Biomedical, Life, Physical, and Social Sciences.


Clinical Evidence
Summarizes the current state of knowledge about the prevention and treatment of clinical conditions, based on thorough searches and appraisal of the literature. It describes the best available evidence from systematic reviews, RCTs, and observational studies where appropriate, and if there is no good evidence it says so.

Joanna Briggs Institute EBP Database This comprehensive database covers a wide range of medical, nursing, and health science specialties and includes a unique suite of information that’s been analyzed, appraised, and prepared by expert reviewers at JBI.

HSTAT U.S. Health Services Technology Assessment Text A free, web-based resource that provides access to full-text documents useful for providing health information and for health care decision-making. Provides access to a wide variety of publications, including: clinical practice guidelines, quick-reference guides for clinicians, consumer health brochures, evidence reports and technology assessments from AHRQ, NIH Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP), etc.

National Guideline Clearinghouse
A comprehensive database of evidence-based clinical practice guidelines and related documents produced by the Agency for Health Care Research and Quality, in partnership with the American Medical Association and the American Association of Health Plans. Updated weekly.
Note: Guideline evidence varies from expert opinion to high levels of evidence. Practice guidelines that are based on meta-analyses and systematic reviews may be considered the highest level of evidence.

Natural Medicines Comprehensive Database:  Scientific clinical information on dietary supplements, natural medicines, and complementary, alternative, and integrative therapies. Search by therapy or condition.

Nursing Reference Center

Evidence Based Care Sheets are one section of the Nursing Reference Center (NRC) where aggregated summaries cite evidence according to a coding matrix in order of strength of evidence: Meta-analysis, systematic or integrative literature review, RCT, and so on.  Select Advanced Search, then limit your search to "evidence based care sheets."

OT CATS
Critically appraised topics (CATs) and critically appraised papers (CAPs) focussing on occupational therapy interventions.
http://www.otcats.com/

OT Seeker
Free site contains abstracts of systematic reviews and RCTs relevant to occupational therapy.  (Critically appraised and rated to assist you to evaluate their validity and interpretability).

PEDro is the Physiotherapy Evidence Database from the Centre for Evidence-Based Physiotherapy (CEBP) at the University of Sydney. Free web-based database with access to bibliographic details and abstracts of over 5500 RCTs, systematic reviews and evidence-based clinical practice guidelines in physiotherapy. Most trials on the database have been rated for quality to help you quickly discriminate between trials which are likely to be valid and interpretable and those which are not.

PIER
(enter StatRef, click on "Accept"). Evidence-based clinical guidance designed for rapid access to clinical information at the point of care. PIER is peer-reviewed, updated continually and includes recommendations based on all levels of medical evidence. Recommendations also include strength-of-recommendation ratings based on the quality of the underlying evidence. From the American College of Physicians.

PubMed Health
Reviews of clinical effectiveness research, with easy-to-read summaries for consumers as well as full technical reports. PubMed Health provides summaries and full texts of selected systematic reviews in one place. The reviews were generally published or updated from 2003. There is also information for consumers and clinicians based on those reviews. A search on PubMed Health runs simultaneously in PubMed. A filter is used to identify all the indexed scientific articles at the NLM that might be systematic reviews. This search includes articles from before 2003.

MORE: Link to organization-specific sites with practice guidelines
(Practice guidelines are developed by local, regional, national, or international groups, professional societies, and affiliated government organizations.  The websites of the groups are a good place to start your search for practice guidelines of interest.)

   

Practice Guidelines are also also searchable in MEDLINE and CINAHL

  • Perform a search in CINAHL Plus via Ebsco , use Refine Search to limit to publication type: Practice Guidelines (Other publication types to consider: Care Plan OR Clinical Innovations OR Critical Path OR Protocol OR Standards)
  • Perform a search in PubMed(Medline), limit to publication type: Practice Guideline

Critically-Appraised Individual Articles

The ACP Journal Club
The editors of this journal screen the top 100+ clinical journals and identify studies that are methodologically sound and clinically relevant. An enhanced abstract, with conclusions clearly stated, and a commentary are provided for each selected article. Published by the American College of Physicians-American Society of Internal Medicine. From Ovid menu choose: ALL EBM Reviews to access ACP Journal Club.

Bandolier
Bandolier is an independent journal about evidence-based healthcare published in the UK. It includes “information about evidence of effectiveness (or lack of it), and put[s] the results forward as simple bullet points of those things that worked and those that did not: a bandolier with bullets. Information comes from systematic reviews, meta-analyses, randomised trials, and from high quality observational studies.”

EvidenceUpdates (BMJ)
Quality articles from over 110 clinical journals are selected by research staff, and then rated for clinical relevance and interest by an international group of physicians. Includes a searchable database of the best evidence from the medical literature and an email alerting system. From BMJ Publishing Group and McMaster University's Health Information Research Unit.

“Evidence-Based…” Journal series
Primary research articles within the discipline are selected for quality and clinical relevance. A structured abstract and expert commentary are provided for each study.

The following are examples (not a complete list) of journals that use predefined criteria to publish evaluated abstracts of the literature and comment on the methodology of each published study.

Evidence-Based Complementary and Alternative Medicine (electronic access only)

Evidence-Based Dentistry (electronic access only)

Evidence-Based Medicine (electronic access only)

Evidence Based Mental Health
Also in print version: Bobst RA410.A1 E95

Evidence-Based Nursing  Bobst RT85.5.E95 Recommended reading: "Purpose and Procedure," "EBN Notebook," columns in each issue. The inside back cover of each print issue includes a glossary of terms used in evidence-based health care.

Journal of Evidence Based Dental Practice (electronic access only)

Worldviews on Evidence Based Nursing (electronic access only)   the Evidence Digest column provides summaries of recent studies.

Faculty of 1000 Medicine The world's top clinicians and researchers select, rate and evaluate the most important and influential articles, presenting a continuously updated, authoritative guide to the medical literature.

KT+ Knowledge Translation Plus (a knowledge translation site provided by McMaster University’s Health Information Research Unit) provides access to the current evidence on "T2" knowledge translation (i.e., research addressing the knowledge to practice gap), including published original articles and systematic reviews on health care quality improvement, continuing professional education, computerized clinical decision support, health services research and patient adherence. Its purpose is to inform those working in the knowledge translation area of current research as it is published. Includes alerting service; free registration required.

Nursing+  Best Evidence for Nursing Care (McMaster University's Health Information Research Unit). Citations from over 140 premier clinical journals are pre-rated for quality by research staff, then rated for clinical relevance and interest by at least 3 members of a worldwide panel of practicing nurses. A searchable database of the best evidence from the medical literature; an email alerting system; links to selected evidence-based resources.

 


Unfiltered Resources

Evidence is not always available via filtered resources. Searching the primary literature may be required. It is possible to use specific search strategies in MEDLINE and other databases to retrieve the best available evidence.

  • EMBASE
    Major biomedical and pharmaceutical database covering drug research, pharmacology, pharmaceutics, toxicology, clinical and experimental human medicine, health policy and management, public health, occupational health, environmental health, drug dependence and abuse, psychiatry, forensic medicine, and biomedical engineering/instrumentation. Produced by Excerpta Medica and updated weekly. To limit your EMBASE search to the best evidence-producing studies: Click on the ‘Limits’ icon to use ‘Clinical Queries’.
     
  • Medline via PubMed 
    Widely recognized as the premier source for bibliographic and abstract coverage of biomedical literature.
  • Medline via Ovid
    Widely recognized as the premier source for bibliographic and abstract coverage of biomedical literature.
  • PsycINFO (via Ovid)
    International coverage of the professional and academic literature in psychology, medicine, psychiatry, nursing, sociology, education, pharmacology, physiology, linguistics, and other areas. To limit your PsycINFO search to the best evidence-producing studies: Click on the "Refine Search" tab icon to limit to ‘methodology’ types. Click here for Limiting in PsycINFO example.  
  • Scopus
    Scopus is both an abstract and a citation database containing more than 41 million records for peer-reviewed literature and quality web sources. The citation indexing is available from 1996 to the present, and the abstract indexing goes back as far as 1823. Disciplines covered include scientific, technical, medical and social sciences fields with some coverage in the arts and humanities.
     
  • Statistical Insight provides detailed abstracts, indexing, and locator information for all statistical reports of general research value issued by the federal government since the early 1960's. It also indexes the publications of state and private agencies, and the statistical publications of such IGO's (Intergovernmental Organizations) as the IMF, UN, OECD, World Bank and more. There are direct links to all key statistical data available on federal agency World Wide Web sites as well as direct links to hundreds of reports stored within the Universe service itself.
     
  • Virginia Henderson International Nursing Library (VHINL) a database of nursing research abstracts that have been posted in the Registry of Nursing Research by nurse researchers or collected from other nursing organizations.  Visitors to the library can search for specific information on nursing topics in which they are interested.  Abstracts in the database may include any of the following: research studies, conference presentations, practice innovations, and evidence-based projects.

  • Web of Science International multidisciplinary index to the literature of the social, behavioral, and related sciences. In addition to the over 1700 social sciences journals, relevant social sciences items are indexed from over 3400 natural and physical sciences journals. Some of the subject categories included that are relevant to health science researchers are: special education, family studies, geriatrics & gerontology, health policy & services, language & linguistics, legal medicine, nursing, psychiatry, psychology, public health, rehabilitation, biomedical social issues, substance abuse, and women's studies. The Web of Science databases have the ability to link to relevant prior research and perform cited reference searches to track subsequent research.

 

Background Information/Expert Opinion

Note: Evidence in these resources may vary from expert opinion to high levels of evidence.

AccessMedicine: more than 50 medical texts including Harrison's online, drug monographs, images and illustrations, interactive self-assessment, case files, diagnostic tools, patient education, Quick Answers from Current Medical Diagnosis & Treatment (CMDT), more.

CINAHLPlus Evidence Based Care Sheets: CINAHL provides nearly 150 Evidence-Based Care Sheets, which are designed to give a "general informational overview of the subject for the healthcare professional" on a variety of topics. Most are two pages long, and include information on "What We Know" and "What We Can Do," supported by a list of References for further information.  While the Evidence-Based Care Sheets are written, edited, and reviewed by RNs and MDs, they are published by CINAHL Information Systems, so they are not considered journal articles. Use these for background information and helpful references. View these helpful summaries by clicking on Evidence-Based Care Sheets at the top left of the CINAHL screen. Link to CINAHLPlus here.

 

Clinical Key
A single source (aimed at a physician audience) to search across a collection of Elsevier journals, 900 medical and surgical reference books, Pubmed abstracts, Medical and Surgical clinics, First Consult point of care clinical monographs, Procedures Consult, drug monographs, videos, images, practice guidelines, patient education handouts (in both English and Spanish, where available), and more.


Clinical Evidence

Summarizes the current state of knowledge about the prevention and treatment of clinical conditions, based on thorough searches and appraisal of the literature. It describes the best available evidence from systematic reviews, RCTs, and observational studies where appropriate, and if there is no good evidence it says so.

Ebook Central collection of electronic books in all disciplines.

Gale Virtual Reference Library: encyclopedias and specialized reference sources for multidisciplinary research. SCROLL to view publications in medicine,  including the Gale Encyclopedia of Public Health, Encyclopedia of Pain, Encyclopedia of Cancer, Encyclopedia of Nursing & Allied Health, Encyclopedia of Medicine, Encyclopedia of Public Health, Encyclopedia of Alternative Medicine, sources for patients and caregivers, and MORE.

Harrison's Online Searchable and continually updated version of Harrison's Principles of Internal Medicine.



Medscape Reference
Drugs, Diseases, Procedures, Image collections.
(Requires free registration)

MICROMEDEX 2.0
Comprehensive disease, drug, acute care, and toxicology information.

Oxford Reference Online Medicine subset searches: The Oxford Companion to the Body, A Dictionary of Dentistry, A Dictionary of Food and Nutrition, Concise Medical Dictionary, An A-Z of Medicinal Drugs, The Oxford Companion to Medicine, A Dictionary of Nursing, A-Z of Plastic Surgery, A Dictionary of Psychology, A Dictionary of Public Health, The Oxford Dictionary of Sports Science Medicine.

STATREF Medical Reference Library. Full-text medical and drug information for healthcare professionals. Includes more than 25 medical resources such as Current Medical Diagnosis and Treatment, Current Pediatric Diagnosis and Treatment, DSM-V, USP DI Vols 1 and 2, AHFS Drug Information and many more.

UpToDate
A clinical information resource, which offers up-to-date, fully referenced expert answers to patient-care, diagnosis, and treatment questions. Topic reviews are written by recognized authorities who review the topic, synthesize the evidence, summarize key findings, and provide specific recommendations.

 


Evidence-Based Healthcare Information Sites

Centre for Evidence-Based Medicine (Oxford University) The Centre promotes evidence-based health care and provides support and resources to anyone who wants to make use of them. Includes the EBM Toolbox, an assortment of materials which are very useful for practitioners of EBM, and EBM Teaching Materials, including PowerPoint presentations.

Centre for Evidence-Based Medicine (Toronto) Includes many resources for practicing and teaching EBM.


Users' Guides to Evidence-Based Practice From the University of Alberta's Centre for Health Evidence. Includes the complete set of EBM Users' Guides originally published as a series in the Journal of the American Medical Association (JAMA).

 

 


References

*Sackett, D. L., Rosenberg, W. M. C., Gray, J. A. M., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: What it is and what it isn't. British Medical Journal, 312(7023), 71-72.
link to article
 **Cullum, N. (2008). Evidence-based nursing: An introduction. Oxford: Malden, MA: Blackwell Pub./BMJ Journals/RCN Pub.
*** Kovner, A. R., & Rundall, T. G. (2006). Evidence-based management reconsidered. Frontiers of health services management, 22(3), 3-22.
link to article
**** ADA Policy on Evidence-Based Dentistry: http://www.ada.org/1754.aspx