Searching for the evidence
Lots of different information sources are available to OTs when they are searching for evidence to guide their Evidence Based Practice. The different types each have different levels of usefulness related to patient care.
Some example sources and their uses are:
- Guidelines – help OTs to make decisions quickly as you do not need to search and review literature yourself. Someone eg NICE has done this (plus taken into account the cost/benefit) already for you.
- Protocols – defined steps or rules used to describe the process for a particular treatment or assessment. Often specific to local contexts; stricter and hold more weight legally than a guideline.
- Blogs – useful to understand public opinion around a certain issue; can read a wide range of opinions and see what evidence is used to back each up (or question whether any has!). Is this where patients have researched healthcare in the absence of journal access, and does this explain their viewpoints?. Some professional organisations also have blogs, such as this BMJ evidence based nursing blog.
- Theories – explanations of phenomena. They can be tested to see if they work in practice via research hypotheses, so in this way evidence could prove or disprove theory.
- Care pathways – similar to a guideline, it’s a locally agreed plan outlining how specific conditions should be treated to achieve a positive outcome. It advises who should provide the care, at what stage and where, and how it should be funded.
- Legal ethical principles – These have to be applied to your practice as a legal requirement. They are formed from national legislation or case law.
- Professional Body standards – The professional body for Occupational Therapy is the BAOT/COT. You must follow the code of conduct or be held accountable.
- Web pages – a means to access different resources, but not evidence itself – you should always find out where the website’s information has come from.
- Professional judgement – Your own clinical expertise forms part of the ‘artistry’ that ultimately decides the most beneficial blend of research conclusions and patient preference.
- Patient preference – The patient themselves will be the best source of information about what they prefer or is important to them! Patient preference should be taken into account along clinical expertise and research findings to form Evidence Based Practice.
- Research evidence – can be a source of reliable, factual information but research should always be quality checked before basing any decisions on it’s findings.
- Prior experience – advice from mentors or colleagues is often remembered well and a common source of knowledge. However there are novice and expert practitioners, those that reflect and those that don’t so the quality of this advice can vary widely.
When you are searching for evidence, you should start with the most reliable sources and work your way down. You can refer to hierarchies of evidence to guide you through which types of evidence are the best ones to start with, and if you find nothing in the most reliable category then work your way down through to the least. Examples of evidence hierarchies can be found here.
For example if you found no evidence in peer-reviewed journals you could try grey literature (this is literature produced by organisations/academics/business/industry but not peer-reviewed/available in official databases; as well as unpublished PhD theses), and if this failed you could try speaking to senior colleagues or reviewing information from other services. If you find nothing on a topic or in answer to your question, then you could plan or conduct research yourself so that future practitioners will have evidence available on this topic!
The Royal College of Occupational Therapists recommends using a wide range of sources when conducting a literature review (Steward 2004), for example:
- Formal published academic papers
- citation searches
- government documentation
- in-house reports
- conference abstracts
- internet publications.