Occupational Therapy Master-Level Students' Evidence-Based Practice Knowledge and Skills Before and After Fieldwork

ABSTRACT

Evidence-based practice (EBP) has become a universal standard for practice among healthcare professions, but due to barriers to EBP, the most effective ways of teaching EBP are not well understood. The purpose of this study was to report students’ EBP knowledge and skill gained from an entry-level Master's of Science in Occupational Therapy course in EBP. The Adapted Fresno Test of EBP was administered at the beginning and end of the course and after fieldwork experience. Results indicated that EBP knowledge and skills increased between the precourse and postcourse measurements (t = ?7.98; p < 0.001), but declined between postcourse and postfieldwork measurements (t = 6.65; p < 0.001) indicating that the course improved basic EBP skills and knowledge, but was ineffective in giving the students the strategies to retain and use those skills beyond the classroom. Suggestions are made to strengthen the student retention and use of EBP skills and knowledge after graduation.     

Practitioner Training for Use of Evidence-Based Practice in Occupational Therapy

The purpose of this integrative review was to examine the evidence-based practice (EBP) training literature for occupational therapy practitioners in order to describe the relationships between EBP use in practice and practitioner training for EBP. A systematic search of literature related to EBP training in occupational therapy was followed by a research evaluation, review of case examples, and qualitative content analysis. Findings suggest that comprehensive, contextually-relevant, and collaborative training approaches are necessary for practitioners to address implementation of EBP. Research investigating the mechanisms of practitioner training and ways to measure the relationships between training, changes in how practitioners use evidence-based practices, and client outcomes and other quality indicators is recommended.     

The Nature of Emerging Practice in Occupational Therapy: A Pilot Study

The profession of occupational therapy is responding to changes in the health care system by expanding the contexts and models for service provision, typically referred to as emerging practice. As a pilot study, a survey was completed by 174 occupational therapists to gather information and opinions about emerging practice. Results indicated occupational therapists hold diverse perceptions about emerging practice settings and services as well as the role and significance of emerging practice within the profession. Occupational therapists engaged in emerging practice described numerous rewards and challenges inherent within the process of developing and delivering services. The findings indicate continued professional dialogue and research are needed to support the development and efficacy of occupational therapy services in emerging settings and roles.     

Using Journal Clubs to Promote Skills for Evidence-Based Practice

Occupational therapy students in Pittsburgh, Pennsylvania, participated in a 9-week journal club experience within an evidence-based practice course. Working in groups of seven, students were provided with an overall framework to develop and conduct weekly journal club sessions. They determined the focus and direction for their journal club section, decided on the number, type, and focus of research articles that were discussed each week, created methods for evaluating individual and group performance, and determined the effect of the journal club experience on their knowledge and professional behavior. Students completed a weekly reflective journal and at the conclusion of the course, results were uniformly positive. Review of the reflexive journals indicated substantive changes in the students' professional development, commitment to evidence-based practice, and perceived responsibility to demonstrate leadership in this area.     

Creating Occupational Therapy: The Challenges to Defining a Profession

The creation of a new profession in the early 20th century, such as occupational therapy, required a commitment to certain ideas and a willingness to accept certain challenges. This study examines the commitment to the idea of therapeutic and health supporting occupation by the early leaders and proponents of the profession and the challenges they faced in gaining acceptance of occupational therapy as a profession capable of delivering a valued health care service to society. Six challenges are reviewed as they occurred in the history of the profession and as they continue to challenge the profession into the present era.     

Mindfulness in Occupational Therapy Education

ABSTRACT

The purpose of this paper is to explore the value of mindfulness and its role in occupational therapy education. The plethora of research on mindfulness-based stress reduction programs has shown consistent and positive results to enhance quality of life in clinical and nonclinical populations. Offering students the opportunities to learn and experience mindfulness could lead to enhanced self-awareness and care, focus and empathy, and a decrease of client judgment enhancing the success of clinical interventions.     

An Exploratory Survey of Physical Rehabilitation Occupational Therapy Practice Patterns

A computer-assisted survey was developed and administered to 66 occupational therapists working in adult physical rehabilitation to explore how and to what extent occupational therapists evaluate and treat medication management impairments. Approximately 90% of the sample evaluate and treat medication management, but only about 25% addressed medication management on a consistent basis. This suggests that current medication management service provision levels may be insufficient to meet clients’ needs. Research is warranted to understand and improve occupational therapists’ abilities to address medication management in practice.     

Predictors to Private Practice Occupational Therapy Fieldwork Opportunities in Canada: New Evidence suggests New Solutions

Abstract

The study examined predictors to increasing and enhancing fieldwork education opportunities provided by occupational therapists working in private practice. A cross-sectional design that used a self-administered questionnaire was provided to Canadian occupational therapists in private practice. Participants receiving funding from the workers’ compensation sector, those with between 11 and 20?years of work experience, and therapists working full-time hours were more likely to accept a student in fieldwork placement. Respondents who indicated that physical space and resources were not barriers to taking students on placement were more likely to accept students. Therapists more comfortable with the criteria and methods for appropriate and effective student teaching and supervision were also more likely to accept a student for fieldwork placement. The study findings can inform academic programs on how best to support preceptorship and guide university fieldwork coordinators’ strategies for outreach and education for private practitioners.     

A Course in Autoethnography: Fostering Reflective Practitioners in Occupational Therapy

This paper describes an academic course designed to lay the foundation for reflective practice in occupational therapy. In this course, students conduct highly personalized research based on experiences in Level II fieldwork that leads to writing an autoethnography. The paper describes autoethnography, details its use in occupational therapy literature, and discusses the design and outcomes of the course. Students' experiences with this autobiographical genre of qualitative research are illustrated. In the writing process, students find clinical stories that must be told and learn to “move around” in their stories. The outcomes of the course include integration of personal and professional experiences, closure to academic preparation, and deep reflection about what it means to be an occupational therapist.     

The Forensic Model of Occupational Therapy

In the past decade attorneys have increasingly sought the services of occupational therapists to serve as experts in legal and quasi-legal personal injury proceedings. This emerging specialty area of forensic practice is rapidly developing. The unique qualifications of the therapist enables him to assess and document functional assets and deficits of the individual and relate them to daily life tasks. This ability makes the occupational therapist an important expert on the forensic panel. The therapist provides reports and information to persons who are responsible for applying the law, but who are without medical backgrounds and therefore do not understand the problems or lack of problems which an injured person has in meeting the physical demands of work and daily life. Common proceedings in which the occupational therapist's expertise is called for include Social Security disability and Workman's Compensation hearings and personal injury litigation. The complementary group of forensic experts, of which the occupational therapist is one, frequently consists of physician, psychologist, vocational expert and economist. Information is provided through verbal and written reports as well as through testimony.     

Teaching Ill-Structured Problem Solving Using Occupational Therapy Practice Epistemology

ABSTRACT

Epistemic and ontological cognition (EOC) have to do with an individual's beliefs about knowledge and knowing. Research has shown that EOC have an influence on learning and achievement. EOC may be discipline-specific with a profession being defined by its practice epistemology. If an individual's EOC is inconsistent with the profession's practice epistemology, the student or practitioner may struggle with effectively solving ill-structured occupational performance problems. The purpose of this paper is to increase awareness of the constructs of EOC, to describe its importance to occupational therapy education and practice, and to provide recommendations for educators and researchers. Specific examples are detailed and recommendations for future research are proposed.     

Occupational therapy-based and evidence-supported recommendations for assessment and exercises in hand osteoarthritis

Abstract

Aims: The aims of this study were to develop recommendations for occupational therapy assessment and design of hand exercise programmes in patients with hand osteoarthritis. Methods: An expert group followed a Delphi procedure to reach consensus for up to 10 recommendations for assessment and exercises, respectively. Thereafter, an evidence-based approach was used to identify and appraise research evidence supporting each recommendation, before the recommendations were validated by the expert group. Results: The process resulted in 10 recommendations for assessment and eight for design of exercise programmes. The literature search revealed that there is a paucity of clinical trials to guide recommendations for hand osteoarthritis, and the evidence for the majority of the recommendations was based on expert opinions. Also, even if a systematic review demonstrates some evidence for the efficacy of strength training exercises in hand OA, the evidence for any specific exercise is limited to expert opinions. Conclusions: A first set of recommendations for assessment and exercise in hand osteoarthritis has been developed. For many of the recommendations there is a paucity of research evidence. High-quality studies are therefore needed to establish a high level of evidence concerning functional assessment and the effect of hand exercises in hand osteoarthritis.     

Achieving Evidence-Based Practice: A Process of Continuing Education Through Practitioner-Academic Partnership

SUMMARY

Occupational therapy is required to deliver and generate evidence-based practice. As currently articulated, evidence-based practice requires particular skills and takes time and is rarely realized. This paper illustrates a collaborative approach to building an evidence based training program within a practice context. The aim of the training program was to enable therapists in a large mental health setting to engage in evidence-based practice. Specifically, the partnership between the United Kingdom Centre for Outcomes Research and Education (UK CORE) and Gloucestershire Partnership NHS Trust (GPT) will be described. This article describes the GPT/UKCORE partnership, the process of building an evidence-based practice training program, the final structure of the evidence-based practice training program, and the evaluation of the evidence-based practice training program.     

Homelessness: Perspectives,Misconceptions, and Considerations for Occupational Therapy

SUMMARY

Like poverty, the problem of homelessness has been with us to varying degrees since the founding of our nation. Attempts to explain homelessness have an equally long history. Hence, the literature and popular media are home to divergent perspectives, explanations, and characterizations of homelessness. The objectives of this paper are to present a unifying taxonomy of prominent perspectives on homelessness, and to illustrate how various perspectives lead to particular characterizations of persons who become homeless. The taxonomy traces the connection between perspectives and interpretations of the problem and helps to illuminate implicit and often unexamined assumptions about who becomes homeless and why. Critical examination of these perspectives is vital because our individual and collective understanding of homelessness is a powerful determinant of how we approach occupational therapy practice with this population. Implications for community practice and program planning for individuals and families in homeless shelters are also discussed.     

Evaluating Cultural Competence in an Occupational Therapy Pediatric Course

Abstract

This study examined the impact on student cultural competence of using specific guided activities in a pediatric occupational therapy course. A combined two-group pre-posttest design was used with a convenience sample of 41 entry-level occupational therapy doctoral students. Using a measure of cultural competence change, results indicated significant increase in scores from pre to post course testing suggesting cultural competence structured activities in course work were associated with an increase in student cultural competence. Implications for occupational therapy education are discussed.     

Teaching Evidence-Based Practice in a Distance Education Occupational Therapy Doctoral Program: Strategies for Professional Growth and Advancing the Profession

ABSTRACT

The Centennial Vision of the American Occupational Therapy Association (AOTA) projects that by 2017 all occupational therapy (OT) practice areas will be supported by evidence. Achieving this goal requires preparing clinicians with the skills to assimilate, analyze, and apply research to their areas of practice and communicate the value of OT services to consumers and payers. These skills are at the heart of evidence-based practice (EBP). Educators must be prepared to teach EBP skills in both entry-level and postprofessional programs. This article outlines how EBP can be taught to postprofessional occupational therapy clinical doctoral students using a distance education format. Key features of a successful EBP course include having access to full-text electronic articles, opportunities for students to explore the literature in their own areas of interest, consistent and timely feedback on written work and discussion topics, and opportunities to collaborate with peers.     

Occupational therapy with people with depression: Using nominal group technique to collate clinician opinion

Aims. This aim of this study was to obtain a consensus from clinicians regarding occupational therapy for people with depression, for the assessments and practices they use that are not currently supported by research evidence directly related to functional performance. The study also aimed to discover how many of these assessments and practices were currently supported by research evidence. Methods. Following a previously reported systematic review of assessments and practices used in occupational therapy for people with depression, a modified nominal group technique was used to discover which assessments and practices occupational therapists currently utilize. Three online surveys gathered initial data on therapeutic options (survey 1), which were then ranked (survey 2) and re-ranked (survey 3) to gain the final consensus. Twelve therapists completed the first survey, whilst 10 clinicians completed both the second and third surveys. Major findings. Only 30% of the assessments and practices identified by the clinicians were supported by research evidence. A consensus was obtained on a total of 35 other assessments and interventions. These included both occupational-therapy-specific and generic assessments and interventions. Principle conclusion. Very few of the assessments and interventions identified were supported by research evidence directly related to functional performance. While a large number of options were generated, the majority of these were not occupational therapy specific.     

The Prevalence of Evidence-Based Drug Use Prevention Curricula in U.S. Middle Schools in 2005

Since the promulgation of its Principles of Effectiveness in 1998, the Office of Safe and Drug-Free Schools of the U.S. Department of Education has promoted the use of evidence-based drug prevention programs in the nation’s schools. We report the results of a survey, conducted in 2005, of a nationally representative sample of 1,721 schools with middle school grades. Respondents comprised the staff member in the school identified as most knowledgeable about the school’s drug prevention programs. The total response rate was 78%. Respondents answered questions concerning which drug use prevention curricula they used, and, if they used more than one, which one they used the most frequently. Three federally-sponsored registries were used to specify which curricula were considered evidence-based. Findings from 2005 were then compared to earlier estimates based on a similar 1999 survey. We found that 42.6% of the nation’s schools with middle school grades were using an evidence-based curriculum, an increase of 8% from our 1999 estimate. The two most prevalent curricula in use, at 19% each, were Life Skills Training and Project ALERT. We note, however, that only 8% of Life Skills Training users and 9% of Project ALERT users reported using those curricula the most, and that only 23% of respondents overall reported that they used an evidence-based curriculum the most. More information is needed as to why over three-quarters of the nation’s schools with middle school grades continue to administer curricula that have not been identified as effective.