Is there enough evidence for evidence-based practice in occupational therapy?

Stephanie Viau, MS, OTR, is Staff Occupational Therapist, Pinecrest Medical Care Facility, Powers, MI. In recent years, the health professions have seen an increasing call for evidencebased practice. Evidence-based practice is the “conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients” (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996, p. 71). Law and Baum (1998) further defined evidencebased practice as “placing more emphasis on the integration and transfer of research knowledge into practice to be used along with clinical judgment, client choice, and clinical training” (p. 131). In 2000, Holm discussed evidence-based practice related to the profession of occupational therapy and described how evidence-based practice is congruent with our profession’s Code of Ethics. Because occupational therapy as a profession has a code of ethics that calls for therapists to provide services on the basis of accurate and current information, we must, therefore, be concerned about the evidence-based research literature that supports evidence-based practice. Evidence-based research literature is important to the profession of occupational therapy for several other reasons. As early as 1985, Ottenbacher and Petersen stated that occupational therapy was a developing profession and, therefore, therapists must seek progress toward the emergence of a more scholarly approach to practice. Ottenbacher (1987) also stated that an increase in information would lead to the refinement of existing treatment techniques and the development of new therapeutic options. In 1998, Law and Baum described evidencebased research as also effective when communicating with other professions in the clinic. Not only do other professions discuss their practice in terms of evidence, but also clinical decisions, such as referral choices, could be based on the amount of evidence professions are able to provide to demonstrate the effectiveness of service. The need for evidence is also apparent when discussing health care spending and reimbursement issues. Law and Baum (1998, p. 131) stated that “the need for increased accountability, in conjunction with health care spending restraint, has accelerated interest in the use of research evidence as the basis for occupational therapy practice.” If we are unable to document the effectiveness of treatment, we may receive neither appropriate recognition nor adequate reimbursement for our services (Ottenbacher & Petersen, 1985). The issue for the profession, therefore, is that to be able to participate in evidencebased practice, we must have adequate evidence on which to base our treatment decisions. Ottenbacher and Petersen (1985) examined the occupational therapy literature for trends in research published over a 10-year period from 1973 to 1983. They classified research articles into four categories on the basis of the type of statistical analyses used: no statistical analyses; Dirette, D., Rozich, A., & Viau, S. (2009). The Issue Is—Is there enough evidence for evidence-based practice in occupational therapy? American Journal of Occupational Therapy, 63, 782–786.