Therapists awake! The challenge of evidence-based occupational therapy.

We have entered a new therapy-world called the world of evidence-based practice. That this world is new is, in its own way, rather odd. On one level of thinking, one would hope that we have engaged in evidence-based practice for a long time already, if not forever. Surely, none of us engages in therapy strategies and techniques that have no evidence for being effective, do we? Well, yes and no. Yes, we do engage in therapy based on evidence, but that evidence has not been derived primarily from systematic scientific reviews of published research. Instead, we have tended to rely on other forms of evidence, such as the voice of an expert, uncritical acceptance of the findings of a single published study or a published manual, and reliance on our own previous experiences and the experiences of those around us. In the new therapy-world of evidence-based practice, these forms of evidence are not being negated; however, in the new world, we are being asked to wake up to the world of health care research and to use findings from this world of research in addition to more familiar sources of evidence to guide treatment planning for our clients. We believe that an urgent need exists for all of us in occupational therapy to develop and use the skills necessary to plan treatment strategies for individual clients based on what is supported by evidence (Rothstein, 2001). Five offerings in this issue of The American Journal of Occupational Therapy (AJOT) focus on the topic of evidencebased practice. In this editorial, we provide a brief historical overview of the concepts and principles of evidence-based practice as developed in the past decade, both in health care broadly and within occupational therapy. Additionally, three feature articles in this issue of the journal contribute to our knowledge of evidence-based practice: Two articles by Trombly and Ma constitute Parts I and II of a systematic review of articles that address the efficacy of occupational therapy treatment for persons with stroke, and a third by Dysart and Tomlin reports a survey of occupational therapists’ attitudes toward the concept of evidence-based practice. Finally, the Evidence-Based Practice Forum offers an article by Lieberman and Scheer in which the American Occupational Therapy Association (AOTA) Evidence-Based Practice Literature Review Project is described. The project represents a comprehensive effort by the Association to develop systematic reviews and to disseminate research evidence related to particular areas of practice to members of the profession. The expansion of evidence-based practice lately has become something of a revolution in the health care literature. The title of a recent article in a medical journal illustrates the point: “What Is EvidenceBased Medicine: The Revolution Coming Your Way” (Manser, 2001). Stevens, Abrams, Braxier, Fitzpatrick, and Lilford (2001) traced the development of this revolution from the focus in the early 1970s on health technology assessment and Cochrane’s (1972) critique of the effectiveness and efficiency of health services research. The current methods used in evidence-based medicine (EBM) have their roots in clinical epidemiology and evolved in conjunction with the development of Therapists Awake! The Challenge of Evidence-Based Occupational Therapy