Accepting the challenge of outcome research: examining the effectiveness of occupational therapy practice.

The theme of this speciaJ issue of the Amen'can Journal of Occupational Therapy (AJO!) is functional outcomes of occupational therap)' praCtice. The focus on functional outcomes is critical because it targets attention appropriately on the patient. Patients who come to occupational therapy share several expectations about the services they receive. First, they expect that the choice of interventions will be based on science or, in the absence of science, on a consensus of experts, and that the intervention will be delivered by a competent therapist using state-of-the-art technology as applicable. Second, patients expect the services to be appropriate for their own unique health care needs. In applying science to individual patients, therapists make a clinical judgment about what should be done for a particular patient in a particular situation. Standards of the appropriateness of care are based on a consensual judgment of practicing therapists. In other words, given the same patient under the same conditions, to what extent would other therapists agree with the treatment regimen? Third, patients expect the services to be consistent with their own preferences. In formulating therapeutic decisions, the therapist is expected to inform the patient of alternative treatments and, subsequenrly, to take the patient's perspeCtive into account in making decisions. Lastly, patients expeCt [he occupa[ional therapy interventions [0 be effective, that is, to lead to the designated outcomes. Because alternative [reatments may lead to different outcomes, or achievement of the same outcomes at a different rate, patients need to be aware of the outcomes associated with each intervention to make informed choices. These expectations reflect the social contract between occupational therapy and the recipients of occupa[ional therapy services. Joan C. Rogers, Margo B. Holm