Dr M Clare Taylor
Coventry University, UK
Takk for at jeg ble invitert til å
snakke på denne konferansen
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Evidence-based practice
Evidence-informed practice
Evidence-inspired practice
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Evidence-based practice
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Evidence-based medicine
 The conscientious, explicit and judicious use
of current best evidence in making decisions
about the care of individual patients
Sackett et al, 1996: 71
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Evidence-based health care
 An approach to decision-making in which the
clinicians uses the best evidence available, in
consultation with the patient, to decide upon
the option that suits the patient best
Gray, 2001: 17
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
Evidence-informed practice
Evidence-inspired practice
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
Evidence-informed practice

The practice of a range of professionals whose
decisions are grounded in a sound knowledge of
the needs of service users. This knowledge is
informed by the best available evidence of what is
effective, the practice wisdom of professionals
and the experience and views of service users.
Research in Practice, 2005: 14
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Evidence-inspired practice
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Does it work?
How well does it work?
How does it work?
Michie & Abraham, 2004
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Evidence-based occupational therapy (EBOT)
 Client-centred enablement of occupation
based on client information and a critical
review of relevant research, expert
consensus and past experience
CAOT, ACOTUP, ACOTRO, & PAC, 1999
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So, what really is evidence-based/
informed/inspired practice?

Doing the right things right
Gray, 2001: 20
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Asking the ‘right’ questions
Cusick, 2001
Supported by appropriate, sound, evidence
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Evidence-based practice
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Health care
Simple interventions
Hierarchy of evidence
 Emphasis on RCTs & SRs

Evidence-informed practice
Social care
 Complex, multi-faceted interventions
 A variety of evidence
 The consumer voice

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
Evidence-based
hierarchy

Evidence-informed
range
Organisational
knowledge
 Practitioner
knowledge
 User knowledge
 Research knowledge
 Policy knowledge
Guidelines
 Systematic reviews
 RCTs
 Other experiments
 Descriptive
 Expert consensus
 Respected opinion
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Different questions need different types of
evidence
All evidence needs to be critically appraised
and reviewed
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Perceived barriers
Lack of appraisal skills
 EBP is a low departmental priority
 Limited management support
 Lack of time
 Limited awareness of and access to research
 Isolation from like minded colleagues
 How to apply evidence in practice?
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Inspire and inform ‘EBP champions’
Educate and support the ‘early adopters’
Find ways of translating the evidence:
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CAPs
CATs
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Critically Appraised Papers
 Structured summary of a
published paper
 Critical commentary of the
strength of the evidence
and its application

by a clinician
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Critically Appraised Topic
 Short summary of evidence
 Less rigorous that a
systematic review
 ‘Clinical’ question
 Overview of the search
 Appraisal of the papers
 Summary of the best
evidence
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Creating the evidence
Using the evidence
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Intervention effectiveness
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Sound designs
Clear, relevant, outcome measures
Clearly defined interventions
Service user perspectives
Practitioner knowledge
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Critical reflection on practice
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ask -> find -> appraise -> act -> evaluate
 Individual
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Group
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Be a critical consumer of evidence
Start a journal club
Department/organisation
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Develop an EB culture
informed by Walter et al, 2004
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EBOT strategy &
mission statement
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Give people time
SWOT analysis
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Identify EBOT
knowledge & skills, &
any gaps
Workshops to develop
specific EBP skills, e.g.:
 searching
 appraisal
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Journal clubs
EB reflection & supervision
Action learning sets
Developing EB case studies
EB audit
Developing an EB resource
file/library
Developing or using EB
guidelines
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Pre-contemplation
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Contemplation
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Seeking information
Action
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Thinking about change
Preparation
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No plans to change
Process of learning & change
Maintenance
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Permanent change
Prochaska & DiClemente, 1983
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Types of people:
 Innovators
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Early adopters
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Traditional views, but able to change
Late majority
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Opinion leaders and champions
Early majority
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Often isolated and distrusted
Reluctant to change
Laggards
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Change has to be forced on them
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Asking the ‘right’ questions
Finding and using a variety of evidence to
inform decision-making
Critically exploring the role of OT for today
& tomorrow
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P=MxC
B
P = performance
M = motivation
C = competence
B = barriers
Gray, 2001: 13
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
What are YOU
going to o to
become a more
evidence-based
OT?



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Locally?
Nationally?
Internationally?
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Tusen takk for deres oppmerksomhet
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Dr M Clare Taylor
m.c.taylor@coventry.ac.uk
+44 (0)24 7688 7068
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