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FRAMEWORK FOR EVIDENCE-BASEDOCCUPATIONAL THERAPY PRACTICE The process of evidence-based practice is essentially thesame for occupational therapy as for other health disci-plines.Although not represented in the framework, evalu-ation of this process is undertaken to determine improve-ment in relevant outcomes and to identify factors that willmake the process more1, drawingon concepts presented by Bennett and Glasziou (1997),Law et al.(1996), and Sackett, Richardson, Rosenberg &Haynes, (1997).Clinical reasoning is usedto determine whether the evidence 'fits' with each featureof the client's context (person, occupation and environ-ment).This framework presents evidence-basedpractice as a process that follows a cycle stemming fromclinical decisions that need to be made in all stages of theoccupational therapy treatment process.Clinical questionsare identified that reflect the information needed to makeclinical decisions, and which take into account the specificclient or group of clients being treated, as well as the con-text in which treatment occurs.However, some differences in its application arisefrom the differing practice domains and theoretical mod-els used.A framework for the use of evidence-based prac-tice in occupational therapy is presented in Fig.As not all studies are wellperformed, a critical appraisal of the article for its validityand clinical usefulness is important.Clients, and whereappropriate families or carers, are actively engaged in thedecision making process to determine the action to betaken.
FRAMEWORK FOR EVIDENCE-BASEDOCCUPATIONAL THERAPY PRACTICE The process of evidence-based practice is essentially thesame for occupational therapy as for other health disci-plines. However, some differences in its application arisefrom the differing practice domains and theoretical mod-els used. A framework for the use of evidence-based prac-tice in occupational therapy is presented in Fig. 1, drawingon concepts presented by Bennett and Glasziou (1997),Law et al.(1996), and Sackett, Richardson, Rosenberg &Haynes, (1997). This framework presents evidence-basedpractice as a process that follows a cycle stemming fromclinical decisions that need to be made in all stages of theoccupational therapy treatment process. Clinical questionsare identified that reflect the information needed to makeclinical decisions, and which take into account the specificclient or group of clients being treated, as well as the con-text in which treatment occurs. A literature search isundertaken to identify the best research evidence avail-able to answer the question. As not all studies are wellperformed, a critical appraisal of the article for its validityand clinical usefulness is important. Perhaps the most cru-cial aspect of the evidence-based practice process is theuse of evidence with the client. Clinical reasoning is usedto determine whether the evidence ‘fits’ with each featureof the client’s context (person, occupation and environ-ment). Particular attention should be given to the prefer-ences and values of the client. Consideration must also begiven to the practice setting, clinical expertise, andresources available to the therapist. Clients, and whereappropriate families or carers, are actively engaged in thedecision making process to determine the action to betaken. Although not represented in the framework, evalu-ation of this process is undertaken to determine improve-ment in relevant outcomes and to identify factors that willmake the process more
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