1. Dr M Clare Taylor Coventry University, UK

2. Takk for at jeg ble invitert til å snakke på denne konferansen exploring EBOT2

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4. 4  Evidence-based practice  Evidence-informed practice  Evidence-inspired practice

5. exploring EBOT5  Evidence-based practice

6. exploring EBOT6 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

7. exploring EBOT7 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

8. exploring EBOT8  Evidence-informed practice  Evidence-inspired practice

9. exploring EBOT9  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

10. exploring EBOT10  Evidence-inspired practice  Does it work?  How well does it work?  How does it work? Michie & Abraham, 2004

11. exploring EBOT11 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

12. exploring EBOT12 So, what really is evidence-based/ informed/inspired practice?  Doing the right things right Gray, 2001: 20  Asking the ‘right’ questions Cusick, 2001 Supported by appropriate, sound, evidence

13. exploring EBOT13

14. exploring EBOT14  Evidence-based practice  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

15. exploring EBOT15  Evidence-based hierarchy  Guidelines  Systematic reviews  RCTs  Other experiments  Descriptive  Expert consensus  Respected opinion  Evidence-informed range  Organisational knowledge  Practitioner knowledge  User knowledge  Research knowledge  Policy knowledge

16. exploring EBOT16  Different questions need different types of evidence  All evidence needs to be critically appraised and reviewed

17. exploring EBOT17

18.  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? exploring EBOT18

19. exploring EBOT19  Inspire and inform ‘EBP champions’  Educate and support the ‘early adopters’  Find ways of translating the evidence:  CAPs  CATs

20. exploring EBOT20 Critically Appraised Papers  Structured summary of a published paper  Critical commentary of the strength of the evidence and its application  by a clinician

21. exploring EBOT21 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

22.  Creating the evidence  Using the evidence exploring EBOT22

23. exploring EBOT23  Intervention effectiveness  Sound designs  Clear, relevant, outcome measures  Clearly defined interventions  Service user perspectives  Practitioner knowledge  Critical reflection on practice

24. exploring EBOT24 ask -> find -> appraise -> act -> evaluate  Individual  Be a critical consumer of evidence  Group  Start a journal club  Department/organisation  Develop an EB culture informed by Walter et al, 2004

25. exploring EBOT25  EBOT strategy & mission statement  Give people time  SWOT analysis  Identify EBOT knowledge & skills, & any gaps  Workshops to develop specific EBP skills, e.g.:  searching  appraisal  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

26. exploring EBOT26  Pre-contemplation  No plans to change  Contemplation  Thinking about change  Preparation  Seeking information  Action  Process of learning & change  Maintenance  Permanent change Prochaska & DiClemente, 1983

27. exploring EBOT27 Types of people:  Innovators  Often isolated and distrusted  Early adopters  Opinion leaders and champions  Early majority  Traditional views, but able to change  Late majority  Reluctant to change  Laggards  Change has to be forced on them

28. exploring EBOT28  Asking the ‘right’ questions  Finding and using a variety of evidence to inform decision-making  Critically exploring the role of OT for today & tomorrow

29. exploring EBOT29  P = M x C B  P = performance  M = motivation  C = competence  B = barriers Gray, 2001: 13

30.  What are YOU going to o to become a more evidence-based OT?  Locally?  Nationally?  Internationally? exploring EBOT30

31. Tusen takk for deres oppmerksomhet 31 exploring EBOT

32. 32 Dr M Clare Taylor m.c.taylor@coventry.ac.uk +44 (0)24 7688 7068