Identification and Use of Assessment Tools in Spanish Occupational Therapists: An Exploratory Study

The use of standardized assessment tools is essential for the occupational therapy intervention process to ensure clinical practice is appropriate and of high quality. This study aimed to explore which assessment tools Spanish occupational therapists use in their clinical practice. An ad hoc online questionnaire of 19 open and closed questions was used to collect information on assessment tools, socio-demographics, and academic background. The assessment tools were classified according to the main domains of occupational therapy using the last edition of the American Occupational Therapy Association framework. The survey was completed by 73 Spanish occupational therapists, of whom 86.3% were women; the median age was 31 years, and more than 60% treated people suffering from neurological and neurodegenerative disorders or worked in geriatric medicine. Of 147 assessment tools identified, those designed to assess activities of daily living, body functions, process skills, and motor skills were the instruments most frequently used. Specifically, the Barthel Index, Lawton Instrumental ADL Scale, Functional Independence Measure, Sensory Profile 2, and Mini-Examen Cognoscitivo were the tools most employed by Spanish occupational therapists. However, more than one third of the participants used assessment tools without knowing whether they were validated in the Spanish context and/or a specific target population. To our knowledge, this is the first time a study has examined the use and type of assessment tools in Spanish occupational therapists. Our results may constitute a positive step forward for developing strategies for enhancing evidence-based assessment in occupational therapy practice.

Making Decision-Making Visible-Teaching the Process of Evaluating Interventions

Significant efforts in the past decades to teach evidence-based practice (EBP) implementation has emphasized increasing knowledge of EBP and developing interventions to support adoption to practice. These efforts have resulted in only limited sustained improvements in the daily use of evidence-based interventions in clinical practice in most health professions. Many new interventions with limited evidence of effectiveness are readily adopted each year-indicating openness to change is not the problem. The selection of an intervention is the outcome of an elaborate and complex cognitive process, which is shaped by how they represent the problem in their mind and is mostly invisible processes to others. Therefore, the complex thinking process that support appropriate adoption of interventions should be taught more explicitly. Making the process visible to clinicians increases the acquisition of the skills required to judiciously select one intervention over others. The purpose of this paper is to provide a review of the selection process and the critical analysis that is required to appropriately decide to trial or not trial new intervention strategies with patients.

Sources of evidence for professional decision-making in novice occupational therapy practitioners: clinicians’ perspectives

Introduction

Evidence-based practice skills and habits begin during undergraduate education and continue through professional life. It is important novices learn the skills in their education programme that are required in practice. This study explores strategies experienced occupational therapy supervisors use to encourage novices to be evidence based, and how these might be enhanced.

Method

Qualitative descriptive methodology was used to explore the views and experiences of 15 experienced supervisors from a range of practice areas and geographical locations, interviewed in four focus groups.

Results

Evidence-based practice is an element of professional reasoning not isolated from client-centred practice or from reflective practice. Five sources of evidence to inform competence in professional decision-making were identified: (a) research evidence from literature; (b) local environment, resources and culture; (c) client’s expertise and perspective; (d) expertise of others; and (e) practitioners’ own knowledge and experience.

Conclusion

Intentional use of all five sources of evidence to inform professional decision-making contributes to habits of evidence-based thinking and practice. Experienced therapists and educators can support evidence-based practice in novices by prompting questioning and developing systems supportive of scanning for evidence in each area. Collaboration in this endeavour will enhance integration of academic and practice education.

How soon do allied health professionals lose confidence to perform EBP activities? A cross-sectional study

OBJECTIVE

To explore if there is a relationship between allied health professionals' confidence to perform a range of evidence-based practice (EBP) activities and the time since they graduated from their entry-level degree and the presence of postgraduate qualifications.

DESIGN

Cross-sectional survey.

SETTING

Allied health professionals from two Australian public metropolitan health services, including acute, subacute, and community settings.

PARTICIPANTS

Sample of 288 (n = 288) allied health professionals from the disciplines of physiotherapy, occupational therapy, speech pathology, social work, dietetics/nutrition, and other.

MAIN OUTCOME MEASURE

Cross-sectional survey including 12 questions measuring respondents' confidence to conduct a range of EBP activities.

RESULTS

Allied health professionals begin to lose confidence related to EBP activities within the first 5 years of clinical practice, particularly for those activities involving critical analysis of published studies. Respondents with postgraduate qualifications were more likely to report greater confidence with EBP activities, suggesting that higher level qualifications protect against the effect of degradation of EBP skills and confidence over time.

CONCLUSIONS

Allied health professionals' confidence to perform EBP activities degrades over time, particularly for those individuals with no postgraduate qualifications. Registration and accreditation bodies along with allied health professional employers should explore potential strategies to preserve and enhance EBP skills, confidence, and behaviours.

Evaluation in everyday occupational therapy practice: Should we be thinking about treatment fidelity?

Evaluation is a core component of the occupational therapy process. To draw meaningful conclusions about the effectiveness of occupational therapy practice, it is essential that therapists consider not only what outcomes are achieved, but also reflect on how interventions are delivered. We suggest that incorporating the concept of ‘treatment fidelity’ into clinical practice offers therapists a means of differentiating between interventions and demonstrating clearer links between occupational therapy practice and successful client outcomes. In so doing, practitioners can highlight more explicitly the unique contribution of occupational therapy interventions.

Supporting Children with Visual Stress: The Development of a Web Resource for Parents and Professionals

Introduction

Visual stress is a condition which makes reading difficult. The use of coloured lenses in spectacles to alleviate the symptoms of visual stress has attracted increasing interest. The aim was to develop a web-based resource to centralize information about the condition and the processes for the screening, assessment, and provision of coloured lenses.

Method

Action research methods were employed. The exploratory phase used semi-structured interviews to gather parents' and professionals' views on the condition and their suggestions for the content and layout of a supporting web resource. The innovatory phase was used to design the prototype web resource. The evaluative phase was used to appraise and enhance the prototype website and collate data on website usage.

Results

Parents and professionals had some awareness of the condition but felt less sure of the evidence base for coloured lenses. Professionals valued research as evidence, whereas parents preferred testimonials. Suggestions for the content of a web resource to centralize information on the topic were clearly articulated by professionals, parents, and experts in the field. In the first year, over 7,500 individual web users visited the resource.

Conclusion

The first collaborative resource on the topic has been successfully produced, thereby offering a centralized information resource.

Systematic Reviews of Occupational Therapy Interventions: Summarizing Research Evidence and Highlighting the Gaps

As services are commissioned based on effectiveness, occupational therapists are under pressure to demonstrate the efficacy of their interventions. Occupational therapists also need to know that the interventions they are providing are effective. Robertson et al (2013) demonstrated that the occupational therapy literature is important for clinicians and is an essential part of their practice. However, as more research is published, it can be increasingly time-consuming and confusing for clinicians to keep abreast of the current literature. Occupational therapy-related research may be published in different forms, in a range of locations, and be of varying methodological quality. Furthermore, readily available published studies that investigate occupational therapy efficacy may not be sufficiently powered, or may lack external validity, when applied to different clinical settings. When well conducted, systematic reviews provide a useful way of synthesizing and evaluating the evidence on a particular topic and, to some extent, provide a solution to this problem. This paper focuses upon reviews of randomized controlled trials, as these provide the highest quality of evidence on the question of a particular intervention's effectiveness. The merits of reviews of qualitative studies are also considered, together with the possibility of combining more than one type of review.