Occupational Therapy

Guide to research in the area of occupational therapy. Also helpful for the areas of physical therapy, nursing, health, physiology and kinesiology.

EBM: Evidence Based-Medicine

What is EBM (Evidence-Based Medicine)?

EBM is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research."

How do you do this? Click on the tabs above to learn more


Source: Sackett, D., Rosenberg, W., Gray, J., Haynes, R., & Richardson, W. (1996, January 13). Evidence based medicine: What it is and what it isn't. BMJ, 312(7023), 71-72. Retrieved from http://www.bmj.com​.

  1. Use the PICOT acronym to help you create a research question:
P = Patient/Population/Problem

Who is your patient? Identify a disease, health status, age, race, geographic region, sex, or a specific characteristic important to your question.

Example: stroke patients

= Intervention/Indicator

What do you plan to do for the patient? Identify a specific test, therapy, medication or management strategy.

Example: virtual reality, occupational therapy

= Compare/Control

What is the alternative to your plan? Examples may include: no treatment or a different type of treatment.

Example: non-VR (or option to have no comparison)

= Outcome

What outcome do you seek? Identify possible outcomes/results of the intervention such as less symptoms, no symptoms, or better quality of life...etc.

Example: rehabilitation, flexibility, mental health

= Time/Type of Study or Question (This element is optional and not always included)

What is the time frame? What study types will most likely have the information you seek? 

Example: systematic review

 

  1. Search article databases using some of the concepts/words you generated from the PICO acronym:

P = patient/population/problem
I = intervention/indicator
C = compare/control
O = outcome
T = time/type of study or question

INTERVENTION

This question addresses the treatment of an illness or disability.

In _________ (P), how does _________ (I) compared to _________(C) affect _______(O) within _______ (T)?
In _______(P), what is the effect of _______(I) on ______(O) compared with _______(C) within ________ (T)?

Example:

In middle-aged adults with chronic ankle instability(P), how does kinesio-taping (I) compare to ankle support brace (C) affect the reoccurrence of ankle injuries(O)?

In student athletes with chronic knee pain(P), how does acetaminophen(I) compared to ibuprofen(C) affect liver function(O)? 

PREVENTION

This question addresses how to reduce the chance of disease by identifying and modifying risk factors and how to diagnose disease early by screening.

For ________ (P) does the use of ______ (I) reduce the future risk of ________ (O) compared with _________ (C)?

Examples:

In adolescents(P) receiving a routine physical examination how effective is an initial 12-lead EKG(I) versus the standard auscultation(C) in predicting and preventing sudden death cardiac events(O)?

In adolescents(P) experiencing a sudden death cardiac event how effective is hands-only CPR versus hands plus breathing CPR at preventing mortality?

PROGNOSIS/PREDICTIONS

This questions address the causes or origin of disease, the factors that produce or predispose an individual towards a certain disease or disorder.

Are ____ (P) who have _______ (I) at ___ (Increased/decreased) risk for/of_______ (O) compared with ______ (P) with/without ______ (C) over _____ (T)?

Are ______(P) who have ______(I) compared with those without _______(C) at ________ risk for/of _______ (O) over ________(T)?

Examples:

Are athletes(P) that participate in high impact sports(I) following repeated traumatic brain injuries(T) at increased risk for dementia(O) compared with athletes(P) that participate in low impact sports without repeated traumatic brain injuries(T)?

Do children(P) diagnosed with obesity prefer dietary changes(I) or exercise (play, sports, or modeling)(C) to reduce weight(O) during the ages of 5 to 12 years(T)?

ETIOLOGY

This questions address the causes or origin of disease, the factors that produce or predispose an individual towards a certain disease or disorder.

Are ____ (P) who have _______ (I) at ___ (Increased/decreased) risk for/of_______ (O) compared with ______ (P) with/without ______ (C) over _____ (T)?

Are ______(P) who have ______(I) compared with those without _______(C) at ________ risk for/of _______ (O) over ________(T)?

Examples:

Are athletes(P) that participate in high impact sports(I) following repeated traumatic brain injuries(T) at increased risk for dementia(O) compared with athletes(P) that participate in low impact sports without repeated traumatic brain injuries(T)?

Do children(P) diagnosed with obesity prefer dietary changes(I) or exercise (play, sports, or modeling)(C) to reduce weight(O) during the ages of 5 to 12 years(T)?

DIAGNOSIS

This question addresses the act or process of identifying or determining the nature and cause of a disease or injury through evaluation.

Are (is) _________ (I) more accurate in diagnosing ________ (P) compared with ______ (C) for _______ (O)?
In ________ (P) are/is ________(I) compared with ________(C) more accurate in diagnosing ________(O)?

Example:

In athletes that have experienced a popping sensation(P), is the Lachman tests(I) compared to a Lelli's Test(C) more accurate in diagnosing an Anterior Cruciate Ligament Tear?

MEANING

This question address how one experience a phenomenon or event.

How do ________ (P) diagnosed with _______ (I) perceive ______ (O) during _____ (T)?

Example:

How do athletes(P) perceive reporting (O) for drug-testing programs as a deterrent from using performance-enhancing drugs prior to spring training(T)?

In athletes(P) who have experienced panic-attack-like-symptoms, how does the consumption of(I) or abstinence from(C) consuming energy drinks impact the occurrence of additional episodes after the initial onset of symptoms(T)?

(thank you to Traci Mays at FGCU Library for permitting use of these examples)

Evidence-Based Medicine is based on specific types of studies
Meta-Analyses and Systemic Reviews

A meta-analysis will thoroughly examine a number of valid studies on a topic and combine the results using accepted statistical methodology as if they were from one large study.  Articles that are Systemic Reviews are desirable because they usually focus on a clinical topic with a specific answer and an extensive literature search is conducted to identify all studies with sound methodology. In other words, systemic reviews do the work for you by gathering many research studies together, analyzing them and presenting you with sound, evidence-based results.

(click image to enlarge)

A meta-analysis will thoroughly examine a number of valid studies on a topic and combine the results using accepted statistical methodology as if they were from one large study.  Articles that are Systemic Reviews are desirable because they usually focus on a clinical topic with a specific answer and an extensive literature search is conducted to identify all studies with sound methodology. In other words, systemic reviews do the work for you by gathering many research studies together, analyzing them and presenting you with sound, evidence-based results.

Example of a Systematic Review Article

Sometimes "Systematic Review" or "Meta-Analysis" will be in the article title. Authors did an extensive review of the medical literature to find all other articles about virtual reality and gait/balance in stroke patients. Conclusions point you to what the current evidenced-based practices are. This systematic reviews shows that virtual reality training has proven beneficial for gait/balance rehabilitation of stroke victims.

(click image to enlarge)

Sometimes "Systematic Review" or "Meta-Analysis" will be in the article title. Authors did an extensive review of the medical literature to find all other articles about virtual reality and gait/balance in stroke patients. Conclusions point you to what the current evidenced-based practices are. This systematic reviews shows that virtual reality training has proven beneficial for gait/balance rehabilitation of stroke victims.

Searching for Evidence-Based Medicine Articles

Try some of these databases to locate Evidence-Based Medicine Articles

Search Tips

Consider the steps outlined in here and in the image below.

  1. Enter Search Terms
  2. Select the "Evidence-Based Practice" limiter

(click image to enlarge)

1. Enter Search Terms 2. Select the "Evidence-Based Practice" limiter

Search Tips

Consider following the steps shown in the image below.

  1. Enter search terms in a separate box
  2. On one line, include "systematic review" and choose the "Document Title" option in the field to the right

(click on image to enlarge)1. enter search terms in separate box 2. On one line, include "systematic review" and choose the "Document Title" option in the field to the right

 

 

click image to enlarge:

Video Tutorial: Using PICOT to Structure a Literature Search

Video Tutorial: Evidence-Based Medicine

Video Tutorial: What is PICOT?