Those three words encompass all therapeutic disciplines, from pediatrics to geriatrics. In the simplest of terms, it means that the decisions we make as clinicians must be founded in research. The kind of stuff that makes families willing to shell out their hard earned money on co-pays, or that prompts insurance companies to reimburse for all that hard work we have done. This is how each of our professional organizations fight for us to prove that we provide services that work. Services that make us better than some untrained, unskilled person off the street.
So yes, you get it already. Evidence based practice is important. Now, all you therapists out there, I need you to think about your daily treatment sessions. Is it fair to say that at least some of what you do is “because you’ve always done it that way” ? Did you pick something up from someone, who picked it up from someone else, who maybe went to a course a long time ago? Are you working off of anecdotal evidence that just kind of “makes sense”? Of course; it happens all the time. You probably just don’t sit there and question everything you are doing, especially if your clients are making progress and meeting goals. The beauty of being a clinician is that you can use your clinical reasoning to work through many problems. But what about when you are stuck and frustrated because your clients are plateauing, or you just aren’t sure where to go next. Is there something you might be missing?
In an ideal world, we would all be reading and contributing to the latest research, sharpening our skills and staying on the edge of what’s next. However, anyone that’s out there practicing knows that this isn’t always possible. There are many factors that impact our consistent use of evidence based practice in therapy.
Availability and Access to Research:
It would be wimpy of me to just whine that there isn’t enough research out there, because that’s not entirely true. What is true is that we don’t all have access to the latest research. In graduate school, they allow students access to databases that house tons of full research articles. If I tried looking something up now, I would most likely have to pay to get the full article. Yeah, I’m probably not going to do that.
This is why I think it’s nice to have a student at a facility, because as a part of their fieldwork, they typically have to complete a project about whatever their instructor decides upon. This is a great opportunity to breathe some fresh evidence based practice into your clinic or practice setting.
Also, don’t knock those new graduates that are so bright-eyed and bushy-tailed. They probably hold a lot of the latest information due to the fact that they just spent so much time in school scouring research papers for their thesis projects.
I can’t avoid the other obvious here, who really wants to go home from a long, hard day at work and read through tedious research articles? Those things aren’t meant to be thrillers. Don’t blame me if I just want to read a trashy magazine or the latest vampire romance novel. Therapists often struggle to find a work/life balance, and I’ll let you know, most business aren’t going to provide the opportunity to peruse research articles on company time. That’s for billing patient contact hours, people.
Now, the obvious solution to this issue is continuing education. We are all required to complete a certain amount of hours in order to keep our licenses. The problem here? Courses are expensive. I could spend anywhere from a couple hundred to a couple thousand dollars on a course. On top of that, you often have to use vacation time or your weekends to complete these courses, and might even have to travel far away for a course that’s any good. The cheaper courses are sometimes a joke or a complete waste of your time…pretty much a crap shoot. Plus, you may only complete 1 or 2 courses a year; not nearly enough to keep up with an ever-changing caseload.
Personal interpretation of research:
You have to let the research guide your clinical decisions, and interpret it with a critical eye. Look for the limitations and how they apply to your practice setting. Let’s say that one study found that pencil grasps do not ultimately impact handwriting legibility. Does it mean that you should never look at a child’s grasp again? No; it means that you weigh the impact of the grasp on a particular child’s handwriting and determine if it is worth changing (i.e. biomechanical joint stress, weakness, etc). Just reading the articles isn’t going to change your practice unless you interpret it and learn how to incorporate it in your day to day treatment.
Therapist personality types:
I find it interesting that in my time as an OT, I have met many different types of therapists. Some that are flighty, doing a few activities here, a few activities there, without a real “plan” in place. I’ve met people that are insanely rigid in their practice, OT rock stars that are quoting AOTA framework and ICF models. (Yes, these people often track me down on the website and let me know what I’ve been doing “wrong”.) Yikes.
These different personality types are ultimately going to contribute to the therapy they provide. Remember that whole “therapeutic use of self” thing? We can’t change who we are and how we naturally go about solving problems, but we can always try to improve.
So I guess it’s a pretty fair to say that we can never know it all. We really just have to do the best with what we have available to us. Also, we should never be afraid to ask questions and collaborate with those around us.
After saying all of this, am I going to go out and create some ground breaking research? Sadly, probably not. However, I am going to continue to try my best to make sure I can always back up what I’m doing. Stop yourself during a session and think, “Why am I doing this?” In your mind you might think: We are working on proximal stability as well as development of the palmar arches, all while addressing letter memory and sequencing. Bam! Skilled intervention!