The Elevate OT Blog
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Being an evidence based OT isn't easy. Even when the evidence is staring you in the face it can be hard to know what direction to take. Sometimes it’s straight-forward, but most of the time it’s a real mess to sort out. In some cases, what you’ve been using successfully for years doesn’t seem to show in the literature. What the hell is going on?
Well, making choices on evidence based practice related to OT interventions requires more than simply reading the evidence. Our practices are intimately connected to both who you are as an clinician (you background, skills, interests, etc..) and who the patient is (wants, needs, etc..). Proving if something works or doesn’t is only part of the picture.
To highlight this conundrum, we’ve chosen to take a look at Neurodevelopmental treatment (NDT) this week.
In 2005, Dr. John Ioannidis a physician and scientist wrote highly cited article called “Why Most Published Research Findings Are False” (open access here). In the essay, John argues that most scientific findings (in all fields) are incorrect and he gives several suggestions on how we can better analyze findings.
No systematic review of occupational therapy intervention in obesity has been done yet, but there have been a few studies that explore the role (see below). Could obesity be an area of untapped OT potential?
Memory impairments are one of the most common things we think about as we age. But, older adults have access to few evidence-based interventions to improve memory. Most of our clients aren’t aware that memory problems are amenable to treatment, and providing them with supports can help them feel more hopeful, optimistic and proactive.
Patients working to restore upper extremity function post stroke deserve intervention that is meaningful and effective.
The good news is that review after review demonstrates that real, functional activities are the best way to restore upper extremity function after stroke.
Although mindfulness practice dates back thousands of years, it’s only over the past few decades that it has begun to filter into mainstream culture.
But how is mindfulness related to occupational therapy?
For therapists working with hip replacements, precautions have been the standard recommendation for decades. But just how effective are these practices and what does the evidence say?
It’s easy to think that chronic health conditions are just for the elderly.
But in the US alone it’s estimated that 15-20% of all adolescents are living with a chronic health condition.
One way to help this population is with better medication adherence.
Coaching in healthcare is not unique to OT. In fact, it’s recognized in the fields of psychology, counselling, education, and more; and it continues to spread in the world of healthcare.
So how exactly do OT’s use coaching and what is the evidence behind this?
Physical exercise is a regular challenge that many patients (and OTs like us) struggle with starting or maintaining. Sometimes it seems like a constant battle to take action and do what we know is right; something our patients struggle with all the time.
So how can we help?
Chronic low back pain is an issue that many (if not most of us) will face in our lives - professionally and/or personally.
Several organizations around the world have established guidelines for treatment related to pain, and today we’ll look at an evidence based set of guidelines called the National Institute for Health and Care Excellence (NICE) guideline for low back pain.
500 Million people in the world experience mental health problems. Put to scale, that’s basically the population of all of North America. Further, in many parts of the world mental health issues are on the rise, due in part to inadequate treatment.
Rising healthcare costs world-wide have renewed interest in solutions (and OT) for primary care.
The problem is that primary care (and primary health care) is still defined by the services provided only by physicians, nurse practitioners, and physician assistants - and not by other health providers such as OTs.
Today’s Elevate Tuesday is inspired by a reader’s suggestion to look at literature for OT and women’s health (Thank-you! We love our members’ input).
Women face unique health challenges, roles, and transitions that should be considered in the framework of occupational therapy.
As humans we are filtering machines. Our brains struggle to grapple with the complexities of reality and so our biology tunes out most of it.
Up to 40% of older adults live with some kind of disability that makes engaging in IADLs difficult.
IADL intervention is an integral part of OT practice, so clarifying what works is essential and this systematic review sets out to do just that.
We have such a diverse profession. Many of us became OTs for that particular reason, with hopes of a varied and broad career full of opportunity. We can choose one profession, yet explore many careers. Many of us become Jack and Jills of all trades.
Occupational therapists have traditionally played an integral role in connecting individuals to assistive technology.
But as technology advances and everyday solutions become readily available to consumers, our role becomes less clear and necessary.
So what’s our role here these days?
Thanks to inspiration from Brock Cook (who is the author of the fantastic Occupied Podcast), I recently ran an informal “occupational audit” of my practice. In my case I wanted to understand not just how much time I was spending doing therapy - but how often was I engaged in occupation-based practice.
Fatigue is a key problem in persons with multiple sclerosis (MS). OTs often use energy conservation techniques to address fatigue through a variety of methods. As health apps become more popular, we need to know which ones are effective for OT.
If you don’t work in a school setting it may come as a surprise that handwriting issues are one of the main reasons for OT referrals.
Handwriting is an important activity for young children that still plays an integral role in learning. It’s suggested that up to 30% of kids show difficulties with writing that affect their academic performance.
Since the inception of our profession, occupation has confounded definition. It’s not just a philosophical debate - the lack of clarity on the topic has hamstrung our attempts at advocating for our profession and helping it be better understood.
Dementia affects roughly 5-7% of older adults (age 60+). It’s associated with disability across all aspects of life, including a high degree of suffering for the patient, their family and social network.
Do interventions aimed to improve function and encourage meaningful occupation help you improve quality of life (QOL) for your patients with dementia?
Whenever I find myself confused about what I do as an OT (which is often), I find it helpful to peel back the layers of the OT onion, get through the theories and frames of reference, the interventions and tools, the history and vision - and see what’s left.
Nearly 76 million people worldwide are affected by Rheumatoid Arthritis (RA), leading to pain, loss of function and disability.
Breakthroughs in the treatment and management of RA have happened over the past few decades (including medications, early diagnosis and management), but it’s still unclear if improvements in occupational performance have correlated with these advancements.
What interventions can you use to better outcomes for your patients with RA?
Falls are a major health risks and occupational performance issue for older adults in the community. As an OT, the chances you’ll work with a patient susceptible to falls is high.
So how can you support your practice in falls prevention?
Ayres sensory integration (ASI) has a long and celebrated (though sometimessordid) history in the occupational therapy world. If you finished OT school within the last five years, then it’s likely you’ve had at least one argument about it in school.
Regardless, as one of the only OT-derived neurological and intervention theories, it’s done well for itself. Also, while the exact theory and mechanisms of action may not be well established scientifically, it seems sensory integration therapies do have good results for many children.
But should you use this treatment framework?
Cognitive issues from Traumatic Brain Injury (TBI) lead to disability for millions of people, and cognitive rehab has a ton of approaches. The challenge for you as an OT, is that occupation-based approaches aren’t as established in research as other strategies.
So how do you choose the best framework?
Holding onto your roots in occupation is a real challenge in today’s workplace.
It's been an issue for years, but as pressures to measure and justify your OT work increase each year, this is especially true for your practice today.jm90
To practice as a modern, evidence based OT means we stay connected to our academic literature. But we can’t effectively conduct or implement research without having an understanding of the current state of it.