Evidence-based practice depends on the routine use of outcome measures.
Outcome and process assessment (Health Care)
Evidence-based medicine (Research)
Occupational therapy (Management)
|Author:||Unsworth, Carolyn A.|
|Publication:||Name: British Journal of Occupational Therapy Publisher: College of Occupational Therapists Ltd. Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2011 College of Occupational Therapists Ltd. ISSN: 0308-0226|
|Issue:||Date: May, 2011 Source Volume: 74 Source Issue: 5|
|Topic:||Event Code: 200 Management dynamics; 310 Science & research Computer Subject: Company business management|
|Geographic:||Geographic Scope: Australia Geographic Code: 8AUST Australia|
Ensuring that practice is evidence based is an important focus for
current occupational therapy research. This theme has permeated our
literature for more than 10 years, but the logical precursor to this,
and a necessary building block, is the use of outcome measures.
Occupational therapists now have an excellent grasp of evidence-based
practice, so there is no need to expound the importance of demonstrating
the effectiveness and efficiency of our service to clients, colleagues
and employers. It is also accepted that having the best evidence to make
judgements about the care of individual clients relies on research being
conducted. Importantly, we need evidence from randomised controlled
trials concerning the value of therapy. However, to conduct these trials
we require standardised outcome measures and we are not making adequate
progress because we are neglecting the important foundation of having
and using these outcome measures. Recent evidence from the United
Kingdom and Australia suggests that the consistent use of a range of
outcome measures remains low (Bowman 2006, Stapleton and McBrearty
2009). The central tenet of this editorial is that to facilitate
evidence-based practice, occupational therapists need to ensure that we
have a toolbox full of standardised outcome measures and, most
importantly, that we use them.
Outcome measures are standardised tools that can establish if therapeutic outcomes have been achieved. When using outcome measures, client data must be collected at two or more points to calculate change over time for an individual or a group. A standardised outcome measure has a uniform procedure for administration and scoring, is known to be reliable and valid, and has a method to reference the score that a client achieves against norms or criteria. The International Classification of Functioning, Disability and Health (World Health Organisation 2002) provides an ideal framework and language to describe how we can measure outcomes in the domains that matter to our clients: impairment, activity/limitation and participation/restriction. Several recent articles in this journal, as well as excellent texts by Law et al (2005) and Laver-Fawcett (2007), can guide us to select and implement outcome measures.
Internationally, occupational therapy practitioners and researchers are creating the evidence we need to show that our services are as effective as we believe them to be, but the pace is slow and the studies too few. To facilitate this research, using outcome measures and recording and sharing data must become a routine element of practice. The routine inclusion of training materials on outcome measures for students, availability of more training sessions for practitioners and support from managers to use outcome measures is required (Stapleton and McBrearty 2009). However, occupational therapists need to consider that while their waiting lists may be long and time pressures high, making time to collect outcome data benefits all clients in the longer term since evidence-based services will continue to be funded. There are no easy solutions to entice occupational therapists to engage more with using outcome measures. Perhaps it is like exercise: we know it is good for us and our clients, so we just need to do it.
Keywords: Outcome measures, activities of daily living, research.
Bowman J (2006) Challenges to measuring outcomes in occupational therapy: a qualitative focus study. British Journal of Occupational Therapy, 69(10), 464-72.
Laver-Fawcett AJ (2007) Principles of assessment and outcome measurement for occupational therapists and physiotherapists: theory, skills and application. Chichester: John Wiley.
Law M, Baum C, Dunn W (2005) Measuring occupational performance. Supporting best practice in occupational therapy. 2nd ed. Thorofare, NJ: Slack.
Stapleton T, McBrearty C (2009) Use of standardised assessments and outcome measures among a sample of Irish occupational therapists working with adults with physical disabilities. British Journal of Occupational Therapy, 72(2), 55-64.
World Health Organisation (2002) Towards a common language for function, disability and health: International Classification of Functioning, Disability and Health (ICF). Geneva: WHO.
Carolyn A Unsworth (1,2,3)
(1) Associate Professor, Department of Occupational Therapy, La Trobe University, Australia.
(2) Adjunct Professor, School of Health Sciences, Jonkoping University, Jonkoping, Sweden.
(3) Visiting Professor, Faculty of Health and Social Care, London South Bank University, London.
Correspondence to: Dr Carolyn A Unsworth, Associate Professor, Department of Occupational Therapy, Faculty of Health Sciences, La Trobe University, Bundoora, Victoria 3086, Australia.
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