The Importance of Evidence-Based Practice in the Field of Occupational Therapy

During my time as an undergraduate occupational therapy student at the University of New Hampshire, I had the opportunity to take several courses that taught me about research. I learned about everything from the universal methodology to the specific application of research to the field of occupational therapy and interdisciplinary professions. During these courses a topic we explored was evidence-based practice. In the field of occupational therapy, this term describes the consideration of three important components to guide intervention: current and reliable research, the client’s values, and clinical expertise. Before engaging in a research project of my own, I recognized the necessity of evidence-based practice to provide ethical treatment. However, it wasn’t until learning experientially through my own research project that I was able to see the true value of each component and the collective impact of evidence-based practice on client outcomes.

Ferris installing a tracking device on a study participant's car. Credit: Jeremy Gasowski

Last summer, I was supported by the Hamel Center's Summer Undergraduate Research Fellowship grant which allowed me to engage in a research project to support individuals with Alzheimer’s Disease and Related Dementia (ADRD) and their caregivers. I implemented a Global Positioning System (GPS)-based technology in the vehicles of drivers with ADRD with the intent to reduce caregiver burden and anxiety. While completing a literature review, I found that there was a significant lack in consistent legislation across the United States regarding methods for recommending when individuals should stop driving due to a diagnosis of ADRD (Davis & Owens, 2021; Babulal et al., 2019; Greenstein, 2017). Although the neurocognitive impacts of this condition are well known and there is a unpredictable nature of progression, a diagnosis does not warrant immediate cessation of activities like driving. It is true that ADRD will eventually present with deficits in attention, visual-spatial processing, judgment, memory, and executive functioning (Malvitz et al., 2023). However, this does not follow a specific timeline. Consequently, there is a present need to have a universally agreed upon method to assess whether an individual should stop driving due to their cognitive deficits.This highlights a crucial component of evidence-based practice: current, reliable, and valid research. The occupational therapy profession along with interdisciplinary health professions have a responsibility to advocate for and engage in research to support an assessment method for this present issue. This promotes ethical treatment for clients with diagnoses like ADRD that have complex implications on quality of life. 

During my literature review I also found that driving serves as an important skill for older adults, as it helps them maintain independence and promotes continued socialization throughout aging (Davis & Owens, 2021; Stamatelos et al., 2021; Allison et al., 2018). This makes driving meaningful and can promote a sense of autonomy among older adults. Occupational therapists value meaning, which connects to another essential component of evidence-based practice—recognizing the client’s values. Occupational therapists focus on supporting not only what the client needs to do but also what they want to do. Working firsthand with care recipients and caregivers helped me see the importance of supporting clients in what is most meaningful and valuable to them. Not only does it allow us to facilitate enhanced quality of life, but it also allows us to help clients maintain their sense of identity which is influenced by how they spend their time. 

The final component of evidence-based practice that I witnessed throughout my research experience was the use of clinical expertise to navigate unique client interactions and implement intervention. As a student, I mainly observed this component through my mentor Dr. Arthanat as I do not yet have years of clinical experience to guide my reasoning. Throughout my project I witnessed him use his clinical expertise to identify which participants may be best supported by the experimental intervention and how to use the technology to develop goals that are client centered and appropriate for their situation. To follow the principles of evidence-based practice, the clinician needs to acknowledge the unique needs, wants, and situation of the client. In the case of my project, this involved developing goals specific to the caregiver’s and care recipient’s wants for the technology. In practice and as I saw during my project, this facilitates improved outcomes of the intervention, aids in building rapport with the client, and supports patient buy-in. 

Overall, my research experience allowed me to see the firsthand impact that evidence-based practice has in the profession of occupational therapy. Rather than simply hearing about the importance of the three components in a lecture with simulated examples, I was able to learn experientially about how evidence-based practice influences occupational therapy practice to support client outcomes in a real-life participant. This experience has been and continues to be incredibly valuable to my education as a future occupational therapist. I will carry the lessons I have learned about the application and importance of evidence-based practice to my future practice as an occupational therapist. 

References

Allison, S., Babulal, G., Stout, S. H., Barco, P. P., Carr, D. B., Fagan, A. M., Morris, J. C., Roe, C. M., & Head, D. (2018). Alzheimer disease biomarkers and driving in clinically normal older adutls: Role of spatial navigation abilities. Alzheimer Disease & Associated Disorders, 32(2), 101-106. https://doi.org/10.1097/WAD.0000000000000257

Davis, R., & Owens, M. (2021). Self-regulation of driving behaviors in persons with early-stage Alzheimer’s disease. Journal of Gerontological Nursing, 47(1), 21–27. https://doi.org/10.3928/00989134-20201209-01

Babulal, G. M., Stout, S. H., Benzinger, T. L. S., Ott, B. R., Carr, D. B., Webb, M., Traub, C. M., Addison, A., Morris, J. C., Warren, D. K., & Roe, C. M. (2019). A naturalistic study of driving behavior in older adults and preclinical Alzheimer’s disease: A pilot study. Journal of Applied Gerontology, 38(2), 277-289. https://doi.org/10.1177/0733464817690679 

Greenstein, A. R. (2017). Dementia and driving: Ethics and the law.  TCNJ Journal of Student Scholarship, 19. https://joss.tcnj.edu/wp-content/uploads/sites/176/2017/04/2017-Greenstein.pdf 

Malvitz, M., Zahuranec, D. B., Chang, W., Heeringa, S. G., Briceño, E. M., Mehdipanah, R., Gonzales, X. F., Levine, D. A., Langa, K. M., Garcia, N., & Morgenstern, L. B. (2023). Driving predictors in a cohort of cognitively impaired Mexican American and non-Hispanic white individuals. Journal of the American Geriatrics Society, 71(11), 3520-3529. https://doi.org/10.1111/jgs.18493