OTseeker

(Occupational Therapy Systematic Evaluation of Evidence)A Database with Pre-Appraised Research for Occupational Therapists

Marianna McCormack, M.S. OTRChatham UniversityNovember, 2012

1Learning ObjectivesDemonstrate knowledge Students will demonstrate the ability to navigate OTseeker and identify a systematic review (SR)or randomized controlled trial (RCT) relevant to their clinical question

2. Apply knowledge Students will formulate conclusions about their SR or RCT based on critical appraisal information provided by OTseeker.

3. Evaluate a problem using that knowledge Students will integrate this evidence into a clinical decision making process.

2What is the historical perspective?Need for Evidence-Based Practice in OT profession is growing

Barriers to EBP include

Lack of time

Access to literature

Difficulty interpreting research results

In order to legitimize our profession, we are compelled to support what we do with evidence, from research as well as from our own clinical experience and the experience of our clients. Insurance companies and other third party payers are also demanding documentation that our services are medically necessary. However, the process of EBP requires time and skills that some therapists may not have. There is a need for methods that reduce the time involved in locating and interpreting research so that we can use this evidence in our treatment decisions.3So to meet this needOTs at U of Queensland and U of W. Sydney developed OTseeker

OTseeker has been freely available at http://www.otseeker.com since March 2003.

OTseeker contains bibliographic details, abstracts, and quality ratings of RCTs

abstract of systematic reviews

These are the only types of studies that Otseeker contains mainly because they are still considered the best types of evidence to inform therapists about effectiveness of interventions that they use. The Ots who developed Otseeker felt that as therapists, we should be most interested in making sure that the interventions we use are evidence-based. If you are looking for information about assessment or prognosis, this may not be the database for you.4Problem-Based Learning Theory

Use of the OTseeker follows the Problem-Based Learning Process. The Problem Based Learning Process is very similar to the EBP process. Both start out with a problem that needs to be explored. In PBL, knowledge is obtained through exploration of the problem. In EBP, knowledge is obtained through a database such as OTseeker, and then integrated with other sources of knowledge such as clinical experience, and client perspective. Then a course of action is chosen.outcomes of the process are assessed.5Importance of OTseeker to the OT ProfessionReduces the time needed to locate research evidence

Helps therapists interpret study results

Encourages practitioners to use research evidence in their daily practice and clinical decisions.

6OTseeker Tutorialwww.otseeker.com/onlineTutorial.ppt

In this slide I have provided you with a link to a wonderful tutorial which navigates you through the Otseeker database and shows you how to use it. As you click on each page, click anywhere on that page several more times and you will get baloons with more cool information about that page. Pay close attention to the SEARCH page, and the INTERVENTION drop-down menu. You will see how these steps will lead you to a list of article titles that are relevant to your topic. The tutorial will also show you how to interpret the PEDro rating scale numbers assigned to each RCT study. This rating process does a lot of the critical appraisal work for you. So go ahead and enjoy the tutorial and I will meet you on the next slide!7Now try it out for yourself!First, formulate a clinical PICO question

Go to the SEARCH page

Generate a list of article titles

Click on one of these titles fora. abstract b. article details c. PEDro rating scale

Go to the search page and type in any keywords you think describe your area of interest, choose an INTERVENTION, choose a Diagnosis or subdiscipline and click SEARCH. This will give you a list of article titles that are relevant to your question. Click on any one of these titles to see all the details of the study, an abstract and the PEDro rating numbers. See? So much of the critical appraisal has already been done for you. You just have to decide if this article suits your need. If not, try another one! 8But dont forget

Once you have found research evidence that suits your need, remember that Clinical decisions always include clinical reasoning and expertise, and most importantthe client perspective9The PEDro Scalehttp://www.otseeker.com/PDF/PEDroScalePartitionedGuidelinesExplanations.pdf

Rates the RCTs for methodological quality in two ways (partitioned)

Internal validity (maximum score of 8)Statistical reporting (maximum score of 2)

Total maximum score is 10

Internal validity random assignment, similarity of groups at baseline, blinding of subjects and investigators, intention to treat analysisStatistical Reporting between group statistical comparisons, mean differences between groups, and measures of variability such as standard deviations or st. error. This info helps the therapist determine if the article contains info about statistical and clinical significance of the study.10Limitations of OTseekerabstracts of some articles in OTseeker are not available.

user must retrieve the full-text article either from the online or printed journal.

only effectiveness of interventions is in the database.no qualitative studies

Due to copyright laws, abstracts of some studies on OTseeker are not available. Users cannot then determine whether a study is applicable to their clinical question unless they locate the abstract elsewhere. Another limitation that is common to other databases as well, is that once a study of interest has been identified, users must retrieve the full-text article either from the online or printed journal. Another limitation of OTseeker is that only articles regarding the effectiveness of interventions are contained on the database. Qualitative studies are not included.11ResearchMcCluskey, A., Lovarini, M., Bennett, S., McKenna, K., Tooth, L., & Hoffmann, T. (2006). How and why do occupational therapists use the OTseeker evidence database? Australian Occupational Therapy Journal, 53, 188-195.

The purpose of this study was to explore the search behaviors of therapists who use OTseeker on a regular basis. The study also looked at what therapists did with the information they obtained from this database, and how therapists felt about the database. Therapists used this database to teach or demonstrate EBP behaviors, answer clinical questions, and keep up to date on the latest research.

12ResearchHoffmann, T., McKenna, K., Hadi, T., Bennett, S., McCluskey, A., & Tooth, L. (2007). Quality and quantity of paediatric research: An analysis of the OTseeker database. Australian Occupational Therapy Journal, 54, 113-123.

The purpose of this study was to analyze the quantity and quality of pediatric research evidence contained in the OTseeker database. An additional goal of the study was to compare this information to survey information of pediatric occupational therapists practice. OTseeker contains only systematic reviews and randomized controlled trials. The results of this study indicated that 11.3% of all research in OTseeker was related to pediatrics. The five most studied topics were mental health/psychosocial issues, neurology, learning disabilities, developmental delay, and other. The five most studied interventions were behavioral interventions, consumer education, psychosocial techniques, interventions for caregivers and parents, and developmental therapy. 13ResearchMcKenna, K., Bennett, S., Dierselhuis, Z., Hoffmann, T., Tooth, L. and McCluskey, A. (2005), Australian occupational therapists' use of an online evidence-based practice database (OTseeker). Health Information & Libraries Journal, 22,205214.

This study explored australian Ots use of Otseeker and their perceptions of Otseeker as well as its impact on their knowledge and practice. Results suggested that lack of time was the main reason that more than half of the participants in the study did not use Otseeker. Results also suggested that Otseeker has the potential to positively influence therapists knowledge and practice through access to research literature.14Additional Resourceshttp://www.otseeker.com/tutorial.htm - this website answers questions and explains terminology used in OTseeker

Bennett, S., Hoffmann, T., McCluskey, A., McKenna, K., Strong, J, Tooth, L. (2003). Introducing OTseeker:A new evidence database for occupational therapists. American Journal of Occupational Therapy, 57(6), 635-638.

http://www.otseeker.com/PDF/PEDroScalePartitionedGuidelinesExplanations.pdf - this website explains the PEDro rating scale and teaches therapists how to use it

Aust J Physiother. 2009;55(2):129-33.The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study.

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