Basic Elements for Conducting Evidence-Based Occupational Therapy

  • Ingrid Söderback


This chapter reports on methodology for evaluating the effectiveness of the interventions discussed in this handbook. The content and the four steps that compose evidence-based interventions are described as well as the various methods for conducting quality assurance. Assessment instruments represent the prerequisites for conducting evaluations of intervention effectiveness. Therefore, their possible aims, psychometric functions, and the process of collecting data and interpreting the results are reported in broad terms. An overview of the various available methods, such as the Goal Attainment Scale for evaluating a single client’s progress when participating in therapeutic sessions, is presented. The terminology of outcome statements is discussed. Finally, recommendations for future advances in occupational therapy are suggested.


Chronic Fatigue Syndrome Assessment Instrument Occupational Therapy Psychometric Function Errorless Learning 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. American Occupational Therapy Association. (2002). Occupational therapy practice framework: domain and process. Am J Occup Ther, 56, 609–634.CrossRefGoogle Scholar
  2. Avlund, K., Vass, M., Kvist, K., Hendriksen, C., and Keiding, N. (2007). Educational intervention toward preventive home visitors reduced functional decline in community-living older women. J Clin Epidemiol, 60(9), 954–962.PubMedCrossRefGoogle Scholar
  3. Backman, A., Kåwe, K., and Bjorklund, A. (2008). Relevance and focal view point in occupational therapists’ documentation in patient case records. Scand J Occup Ther, 15(4):212–220.PubMedCrossRefGoogle Scholar
  4. Barrows, D.M. (1995). Functional capacity evaluations of persons with chronic fatigue immune dysfunction syndrome. Am J Occup Ther, 49(4), 327–337.PubMedCrossRefGoogle Scholar
  5. Bennett, S., McKenna, K., Hoffmann, T., Tooth, L., McCluskey, A., and Strong, J. (2007). The value of an evidence database for occupational therapists: an international online survey. Int J Med Inform, 76(7), 507–513.PubMedCrossRefGoogle Scholar
  6. Bowman, M.H., Taub, E., Uswatte, G., et al (2006). A treatment for a chronic stroke patient with a plegic hand combining CI therapy with conventional rehabilitation procedures: case report. NeuroRehabilitation, 2(21), 167–176.Google Scholar
  7. Bryant, W., Craik, C., and McKay, E.A. (2004). Living in a glasshouse: exploring occupational alienation. Can J Occup Ther, 7(15), 282–289.Google Scholar
  8. Buchain, P.C., Vizzotto, A.D., Henna, N.J., and Elkis, H. (2003). Randomized controlled trial of occupational therapy in patients with treatment-resistant schizophrenia. Rev Bras Psiquiatr, 25(1), 26–30.PubMedCrossRefGoogle Scholar
  9. Burns, T., Catty, J., White, S., Becker, T., Koletsi, M., Fioritti, A., Rössler, W., Tomoy, T., van Busschbach, J., Wiersma, D., and Lauber, C; For the EQOLISE group (2008). The impact of supported employment and working on clinical and social functioning: results of an international study of individual placement and support. Schizophr Bull Apr 21 [Epub ahead of print] PMID: 18403375 [PubMed - as supplied by publisher].Google Scholar
  10. Campbell, L., Wilson, F.C., McCann, J., Kernahan, G., and Rogers, R.G. (2007). Single case experimental design study of Carer facilitated Errorless Learning in a patient with severe memory impairment following TBI. NeuroRehabilitation, 22(4), 325–333.PubMedGoogle Scholar
  11. Chan, S.H., Lee, S.W., and Chan, I.W. (2007). TRIP: a psycho-educational programme in Hong Kong for people with schizophrenia. Occup Ther Int, 14(2), 86–98.PubMedCrossRefGoogle Scholar
  12. Chang, L.H., and Hasselkus, B.R. (1998). Occupational therapists’ expectations in rehabilitation following stroke: sources of satisfaction and dissatisfaction. Am J Occup Ther, 52(8), 629–637.PubMedCrossRefGoogle Scholar
  13. Collaboration Cochrane Library (2008). The Cochrane Library. The reliable source of evidence in health care.
  14. Copolillo, A., and Teitelman, J.L. (2005). Acquisition and integration of low vision assistive devices: understanding the decision-making process of older adults with low vision. Am J Occup Ther, 59(3), 305–313.PubMedCrossRefGoogle Scholar
  15. Cowls, J., and Hale, S. (2005). It’s the activity that counts what clients value in psycho-educational groups. Can J Occup Ther, 72(3), 176–182.PubMedGoogle Scholar
  16. Di Stefano, M., and Macdonald, W. (2003). Assessment of older drivers: relationships among on-road errors, medical conditions and test outcome. J Safety Res, 34(4), 415–429.PubMedCrossRefGoogle Scholar
  17. Donabedian, A. (1980/1982). Explorations in Quality Assurance and Monitoring. Michigan: Health Administration Press.Google Scholar
  18. Fänge, A., and Iwarsson, S. (2005). Changes in ADL dependence and aspects of usability following housing adaptation—a longitudinal perspective. Am J Occup Ther, 59, 296–304.PubMedCrossRefGoogle Scholar
  19. Farina, E., Mantovani, F., Fioravanti, R., et al (2006). Efficacy of recreational and occupational activities associated to psychologic support in mild to moderate Alzheimer disease: a multicenter controlled study. Alzheimer Dis Assoc Disord, 20(4), 275–282.PubMedCrossRefGoogle Scholar
  20. Farrell, J.M. (1993). Predetermined motion-time standards in rehabilitation. A review. Work, 3(2), 56–72.Google Scholar
  21. Farrell, W.J., and Muik, E.A. (1993). Computer applications that streamline test scoring and other procedures in occupational therapy. Am J Occup Ther, 47(5), 462–465.PubMedCrossRefGoogle Scholar
  22. Fisher, W.P. Jr. (1993). Measurement-related problems in functional assessment. Am J Occup Ther, 47(4), 331–338.PubMedCrossRefGoogle Scholar
  23. Fleming, J.M., Lucas, S.E., and Lightbody, S. (2006). Using occupation to facilitate self-awareness in people who have acquired brain injury: a pilot study. Can J Occup Ther, 73(1), 44–55.PubMedGoogle Scholar
  24. Geusgens, C., van Heugten, C., Donkervoort, M., van den Ende E., Jolles, J., and van den Heuvel, W. (2006). Transfer of training effects in stroke patients with apraxia: an exploratory study. Neuropsychol Rehabil, 16(2), 213–229.PubMedCrossRefGoogle Scholar
  25. Gibson, L., Strong, J., and Wallace, A. (2005). Functional capacity evaluation as a performance measure: evidence for a new approach for clients with chronic back pain. Clin J Pain, 21(3), 207–215.PubMedCrossRefGoogle Scholar
  26. Gitlin, L.N., Hauck, W.W., Dennis, M.P., and Winter, L. (2005). Maintenance of effects of the home environmental skill-building program for family caregivers and individuals with Alzheimer’s disease and related disorders. J Gerontol A Biol Sci Med Sci, 60(3), 368–374.PubMedCrossRefGoogle Scholar
  27. Gitlin, L.N., Winter, L., Dennis, M.P., Corcoran, M., Schinfeld, S., and Hauck, W.W. (2006). A randomized trial of a multicomponent home intervention to reduce functional difficulties in older adults. J Am Geriatr Soc, 54(5), 809–816.PubMedCrossRefGoogle Scholar
  28. Goodman, G., Landis, J., George, C., et al (2005). Effectiveness of computer ergonomics interventions for an engineering company: a program evaluation. Work, 24(1), 53–62.PubMedGoogle Scholar
  29. Graff, M.J., Adang, E.M., Vernooij-Dassen, M.J., et al (2008). Community occupational therapy for older patients with dementia and their caregivers: cost effectiveness study. BMJ, 336(7936), 134–138.PubMedCrossRefGoogle Scholar
  30. Graff, M.J., Vernooij-Dassen, M.J., Thijssen, M., Dekker, J., Hoefnagels, W.H., and Rikkert, M.G. (2006). Community based occupational therapy for patients with dementia and their caregivers: randomised controlled trial. BMJ, 333(7580), 1196.PubMedCrossRefGoogle Scholar
  31. Gruwsved, Å., Fernholm, C., and Söderback, I. (1996). Evaluation of a vocational training programme in primary health care rehabilitation: a case study. Work, 7, 47–61.CrossRefGoogle Scholar
  32. Guidetti, S., and Söderback, I. (2001). Description of self-care training in occupational therapy: case studies of five Kenyan children with cerebral palsy. Occup Ther Int, 8(1), 34–48.PubMedCrossRefGoogle Scholar
  33. Hammond, A., and Freeman, K. (2004). The long-term outcomes from a randomized controlled trial of an educational-behavioural joint protection programme for people with rheumatoid arthritis. Clin Rehabil, 18(5), 520–528.PubMedCrossRefGoogle Scholar
  34. Hansen, R., Tresse, S., and Gunnarsson, R.K. (2004). Fewer accidents and better maintenance with active wheelchair check-ups: a randomized controlled clinical trial. Clin Rehabil, 18(6), 631–639.PubMedCrossRefGoogle Scholar
  35. Hill, K.H., O’Brien, K.A., and Yurt, R.W. (2007). Teaching energy conservation. Therapeutic efficacy of a therapeutic cooking group from the patients’ perspective. J Burn Care Res, 28(2), 324–327.PubMedCrossRefGoogle Scholar
  36. Hoare, B.J., Wasiak, J., Imms, C., and Carey, L. (2007). Constraint-induced movement therapy in the treatment of the upper limb in children with hemiplegic cerebral palsy. Cochrane Database Syst Rev, 18(2), CD004149.Google Scholar
  37. Ip, W.M., Woo, J., Yue, S.Y., et al (2006). Evaluation of the effect of energy conservation techniques in the performance of activity of daily living tasks. Clin Rehabil, 20(3), 254–261.PubMedCrossRefGoogle Scholar
  38. Jacobs, K. (1991). Occupational Therapy. Work-Related Programs and Assessments. Boston: Little, Brown.Google Scholar
  39. Kazdin, A.E. (1982). Single-Case Research Designs. Methods for Clinical and Applied Settings. New York: Oxford University Press.Google Scholar
  40. Kiresuck, T., Smith, A., and Cardillo, J.E. (1994). Goal Attainment Scaling Applications, Theory, and Measurement. London: Lawrence Erlbaum Associates.Google Scholar
  41. Kirkley, K.N., and Fisher, A.G. (1999). Alternate forms reliability of the assessment of motor and process skills. J Outcome Meas, 3(1), 53–70.PubMedGoogle Scholar
  42. Kitson, A. (1989). A Framework for Quality. A Patient-Centred Approach to Quality Assurance in Health Care. Harrow, England: Royal College of Nursing.Google Scholar
  43. Koch, L.C., Cook, B.G., Tankersley, M., and Rumrill, P. (2006). Utilizing research in professional practice. Work, 26(3), 327–331.PubMedGoogle Scholar
  44. Krupa, T., McLean, H., Eastabrook, S., Bonham, A., and Baksh, L. (2003). Daily time use as a measure of community adjustment for persons served by assertive community treatment teams. Am J Occup Ther, 57(5), 558–565.PubMedCrossRefGoogle Scholar
  45. Kunkel, S., Rosenqvist, U., and Westerling, R. (2007). The structure of quality systems is important to the process and outcome, an empirical study of 386 hospital departments in Sweden. BMC Health Serv Res, 9(7), 104.CrossRefGoogle Scholar
  46. Lambert, R.A., Harvey, I., and Poland, F. (2007). A pragmatic, unblinded randomised controlled trial comparing an occupational therapy-led lifestyle approach and routine GP care for panic disorder treatment in primary care. J Affect Disord, 99(1–3), 63–71.PubMedCrossRefGoogle Scholar
  47. Law, M., and Letts, L. (1989). A critical review of scales of activities of daily living [see comments]. Am J Occup Ther, 43(8), 522–528.PubMedCrossRefGoogle Scholar
  48. Linacre, J.M., and Wright, B.D. (1991–1996). A User’s Guide to Bigsteps (Manual). Chicago: MESA Press.Google Scholar
  49. Liu, K.P., Chan, C.C., Lee, T.M., and Hui-Chan, C.W. (2004). Mental imagery for promoting relearning for people after stroke: a randomized controlled trial. Arch Phys Med Rehabil, 85(9), 1403–1408.PubMedCrossRefGoogle Scholar
  50. Maitra, K.K., Telage, K.M., and Rice, M.S. (2006). Self-speech-induced facilitation of simple reaching movements in persons with stroke. Am J Occup Ther, 60(2), 146–154.PubMedCrossRefGoogle Scholar
  51. Martin, L., Miranda, B., and Bean, M. (2008). An exploration of spousal separation and adaptation to long-term disability: six elderly couples engaged in a horticultural programme. Occup Ther Int, 15(1), 45–55.PubMedCrossRefGoogle Scholar
  52. Matuska, K., Mathiowetz, V., and Finlayson, M. (2007). Use and perceived effectiveness of energy conservation strategies for managing multiple sclerosis fatigue. Am J Occup Ther, 61(1), 62–69.PubMedCrossRefGoogle Scholar
  53. McCluskey, A., and Lovarini, M. (2005). Providing education on evidence-based practice improved knowledge but did not change behaviour: a before and after study. BMC Med Educ, 19(5), 40.CrossRefGoogle Scholar
  54. McKenna, K., Bennett, S., Strong, J., Tooth, L., and Hoffmann, T. (2008). OT-seeker.Google Scholar
  55. Michaelsen, S.M., Dannenbaum, R., and Levin, M. (2006). Task-specific training with trunk restraint on arm recovery in stroke: randomized control trial. Stroke, 37(1), 186–192.PubMedCrossRefGoogle Scholar
  56. Moberg Mogren, E., and Nelson, D.L. (2006). Evaluating the quality of reporting occupational therapy randomized controlled trail by expanding the CONSORT criteria. Am J Occup Ther, 62(2), 226–235.CrossRefGoogle Scholar
  57. National Library of Medicine. (2008a). PubMed.
  58. National Library of Medicine. (2008b). PubMed: MeSH is NLM’s controlled vocabulary used for indexing articles in PubMed.
  59. Nordenskiöld, U., Grimby, G., Hedberg, M., Wright, B., and Linacre, J.M. (1996). The structure of an instrument of an instrument for assessing the effects of assistive devices and altered working methods in women with rheumatoid arthritis. Arthritis Care Res, 9(5), 358–367.PubMedCrossRefGoogle Scholar
  60. Ottenbacher, K.J., Johnson, M.B., and Hojem, M. (1988). The significance of clinical change and clinical change of significance: issues and methods. Am J Occup Ther, 42(3), 156–163.PubMedCrossRefGoogle Scholar
  61. Ottenbacher, K.J., and Maas, F. (1999). How to detect effects: statistical power and evidence-based practice in occupational therapy research. Am J Occup Ther, 53(18), 181–188.PubMedCrossRefGoogle Scholar
  62. Polit, D.F., and Hungler, B.P. (1999). Nursing Research. Principles and Methods. Philadelphia: Lippincott.Google Scholar
  63. Popovic, M.R., Thrasher, T.A., Adams, M.E., Takes, V., Zivanovic, V., and Tonack, M.I. (2006). Functional electrical therapy: retraining grasping in spinal cord injury. Spinal Cord, 44(3), 143–151.PubMedCrossRefGoogle Scholar
  64. Rosenberg, W., and Donald, A. (1995). Evidence based medicine: an approach to clinical problem solving. BMJ, 310(6987), 1122–1126.PubMedCrossRefGoogle Scholar
  65. Salvatori, P., Simonavicius, N., Moore, J., Rimmer, G., and Patterson, M. (2008). Meeting the challenge of assessing clinical competence of occupational therapists within a program management environment. Can J Occup Ther, 75(1), 51–60.PubMedGoogle Scholar
  66. Schene, A.H., Koeter, M.W., Kikkert, M.J., Swinkels, J.A., and McCrone, P. (2007). Adjuvant occupational therapy for work-related major depression works: randomized trial including economic evaluation. Psychol Med, 37(3), 351–362.PubMedCrossRefGoogle Scholar
  67. Schwoebel, J., Coslett, H.B., Bradt, J., Friedman, R., and Dileo, C. (2002). Pain and the body schema: effects of pain severity on mental representations of movement. Neurology, 59(5), 775–777.PubMedCrossRefGoogle Scholar
  68. Simons, M., King, S., and Edgar, D. (2003). Occupational therapy and physiotherapy for the patient with burns: principles and management guidelines. J Burn Care Rehabil, 24(5), 323–335.PubMedCrossRefGoogle Scholar
  69. Soderback, I. (2008). Hospital discharge among frail elderly people: a pilot study in Sweden. Occup Ther Int, 15(1), 18–31.PubMedCrossRefGoogle Scholar
  70. Stein, F., and Cutler, S.K. (1998). Psychosocial Occupational Therapy: A Holistic Approach. San Diego: Singular Publishing Group.Google Scholar
  71. Stein, F., and Cutler, S.K. (2000). Clinical Research in Occupational Therapy, 4th ed. San Diego: Singular Publishing Group/Thomson Learning.Google Scholar
  72. Stein, F., Söderback, I., Cutler, S.K., and Larson, B. (2006). Occupational Therapy and Ergonomics. Applying Ergonomic Principles to Everyday Occupation in the Home and at the Work, 1st ed. London/Philadelphia: Whurr Publisher/Wiley.Google Scholar
  73. Söderback, I. (1995). Effectiveness in rehabilitation. Crit Rev Rehab Med, 7(4), 275–286.Google Scholar
  74. Twamley, E.W., Jeste, D.V., and Lehman, A.F. (2003). Vocational rehabilitation in schizophrenia and other psychotic disorders: a literature review and meta-analysis of randomized controlled trials. J Nerv Ment Dis, 19(8), 515–523.CrossRefGoogle Scholar
  75. Uyanik, M., Bumin, G., and Kayihan, H. (2003). Comparison of different therapy approaches in children with Down syndrome. Pediatr Int, 45(1), 68–73.PubMedCrossRefGoogle Scholar
  76. van den Ende, C.H., Steultjens, E.M., Bouter, L.M., and Dekker, J. (2006). Clinical heterogeneity was a common problem in Cochrane review of physiotherapy and occupational therapy. J Clin Epidemiol, 59(9), 914–919.PubMedCrossRefGoogle Scholar
  77. van der Velde, G., van Tulder, M., Côté, P., Hogg-Johnson, S., Aker, P., and Cassidy, J.D. (2007). The sensitivity of review results to methods used to appraise and incorporate trial quality into data synthesis. Spine, 32(7), 796–806.PubMedCrossRefGoogle Scholar
  78. Vollenbroek-Hutten, M.M., Hermens, H.J., Wever, D., Gorter, M., Rinket, J., and Ijzerman, M.J. (2004). Differences in outcome of a multidisciplinary treatment between subgroups of chronic low back pain patients defined using two multiaxial assessment instruments: the multidimensional pain inventory and lumbar dynamometry. Clin Rehabil, 18(5), 566–579.PubMedCrossRefGoogle Scholar
  79. Wichrowski, M., Whiteson, J., Haas, F., Mola, A., and Rey, M.J. (2005). Effects of horticultural therapy on mood and heart rate in patients participating in an inpatient cardiopulmonary rehabilitation program. J Cardiopulm Rehabil, 25(5), 270–274.PubMedCrossRefGoogle Scholar
  80. World Health Organization. (2007). ICF Introduction.
  81. Wright, C.C., and Whittington, D. (1992). Quality Assurance. An Introduction for Health Care Professionals. New York: Churchill Livingstone.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Ingrid Söderback
    • 1
  1. 1.OT/Legitimate Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden

Personalised recommendations