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1. Comparison of OT Practice Framework and UT III OT 653
2. Comparison of OT Practice Framework to UT III
3. Comparison of OT Practice Framework to UT III
4. Comparison of OT Practice Framework to UT III
5. Comparison of OT Practice Framework to UT III
6. Comparison of OT Practice Framework to UT III
7. Comparison of OT Practice Framework to UT III
8. Comparison of OT Practice Framework to UT III
9. Comparison of OT Practice Framework to UT III
10. Summary of Issues Changed in OT Practice Framework From UT III OT Practice Framework
(is now)
Areas of Occupation
Performance Skills
Client Factors (Body functions and Body Structures)
Performance Patterns (Roles)
Context or Contexts
UT III
(used to be)
Performance Areas
Performance Components
Performance Components
Roles as part of Performance Components
Performance Contexts
11. Summary of Issues Addressed in OT Practice Framework NOT Addressed in UT III Occupations
Performance Patterns
(Habits and routines)
Activity Demands
Outcomes
12. Levels of Evidence OT 653
13. What is evidence?Support for clinical practice, theory, assessments, and clinical research evolved from systematic study
15. Randomized Controlled Trials Control group
Manipulate a variable
Random assignment
Double-blinded (persons administering the treatment and evaluating the outcomes are both blinded to who receives what intervention)
16. Other Kinds of Experimental Designs
Studies where groups are small (under 30)
Single subject design
Lack of blinding of researcher or data collector or data analyzer
17. Quasi-experimental Studies Studies without a control group
Studies without a control group and without random assignment
Studies where either pre and post intervention measures are collected, or sometimes just post intervention measures
18. Exploratory Studies Data collected on a group at one point in time
The group studied may be stratified
Conclusions are drawn about the trait
studied
Survey is one form of exploratory design
Regression analysis is often used to explore predictive elements of a condition or treatment
19. Descriptive Studies Studies which describe some aspect of a condition, disease, trait or other
Studies where there is no treatment but there is assessment of levels of a given variable
Case studies
Qualitative research
20. Methodological Studies Studies which seek to develop psychometric properties for a new assessment tool
Reliability studies
Validity studies
21. So how are all these kinds of research worked into an evidence-based review??
22. Evaluating the Evidence Doing a CAT, systematic review or a
meta-analysis
All of these formats include deciding which articles to include in your review
Ranking kinds of research
23. One aspect of ranking articles for any evidence-based review is carried out using levels of evidence hierarchies.
24. Such hierarchies are a way to rank kinds of research studies in a systematic and consistent manner.
25. Levels of Evidence There are a number of different levels or typologies of evidence
Groups like the Cochrane Collection or the PEDRO group out of Australia use very rigorous levels
26. For your research projects (systematic reviews or meta-analyses) in this class, we will use the Holms levels of evidence as one criteria with which to judge articles
27. Holms Levels of Evidence* Level I - Systematic reviews, meta-analytic studies
Level II - Randomized controlled trials
Level III - Trials without randomization
Level IV - Nonexperimental studies from more than one center
Level V - Opinions of respected authorities based on clinical evidence, descriptive studies or reports of expert committees
(Holm, 2000, p.581)
28. Level I - Systematic reviews, meta-analytic studiesthat have already been done by other researchers
29. Level II - Randomized controlled trials experimental designs with random assignment, control groups, and large sample size (above 30 clients)
30. Level III Studies included in Level III are studies without randomization, which includes quasi-experimental design where a control group exists.
(FOR THE PURPOSE OF THIS CLASS, PUT SINGLE SUBJECT DESIGNS IN LEVEL III).
31. Level IV To be classified as Level IV, studies must include descriptive data from more than one site, i.e. multiple classrooms, several clinical or practice sites, more than one university setting.
32. Level V criteria Qualitative studies
Descriptive studies from individual centers
White papers, The Issue is, published standards of care
33. In the Future Presently inclusion of only high levels of evidence often results in finding very limited studies
Fields like physical and occupational therapy (even medicine) will have more RCTs available in the future as evidence
Use of more rigorous levels of evidence will be mandatory
In the meantime, practicing clinicians often need to include levels commiserate with existing evidence (descriptive and exploratory evidence)