This text based course is a transcript of the live webinar titled, "Stroke Critically Appraised Topic: Task-Specific Training vs. Strength Training", presented by Sara Benham, MS, OTR/L, ATP.
Introduction
We are going to go through five evidence-based studies and there is a lot of information included in it. I have the electronic handouts and I will shift through to answer questions as best as I can. I cannot give you the electronic copies of the studies, because I did not ask permission from the investigators to distribute them. I can provide all the search criteria so you can at least get the abstract if you search on Google Scholar.
I am pursuing my doctorate through Thomas Jefferson University and this critically appraised topic came out of my interest in upper extremity motor recovery as part of my doctoral capstone project. When you are putting together your capstone, and mine is specifically more of a research capstone, you need to provide a lengthy evidence-based document to justify your project, and a thorough search of the literature. My critically appraised topic came from that. My particular interest is in what specific cognitive impairments, for example memory or executive functions, predict or are related to upper extremity motor recovery after stroke, and if specific treatments for upper extremity motor recovery are more effective than others considering cognitive impairment. When completing this type of critically appraised topic you need to find the highest level of evidence. I could not put together enough studies to produce a critically appraised topic. I had to then throw out the cognitive piece and do a separate critically appraised topic on just the cognition. For this one, we are going to focus solely on task-specific training versus strength training for our clients after stroke.
Looking at our agenda, we are going to review clinically appraised topics using PICO questions. After that, we will look at how to identify the highest quality of evidence and that will help to justify why I chose certain evidence to answer this CAT question. Then we will look at summaries of the best of evidence that answered the CAT question, which compared task-oriented training with strength training. Lastly we will discuss the clinical bottom line and the implications for practice.
Evidence-based Practice Skills
Depending on when you went to school, we learned our OT skills from a hybrid of lectures, textbooks, and evidence-based research articles. However, using your textbooks, at this point, is not a dependable way to search for best practice guidelines due to the quick publication rate of research studies. It is helpful to have some background skills in electronic database navigation; albeit it is not always efficient. It is also important to note that evidence-based practice also includes the clinician’s expertise to apply the treatment intervention as it is appropriate for each client. Best practice includes the ethical consideration of patients’ rights, treatment response, and best available evidence. The OT considers if the gold standard randomized controlled trial is applicable to every patient, given the nature of randomized controlled trials which control the variables with very specific inclusion and exclusion criteria. We need to question the generalizability to each patient. Maybe a lower level study of evidence such as a case-control design might be more appropriate to apply to a specific patient if the characteristics are similar of their inclusion criteria.
Equally important evidence-based practice guidelines also include evidence-based theory, logic, and general rational thought to guide best practice. Evidence-based practice also implies that evidence is relevant to the individuals served. According to Lin, Murphy, and Robinson from an article published in AJOT from 2010, many clinicians agree that evidence-based practice combined with clinical expertise is best practice to improve client care, but real-life factors exist, including if there is a lack of time at an individual’s workplace, the resources which include access to electronic databases or articles, or training to locate and appraise research studies. Our practice organizations have responded, AOTA and Occupational Therapy Association of Australia, by posting online collections of critically appraised papers and critically appraised topics, which are brief summaries of clinical topics of interest. These papers offer a quick access to research studies and a summary of the bottom line.
