Rondalyn: I am so excited to be with you today and to share about research. I want to specifically thank occupationaltherapy.com for taking on this topic and making it available to clinicians. I think it is our year, and I think it is a great way for us to start.
Learning Obj. #1: Identify Clinical Reasoning Skills
All of us who have completed a program or a curriculum have learned about clinical reasoning.
Clinical Reasoning:
- Observe and collect cues following body of knowledge from field re OTPF
- Process the observed information
- Understand patient problem
- Make and implement a plan; Evaluate outcome data (mind the sociocultural context)
- Reflect and learn from the process
We observe and collect cues. We follow the body of knowledge from our field, and we follow the Occupational Therapy Practice Framework, which is a collection of terms and terminology that we use that outlines and defines our scope of practice. We do this every day in our clinical work. We process that observed information. We try to understand the patient's problem based on our body of knowledge, our background, our education, our experience, and from that we make and implement a plan. We have to evaluate the outcome data that we have collected. An example would be number of falls? Or level of pain? How are these affecting participation? We also have to look at that within the sociocultural context of the individual. After we do all of that we reflect and learn from the process.
If we think of being a researcher as another area of practice, here is how the clinical reasoning transfers.
Researchers:
- Observe a phenomenon/review literature [i.e. variables]
- Process observations as related to theory
- Create research question & methodology
- Implement method/ gather data
- Analyze the results/data considering confounders
- Interpret meaning of findings
We observe a phenomena, and often we do that by looking at the literature. We look at what is already published or at what experts or other researchers have already come up with in the literature. What are the variables of interest? What are the salient pieces of what we are observing, the cues or the body of knowledge. Then we process that observation as it is related to theory. What theory says is this: I am going to create a research question that will help me really understand this topic deeper. I am going to either choose or create a methodology that I can systematically use to look at my question. I am going to implement that method, and during that process, I am going to gather the data and analyze the results. I have to consider the confounders, or what variables might be in the way. For example, if you were to ask a question about noise in a classroom, you might have to look at some of the confounders of noise outside of the classroom. Those are variables that are not part of your study, but they could impact the question that you are asking. After you do all that, you interpret the meaning of your results and findings.
There is a lot of correlation and overlap between what we do in clinical practice and what we do in research. Let's just look at some specifics here. In clinical practice, we observe and collect cues, and again the Occupational Therapy Practice Framework defines or operationalizes it. When we define a variable, we are operationalizing it. We determine what we know, and then we assess what we want to know. We know this about the client, and now we need to know something else, so we might use an assessment tool to come up with that information.
We are always using some kind of a theory or a specific approach. As a clinician, we make a plan, set our goals, and implement that intervention. We have to measure the progress against our goals. Then, you want to stop, reflect, and learn from the results of your intervention. With research, we go about things in a very similar fashion. We observe the phenomena that is from the literature, process those observations, and compare and contrast them against the theory. We are going to create some researchable questions and methodology, implement and gather, analyze the data, and interpret the meanings and findings.
Different Levels of Evidence
When we look at information through a researcher's model, it is a little different than clinical practice. There are different levels of the evidence, or different ways that we can design a method.
- Level I: Randomized Control Trial
- Level II: Non-randomized Control Trial- Two Group
- Level III: Non-randomized Control Trial- One Group (One Treatment) Pretest
- Level IV: Single Subject Design
- Level V: Narratives/Case Studies
