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Continued Conversations, The CE Podcast: Evidence-Based Interventions in Pediatric Occupational Therapy

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1.  Which of the following is NOT one of the main pillars of evidence-based practice? Medicare reimbursement rates Best research evidence Clinical expertise Patient/caregiver preferences and values

2.  Which of the following is a landmark article covering the wide array of pediatric OT interventions? Novak, I. (2012). Evidence to practice commentary: the evidence alert traffic light grading system. Physical & occupational therapy in pediatrics, 32(3), 256-259. Marr, D. (2017). Fostering Full Implementation of Evidence-Based Practice. American Journal of Occupational Therapy, 71(1), 7101100050p1-7101100050p5.h is the presence of a strong immune system Novak, I., & Honan, I. (2019). Effectiveness of paediatric occupational therapy for children with disabilities: A systematic review. Australian occupational therapy journal. Reifenberg, G, & Heinekamp, A. (2018). Using the traffic light system to implement evidence-based practice. OT Practice, 23 (20), 28-31.

3.  What is the definition of a systematic review? A subset of systematic reviews; a method for systematically combining pertinent qualitative and quantitative study data from several selected studies to develop a single conclusion that has greater statistical power. A study in which people are allocated at random (by chance alone) to receive one of several clinical interventions. One of these interventions is the standard of comparison or control. A research design that involves repeated observations of the same variables over short or long periods of time. A summary of the results of available carefully designed healthcare studies (controlled trials) and provides a high level of evidence on the effectiveness of healthcare interventions.

4.  What is the intent of Novak’s 2012 Evidence Alert Traffic Light System? To foster knowledge translation from evidence to clinical practice To clearly indicate the strength and direction of clinical recommendations To simplify evidence-based recommendations for ease of understanding All of the above

5.  What does it mean if an intervention is rated “yellow light negative?” Go! Use the intervention! It works! Use the intervention with measure, you should probably keep trying it. Hesitate to use the intervention, you should consider holding off on use of it. Stop! The intervention is ineffective and/or harmful.

6.  How did Novak & Honan compartmentalize clinical recommendations in their 2019 systematic review? Primarily by diagnosis, providing strong evidence for the main pediatric illnesses. They broke down evidence by diagnosis, intervention, intervention approach, outcome, ICF outcome; and described where these data points overlapped. They only explained the well-supported interventions, or those that received a “green light” as they are what is important. They primarily looked at studies related to cerebral palsy (CP) because Novak & Honan work at a CP research center.

7.  Novak & Honan found that what percentage of pediatric interventions systematically described in the literature are qualified as “green-light?” 4% 10% 30% 56%

8.  What did Novak & Honan conclude in regards to the role of parent/caregiver involvement in pediatric OT intervention? Parent/caregiver involvement improves outcomes for the child There is research demonstrating that parents/caregivers can implement OT intervention effectively OTs should embrace the principles of family centered care where the parent is the decision-maker and the expert in knowing their child and the therapist is a technical resource to the family All of the above

9.  At which level of the International Classification of Functioning & Disability (ICF) model do the majority of green-light interventions aim? Body structures & functions Activities Participation Environment

10.  How do Novak & Honan recommend proceeding with “red-light” interventions? Be precise with intervention definitions; split terms to determine exactly what the intervention entails instead of trying to group it in an umbrella with more supported interventions. This will allow us to gather real data on the impact of these interventions. Keep using any interventions that are obviously effective in personal clinical practice, regardless of research recommendations. Those are often far-removed from the real clinic. If the client or caregiver likes the red-light interventions, keep doing them. The client is always right. Don’t let clients and caregivers know that any OT interventions are red-light. If they found out we have done red-light interventions in the past, they will lose trust.