Occupational Therapy: REHB 6006: OT Field Practice 4: Critical Appraisal Topic

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Evidence-Based Review

Completion of the evidence-based practice review will provide you with an opportunity to apply your knowledge of research to answer an evidence-based question relevant to your field practice placement.

You will pose an evidence-based practice question and apply your knowledge of research and evidence-based practice to critically appraise several (guide 3-4) articles and synthesise the results in a form that could inform practice decisions.

Assignment 1500 words: see assessment activity for details.

 

Please refer to your Learnonline course site for full assessment instructions and the marking rubric.

Critically Appraised Topics

Critically Appraised Topics (or CATs) are like miniature systematic reviews and are the preferred format for your assignment. This guide walks you through the process of completing a Critically Appraised Topic, following a few key steps:

  1. Ask (formulate a clinical question)

  2. Access (design and construct a search)

  3. Appraise (assess each study's suitability)

  4. Apply (respond to the clinical question, using the evidence)


Learn More


Need an examplar? View a Critically Appraised Topic from the American Occupational Therapy Association (AOTA).

1. Ask (Use PICO)

The PICO framework is useful for making sense of your clinical scenario and helping to turn it into a question. 

For example: 

A 68 year old woman has been instructed to undertake yoga to maintain physical fitness. She asks if playing the Nintendo Wii, which she enjoys, is a suitable alternative.

 P

  Population / Patient
  What are the patient's or population's characteristics?
  What is the condition or disease you are investigating?

 Older adult

 I / E 

  Intervention / Exposure
  What will be done to the patient? (Treat? Diagnose?)  

 Nintendo Wii

 C

  Comparator / Comparison
  What is the alternative to the intervention? 
  If placebo, or 'conventional treatments', leave this out

 Yoga

 O

  Outcome
  What are the relevant outcomes?

 Physical fitness 


Now use the PICO breakdown to formulate an answerable, focused question:

  • For <Population> what is the effectiveness of <Intervention> compared to <Comparison> in <Outcome>?

So for our example, the question becomes:

  • For older adults, what is the effectiveness of Nintendo Wii compared to Yoga in maintaining physical fitness?

     

Hint: This assignment suggests that you use an effectiveness question, however you are free to ask a different type of EBP question if you prefer.

2. Access: Plan your Search

The next step is to conduct a thorough, reproducible search of the evidence. To do this well, consider the specific scope for your search, such as the:

  • Level of Evidence/Study Designs to be included (Random Control Trials etc)

  • Inclusion / Exclusion Criteria:

    • Minutia of your PICO (eg, Participants: women only etc)

    • Context (region / setting) or limits**

    • Alternative terms for each PICO element (these will become your keywords)

  • Sources of Primary and Secondary evidence to be searched

** When performing a search, do not add limits (such as publication dates or English language) unless discussed with your tutor. Never apply the 'full text only' link, as this will exclude results which we may hold in another database.

2. Access (B): Create a Search, using your PICO

As a rule, use Medline to start building your search.

You should search both keywords and Medical Subject Headings (MeSH), working through each PICO element one at a time. 

 

For each PICO element:

  1. Enter the relevant subject heading/s (MeSH). You can learn how here
  2. If you have more than one Subject heading, give each its own line.
     
  3. Enter all your keywords, combined with OR, on a separate line/s. Learn how to construct a keyword search here
     
  4. Then join these lines to make an 'Overall Set line' for that PICO element, by combining them with OR. ​

 
Finally:

Combine all of your "Set lines" (eg line 3 in the above) with AND. This will find results addressing all your PICO elements.

 
Hint
: You generally do not need to search for your outcome, but if you do, remain unbiased! For example, do not search for "reduced pain", -just search for 'pain', so that you also find papers where a reduction was not the result.

2. Access (C): Run search on other databases

To maintain the  transparency and reproducibility of your review, run the same search on each database -changed only as much as necessary to get it to work correctly.

Typically, this means checking truncation, wildcards and phrases. But if you have used subject headings (eg MeSH), you will need to check these too.

3. Appraise

Before you start extracting the data from your studies, you need to undertake Critical Appraisal, using an approved "Critical Appraisal Tool'.

UniSA's Dr Savana Kumar explains:

4. Apply

You are now ready to write your review. Consult your Course Workbook for a full list of the headings within your review, and the requirements therein, but be sure to include:​
 

CONSORT

You must include a CONSORT flow diagram to illustrate the progress of studies through your review.

Searches

Be sure to record each search, including:

  1.     Title of database searched.
  2.     Name of the database platform e.g. MEDLINE (OvidSP).
  3.     Database date range.
  4.     Date search conducted.
  5.     Years covered by the search.
  6.     Complete search strategy (include all search terms and limits)
  7.     Number of results for each database

Hint: It's a good idea to capture the search as it was run. Take a screenshot, or use the Windows Snipping tool to capture your search history.


A Clinical Bottom Line

This is a statement that explains how the evidence can -and whether it should- be  translated into practice.

It should include:

  • A judgment on the quality/strength of the evidence to determine whether the findings are significant
  • Applicability of the findings to the specific patient / scenario
  • Facilitators / barriers to effective implementation
  • Benefits / disadvantages to using the intervention
  • Opportunities and requirements for education and future research
  • A final 'take home' point and/or recommendation for practice

The below video from the Board of Certification for Athletic Trainers in the US explains more:

More help?

The Student Engagement Unit has created a suite of resources called Study Help that can help you understand different assignment types. 

Have a look at:

Referencing

Referencing roadmap banner. Navigate to the referencing roadmap resource.

You must appropriately cite (‘acknowledge’) all references used in your assignment to avoid plagiarism.

Try: Learn to Reference - Part 1 interactive tutorial
Try: Learn to Reference - Part 2 interactive tutorial

 

If you need help, just ask!

Navigate to the Ask the Library webpage. Navigate to the UniSA study help pals webpage. Navigate to the Studiosity webpage. Navigate to the Learning Advisors' webpage.
Contact: Ask the Library Ask: the Study Help PALs Use: Studiosity Talk to: Learning Adviser