“How do you know what you are doing is working ?” was a question hurled at me across the conference table at a team meeting. Needless to say, I was caught quite off guard. “It is working.” I replied, trying to sound as ‘matter of fact’ as possible. I knew that every other discipline seated at this conference table had more data than my measly percent correct scores… but it was data so I presented it with the utmost confidence of an experienced practitioner.
“According to my notes, Johnny scores jumped from 30% to 60% accuracy this quarter, so yes he is progressing, albeit a bit slow.”
That was a defining moment for me as an OT. It was the first time I was being challenged for my interventions and I felt ill- equipped to defend my interventions. It also left me with this implicit feeling that somehow as an OT my interventions were not valuable or even being considered evidence based. Now that bothered me to no end!!!!
Evidence based practice is a loaded term that is thrown around a lot these days, so let me start there. A study by Salls et al. (2009) revealed that more than 96% of the occupational therapy (OT) practitioners believed that EBP was important in the field of OT. However, the study also stated that practitioners are struggling to translate this belief into practice.
So to be clear… EBP requires a lot more than just reading research articles, it’s about identifying, evaluating and applying the evidence as outlined in the research by Thomas et.al (2012).
Now none of these steps are easy to accomplish for most practitioners. The first 4 steps depend on one’s ability to seek out, evaluate and apply the relevant research out there. However, the last step of efficacy in everyday practice is related to our ability to use data and is really what this blog is about.
Over the years our data collection methods in OT have always revolved around SOAP notes, percentage corrects and a 3 out of 4 trials format. However these methods are simply not robust enough to meet the data based standards trending in healthcare today.
Data has become the core of our everyday decisions. From Google reviews to data driven apps, it’s constantly in our face.
How many steps did you take? How many calories did you eat? What’s your water intake?
Are some of the questions we are riddled with on a daily basis.
So why can’t we as OTs just step up and start taking more data? Why are we as OTs so completely rubbish at it ?
Well, there are a myriad of reasons, some of which were highlighted in a study completed in 2015, indicating the 3 main barriers towards using data/research in practice:
Insufficient facilities (82%)
Lack of time to read research (77%)
Difficulty understanding statistical analyses (75%)
(Samuelsson et al. 2015).
Now, this is what the literature is saying, but there are other more pragmatic reasons OTs don’t take data which need to me considered.
First of all…
🙅 #1 No- one is teaching OTs to take data
Do you recall learning anything about data collection in OT school? Chances are you don’t; because there is no formal training in data collection for OT students.
While OT programs make a valiant effort to emphasize the importance of the EBP processes; no-one is actually teaching these perspectives on an effective way to take data and use it to make clinically informed decisions.
📋 #2 So many settings, so little data.
One of my favorite aspects of being an OT is the ability to work in a variety of settings and being able to address skills across the lifespan. Given the holistic nature of our field, we may address motor coordination, sensory disorders, adapt an eating utensil and fabricate a splint all in the very same week. It’s so versatile!
However, taking data on all these various types of settings, means that we either need a standardized system that can be applied to all settings, or we need to create a data table for each setting. Either way it is a daunting task which requires statistical knowledge & lots of time…all of which that most OTs don’t have.
📈#3 We don’t know how to ‘Show’ our data
OTs are so accustomed to discussing data with other OTs, but do not necessarily know how to translate it to others. Plus there is a very salient yet necessary requirement for data collection: it needs to be clearly and universally understood by everyone. If you are avidly taking data and have all these fancy graphs/ statistics, but no-one except you understands it.. then you might as well not bother.
So in other words.. Our data cannot be too complex or too simplistic. We need data that is easy to understand but meaningful enough statistically to convey a difference. We also need to remember that (80%) people remember what they see, compared to 10 percent of what they hear and 20 percent of what they read. So the more visual the data, the better!
⏰ #4 OTs don’t have time for data collection
We OTs often get 15 minutes/ week of treatment time in certain settings. How much time can we truly afford to allocate to data collection? Not much. This is one of the main logistical reasons, extensive data collection has not been a priority in OT.
Plus our empathetic and client centered principles often steer us away from the perceived strain of data collection. We tend to be highly protective of our 1:1 time with the client and often presume that taking data will eat into this valuable time.
However, as a profession, we have gone on record committing ourselves to being an evidence-based practice and now it’s time to prove it. The question now is…..
“Can OTs meet this commitment of being Evidence based?”
We can take simple steps by seeking out the latest research or simply start asking clinical questions that lead us to evidence based interventions. Or perhaps take a step back and evaluate our own current practices using data. It really depends on you and your comfort level.
For me it all started as a doctoral student. I was becoming quite proficient at reading the latest research and deciphering all the statistical elements, but it was the discovery of Precision Teaching that ignited my passion for data collection in OT.
I learned that Precision Teaching uses a measurement tool called the Standard Celeration Chart (SCC) which is actually a standardized, universally understood measurement tool that literally takes less than 2 minutes to use and is 100% free!
It was originally created by behavioral scientists to help teachers monitor student progress, but I learned that many other professionals are using it. That’s when I started wondering if it could be the solution OTs are looking for. And indeed it was.
Having used it for the past 2 years, I can confidently say that I am an OT who is no longer rubbish at taking data:)