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In the campaign to implement evidence-based practice, the current single-hierarchy model of levels of evidence fails to incorporate at parity all types of research evidence that are valuable in the practice of occupational therapy. A new model, originally developed by Borgetto et al. (2007) and modified and expanded, is presented. By separating the evidence-level criteria of internal and external validity, by incorporating explicitly the evidence provided by qualitative studies, and by retaining the critical notion of rigor, a pyramidal evidence model emerges. This model, the Research Pyramid, aligns itself with the revised model of evidence-based medicine and, more important, with the basic modes of clinical reasoning in occupational therapy. It constitutes a beginning attempt to order evidence-based practice in accordance with the epistemology of the profession. It may better guide occupational therapy research and meta-synthesis and their incorporation into practice decisions.
Tomlin, G., & Borgetto, B. (2011). Research Pyramid: A new evidence-based practice model for occupational therapy. American Journal of Occupational Therapy, 65, 189-196. doi: 10.5014/ajot.2011.000828
KEY WORDS
* evidence-based practice
* models, theoretical
* occupational therapy
* qualitative research
* research design
Since the introduction of evidence-based practice (EBP) into occupational therapy, challenges and barriers to its implementation have been noted. Widespread access to research databases, research skills to gather and interpret findings, the translation of research into practical aphorisms, and the time to perform these tasks at work have been identified as sources of the negative perceptions of therapists toward EBP (Bondoc & Hedges, 2008; Cameron et al., 2005; Dysart & Tomlin, 2002; Lopez, Vanner, Cowan, Samuel, & Shepherd, 2008). This negativity may impede any coordinated effort by members of the profession to review, interpret, and disseminate information pertaining to practice so that evidence is routinely incorporated into decision making.
A more fundamental cause of difficulty, however, may be that the theoretical structure of EBP has not yet evolved so as to align itself with the essential decision-making needs of practitioners (Tickle-Degnen & Bedell, 2003). Occupational therapists concern themselves with occupation and the lived experience of their clients. Their practice is one of dynamic interaction with clients, with a particular focus on outcomes in the real world of physical, social, and spiritual participation. Other professions providing human services have also grappled with...