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International Journal of Health Professions

The journal of Verein zur Förderung der Wissenschaft in den Gesundheitsberufen

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Decision-Making and Sources of Evidence in Occupational Therapy and Other Health Professions. Evidence-Informed Practice / Entscheidungsfindung und Evidenzquellen in der Ergotherapie und weiteren Gesundheitsberufen. Evidenzinformierte Praxis

George S. Tomlin
  • University of Puget Sound, School of Occupational Therapy, 1500 N. Warner St., Tacoma, WA 98416, UNITED STATES
  • Other articles by this author:
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/ Deborah Dougherty
  • University of Wisconsin-La Crosse, Health Professions Department/OT, 1725 State Street, La Crosse, WI 54601, UNITED STATES
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2014-12-30 | DOI: https://doi.org/10.2478/ijhp-2014-0001


Contemporary conditions require health professionals both to employ published evidence in their individual practices and as a profession to produce valid evidence of their outcome effectiveness. Heretofore, these two processes of evidence-based practice have often been confounded as one. This theoretical paper separates the two processes into «Evidence-Supported Practice» and «Evidence-Informed Practice.» Each requires a different approach to evidence accumulation and use. Nonetheless, the two processes can and should be interlinked. For external (research) evidence, the research pyramid model values equally the internal and external validity of studies, as both are important for the implementation of external evidence. Furthermore, external evidence must be combined with internal evidence (data generated in the course of interaction with a client) in the decision-making of practitioners. Examples from recent research on occupational therapy practice and literature from several other health professions are cited for illustration. This paper formulates a more comprehensive model for evidence-based practice. From this model follow specific recommendations for practitioners, researchers, and educators in the health professions.


Von den Gesundheitsberufen wird einerseits verlangt, dass jeder einzelne Praktiker wissenschaftsbasiert arbeitet, d.h. publizierte Evidenz in der Praxis anwendet (Evidence Based Practice, EBP). Andererseits müssen sie als Profession valide Evidenz der Ergebnisse ihres professionellen Handelns produzieren. Diese zwei Dimensionen von EBP werden in der Diskussion oft nicht auseinander gehalten, was zu Verwirrung führt. Dieser theoretische Beitrag differenziert diese beiden Prozesse als “Evidence- Supported Practice” und “Evidence-Informed Practice” und zeigt, wie sie wieder zusammengeführt werden können. Zur Bewertung der externen und internen Validität von externer Evidenz wird die Forschungspyramide verwendet. In der Alltagspraxis müssen externe und interne Evidenzarten verwendet werden. Um den Begriff der internen Evidenz zu erklären, werden Beispiele aus der Ergotherapie und aus der Literatur anderer Gesundheitsberufe herangezogen. Empfehlungen für eine umfassende Strategie Evidenz-Basierter Praxis, adressiert an Praktiker, Forscher, und Lehrer werden formuliert.

Keywords: evidence-based practice; professional decision-making; evidence sources; evidence evaluation; evidence translation

Keywords : Evidenz-basierte Praxis; professionelle Entscheidungsfindung; Evidenz Quellen; Evidenz Bewertung; Evidenz Anwendung


  • American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1). http://dx.doi.org/10.5014/ajot.2014.682006CrossrefGoogle Scholar

  • Bannigan, K., & Moores, A. (2009). A model of professional thinking: Integrating reflective practice and evidence based practice. Canadian Journal of Occupational Therapy, 76, 342-350.Google Scholar

  • Borgetto, B., Born, S., Buenemann-Geissler, D., Duechting, M., Kahrs, A.- M., Kasper, N., … Winkelmann, B. (2007). Die Forschungspyramide: Diskussionsbeitrag zur evidenz-basierten praxis in der ergotherapie [The research pyramid: Contribution to the discussion of evidence-based practice in occupational therapy]. Ergoscience, 2, 56-63.Google Scholar

  • Braveman, B. H., Helfrich, C. A. & Fisher, G. S. (2001). Developing and maintaining community partnerships with “a scholarship of practice.” Occupational Therapy in Health Care, 15, (1/2).Google Scholar

  • Cameron, K. A. V., Ballantyne, S., Kulbitsky, A., Margolis-Gal, M., Daugherty, T., & Ludwig, F. (2005). Utilization of evidence-based practice by registered occupational therapists. Occupational Therapy International, 12, 123-136.Google Scholar

  • Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar

  • Coomarasamy A, & Khan K. (2004). What is the evidence that postgraduate teaching in evidence based medicine changes anything? A systematic review. British Medical Journal, 329, 1017-1019.Google Scholar

  • Copley, J. A., Turpin, M. J., & King, J. L. (2010). Information used by an expert paediatric occupational therapist when making clinical decisions. Canadian Journal of Occupational Therapy, 77, 249-256.Google Scholar

  • Crist, P., Munoz, J. P., Hansen, A. M. W., Benson, J., & Provident, I. (2005). The practice-scholar program: An academic-practice partnership to promote the scholarship of “best practices.” Occupational Therapy in Health Care, 19, (1/2). de Cordova, P. B., Collins, S., Peppard, L., Currie, L. M., Hughes, R., Walsh, M., & Stone, P. (2008). Implementing evidence-based nursing with student nurses and clinicians: Uniting the strengths. Applied Nursing Research, 21, 242-245.Google Scholar

  • Dijkers, M. P. J. M. (2009). When the best is the enemy of the good: The nature of research evidence used in systematic reviews and guidelines. Austin, TX: SEDL. Retrieved from http://www.ncddr.org/kt/products/tfpapers/tfpapers2.html Dollaghan, C. A. (2007). The handbook for evidence-based practice in communication disorders. Baltimore, MD: Paul H. Brookes.Google Scholar

  • Dougherty, D. (2013). Clinicians’ perspectives of “evidence” in everyday practice. Unpublished doctoral manuscript. Thomas Jefferson University, Philadelphia, PA.Google Scholar

  • Dysart, A. M., & Tomlin, G. S. (2002). Factors related to evidence-based practice among U.S. occupational therapy clinicians. American Journal of Occupational Therapy, 56, 275-284.Google Scholar

  • Gabbay, J., & le May, A. (2004). Evidence based guidelines or collectively constructed “mindlines?” Ethnographic study of knowledge management in primary care. British Medical Journal, 329, 1-5.Google Scholar

  • Hinojosa, J. (2013). The Issue Is - The evidence-based paradox. American Journal of Occupational Therapy, 67, e18-e23. doi.org/10.5014/ ajot.2013.005587CrossrefGoogle Scholar

  • Holm, M. (2000). Our mandate for the new millennium: Evidence-based practice. American Journal of Occupational Therapy, 54, 578-585.Google Scholar

  • Johnston, M. V., & Dijkers, M. P. (2012). Toward improved evidence standards and methods for rehabilitation: Recommendations and challenges. Archives of Physical Medicine & Rehabilitation, 93(8, Suppl. 2), 185-199.Google Scholar

  • Kielhofner, G., Hammel, J., Finlayson, M., Helfrich, C., & Taylor, R. R. (2004). Documenting outcomes of occupational therapy: The center for outcomes research and education. American Journal of Occupational Therapy, 58, 15-23.Google Scholar

  • Lin, S. H., Murphy, S. L., & Robinson, J. C. (2010). The issue is…Facilitating evidence-based practice: Process, strategies, and resources. American Journal of Occupational Therapy, 64, 344-347.Google Scholar

  • Llorens, L. A. (1990). Research utilization: A personal/professional responsibility. Occupational Therapy Journal of Research, 10, 3-6.Google Scholar

  • Lopez, A., Vanner, E. A., Cowan, A. M., Samuel, A. P., & Shepherd, D. L. (2008). Intervention planning facets-Four facets of occupational therapy intervention planning: Economics, ethics, professional judgment, and evidence-based practice. American Journal of Occupational Therapy, 62, 87-96.Google Scholar

  • Macdermid, J., & Law, M. (2008). Evaluating the evidence. In M. Law & J. Macdermid (Eds.), Evidence-based rehabilitation (pp. 121-142). Thorofare, NJ: Slack.Google Scholar

  • Mattingly, C., & Fleming, M. (1994). Clinical reasoning: Forms of inquiry in a therapeutic practice. Philadelphia, PA: F. A. Davis.Google Scholar

  • Miller, R. B. (2011). Real Clinical Trials (RCT)-Panels of psychological inquiry for transforming anecdotal data into clinical facts and validated judgments: Introduction to a pilot test with the case of «Anna.» Pragmatic Case Studies in Psychotherapy, 7(1), 6-36.Google Scholar

  • Missal, B., Schafer, B.K., Halm, M., & Schaffer, M.A. (2010). A university and health care organization partnership to prepare nurses for evidence-based practice. Journal of Nursing Education, 49, 456-461.Google Scholar

  • Mitchell, G. J. (1999). Evidence-based practice: Critique and alternative view. Nursing Science Quarterly, 12(1), 30-35.Google Scholar

  • Peterson, D. R. (2006). Connection and disconnection of research and practice in the education of professional psychologists. Training and Education in Professional Psychology S(1), 47-57.Google Scholar

  • Precin, P. (2009). An aggregate fieldwork model: Cooperative learning, research and clinical project publication components. Occupational Therapy in Mental Health, 25, 62-82.Google Scholar

  • Rappolt, S. (2003). The role of professional expertise in evidence-based occupational therapy. American Journal of Occupational Therapy, 57, 589-593.Google Scholar

  • Reagon, C., Bellin, W., & Boniface, G. (2008). Reconfiguring evidence-based practice for occupational therapists. International Journal of Therapy and Rehabilitation, 15, 428-436.Google Scholar

  • Rogers, J. C. (1983). Clinical reasoning: The ethics, science, and art. American Journal of Occupational Therapy, 37, 601-616.Google Scholar

  • Rycroft-Malone, J., Seers, K., Titchen, A., Harvey, G., Kitson, A., & McCormack, B. (2004). What counts as evidence in evidence-based practice? Journal of Advanced Nursing, 47(1), 81-90.Google Scholar

  • Sackett, D. L. (1995). Applying overviews and meta-analyses at the bedside. Journal of Clinical Epidemiology, 48(1), 61-66.Google Scholar

  • Sackett, D. L., Rosenberg, W. M. C., Gray, J. A. M., Haynes, R. B., & Richardson, W. S. (1996). Evidence-based medicine: What it is and what it isn’t. British Medical Journal, 312, 71-72.Google Scholar

  • Salbach, N. M., Jaglal, S. B., Korner-Bitensky, N., Rappolt, S., & Davis, D. (2007). Practitioner and organizational barriers to evidence-based practice of physical therapists for people with stroke. Physical Therapy, 87, 1284-1303.Google Scholar

  • Scheer, J., Arbesman, M., & Lieberman, D. (2008). Using findings from qualitative studies as evidence to inform practice: An update. OT Practice, 13 (10), 15-18.Google Scholar

  • Taylor, M. C., & Savin-Baden, M. (2001). Whose ‘evidence’ are we applying? British Journal of Occupational Therapy, 64, 213.Google Scholar

  • Thomas, A., & Law, M. (2013). Research utilization and evidence-based practice in occupational therapy: A scoping study. American Journal of Occupational Therapy, 67, e-55-e65. doi.org/10.5014/ajot.2013.006395.CrossrefGoogle Scholar

  • Thomas, P., Bracken, P., & Timimi, S. (2012). The anomalies of evidence-based medicine in psychiatry: Time to rethink the basis of mental health practice. Mental Health Review Journal, 17, 152-162.Google Scholar

  • 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.2011.000828CrossrefGoogle Scholar

  • Tonelli, M. R. (2009). Evidence-free medicine: Forgoing evidence in clinical decision making. Perspectives in Biology and Medicine, 52, 319-331. Google Scholar

About the article

Received: 2014-04-15

Accepted: 2014-08-27

Published Online: 2014-12-30

Published in Print: 2014-12-01

Citation Information: International Journal of Health Professions, Volume 1, Issue 1, Pages 13–19, ISSN (Online) 2296-990X, DOI: https://doi.org/10.2478/ijhp-2014-0001.

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© 2015 George S. Tomlin et al., published by De Gruyter Open. This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License. BY-NC-ND 4.0

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