Myth: Is Occupational Therapy Evidence-Based?

Occupational therapy is a health profession that helps individuals achieve their goals and participate in the occupations that are meaningful to them. Occupational therapists (OTs) use a variety of interventions, including exercises, adaptive equipment, and modifications to the environment, to enable individuals to engage in these activities despite any physical, cognitive, or emotional challenges they may be facing. One common myth and misconception is that what occupational therapists is not evidence-based, backed by science, or research. So is this true for the majority of occupational therapy practitioners?

One of the core principles of occupational therapy is that it is an evidence-based practice. This means that the interventions used by OTs are guided by research and scientific evidence, and that OTs use research to inform their assessments, interventions, and outcomes. The American Occupational Therapy Association (AOTA) defines evidence-based practice (EBP) as “the integration of the best available research with clinical expertise in the context of patient/client preferences and values.”((https://www.aota.org/practice/practice-essentials/evidencebased-practiceknowledge-translation)) The AOTA has established standards for evidence-based practice and encourages occupational therapists to use the best available evidence to guide their practice. Occupational therapists are expected to critically appraise the literature, integrate the best available evidence with their clinical expertise and client preferences, and evaluate the outcomes of their interventions. The AOTA also provides resources and education to support occupational therapists in their efforts to use evidence-based practice.

The use of evidence-based practice in occupational therapy is important for several reasons. First, it ensures that the interventions used by OTs are supported by research and are likely to be effective in achieving the desired outcomes. Second, it allows OTs to make informed decisions about the interventions they use, rather than relying on intuition or tradition. Third, it helps OTs to continuously evaluate and improve their practice, by staying up-to-date with the latest research and incorporating it into their practice.

One of the key components of evidence-based practice in occupational therapy is the use of outcome measures. Outcome measures are tools used to evaluate the effectiveness of an intervention and to track progress over time. They provide objective data that can be used to support or refute the effectiveness of an intervention. Occupational therapists use a variety of outcome measures to evaluate the effectiveness of their interventions, such as the Canadian Occupational Performance Measure (COPM).

There is a growing body of research that supports the effectiveness of occupational therapy interventions. For example, studies have shown that occupational therapy can be effective in improving function and quality of life in individuals with conditions such as stroke, traumatic brain injury, and dementia. Occupational therapy has also been found to be effective in improving hand function in individuals with rheumatoid arthritis and in improving upper extremity function in individuals with multiple sclerosis.

Additionally, research has also shown that occupational therapy can be effective in improving mental health outcomes, such as reducing depression and anxiety. For example, studies have found that occupational therapy interventions, such as leisure participation and community integration, can be effective in reducing symptoms of depression and anxiety in individuals with mental health conditions.

Here is where the misconception may arise. In contrast, research also does not support some of the interventions that occupational therapists may use in practice. How does this happen? Some older methods may be popular and believed at the time to be effective. However, due to our then limited knowledge such as lack of studies or what we know about diseases, the technology that was available, and theories that were developed but not yet proven at the time, these may no longer be best practices in modern-day occupational therapy.

They have replaced these older methods with newer research and evidence to support better approaches. However, for many reasons such as therapists not being read up on the latest research, therapists doing what they know, therapists being heavily invested in an approach, or therapists’ own reasons…they may not have stopped doing what they should have stopped doing. While unfortunate, this is a reality of healthcare as even in other fields, some doctors or other therapists may still use older methods that are no longer currently accepted such as lobotomy for mental health conditions.

In pediatrics, occupational therapy interventions have been proven to be effective in improving fine motor skills, hand function, and upper extremity function in children with conditions such as cerebral palsy, developmental coordination disorder, and autism spectrum disorder.

An example of a divide is applied behavior analysis (ABA). “Applied behavior analysis (ABA) has strong evidence of effectiveness in helping people with autism achieve goals, yet it does not seem to be implemented in occupational therapy practice…The occupational therapy literature does not reflect any use of ABA despite its strong evidence base. Occupational therapists may currently avoid using ABA principles because of a perception that ABA is not client centered. ABA principles and occupational therapy are compatible, and the two could work synergistically.”((Christie D. Welch, H. J. Polatajko; Applied Behavior Analysis, Autism, and Occupational Therapy: A Search for Understanding. Am J Occup Ther July/August 2016, Vol. 70(4), 7004360020p1–7004360020p5. doi: https://doi.org/10.5014/ajot.2016.018689))

In conclusion, occupational therapy is an evidence-based practice, meaning that it is guided by research and scientific evidence. Occupational therapists (most of them anyways) use research to inform their assessments, interventions, and outcomes, and they are also involved in generating new knowledge through research. The American Occupational Therapy Association (AOTA) has established standards for evidence-based practice and encourages occupational therapists to use the best available evidence to guide their practice. The use of evidence-based practice in occupational therapy helps to ensure that the interventions used by OTs are supported by research and are likely to be effective in achieving the desired outcomes. It also allows OTs to make informed decisions about the interventions they use, rather than relying on intuition or tradition and continuously evaluate and improve their practice.

OT Dude is committed to the dissemination, use, and practice of evidence-based practice. I try my best to continue reading up and talking with other professionals about what is effective and what is ineffective. I have no skin in any game when it comes to theories or approaches. Above all, I am committed to providing my patients and their clients with the information and approaches that are available and to allow them to make their best-informed choices that are in their best interest.

As a consumer of occupational therapy, you and your family should not blindly accept what an occupational therapist or healthcare provider suggests without feeling comfortable. You have the right to know why, where it comes from, where the evidence comes from, and what some alternative options are that may be just as good if not better. For example, you should question why the therapist is using approaches such as ABA, how long sessions will take, and what evidence has been shown that it works in their practice. How do they measure progress or success? How do these things not have biased on them or a placebo effect?