Australian occupational therapists' use of an online evidence‐based practice database (OTseeker)

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Blackwell Publishing, Ltd.

Australian occupational therapists’ use of an online evidence-based practice database (OTseeker)

Kryss McKenna*

1

, Sally Bennett*

1

, Zoe Dierselhuis*†, Tammy Hoffmann*

1

, Leigh Tooth‡

1

& Annie McCluskey§

1

, *Division of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Queensland, Qld, †Royal Brisbane and Women’s Hospitals, Herston, Qld, ‡School of Population Health, University of Queensland, Qld and §School of Exercise and Health Sciences, University of Western Sydney, New South Wales, Australia

Abstract

Introduction

: Online databases can support the implementation of evidence-based practice by providing easy access to research. OTseeker(www.otseeker.com), an electronic evidence database, was introduced in 2003to assist occupational therapists to locate and interpret research.

Objectives

: This study explored Australian occupational therapists’ use andperceptions of OTseeker and its impact on their knowledge and practice.

Methods

: A postal survey questionnaire was distributed to two samples: (i) aproportionate random sample of 400 occupational therapists from all statesand territories of Australia, and (ii) a random sample of occupational ther-apists working in 95 facilities in two Australian states (Queensland and NewSouth Wales).

Results

: The questionnaire was completed by 213 participants. While mostparticipants (85.9%) had heard of OTseeker, only 103 (56.6%) had accessed it,with lack of time being the main reason for non-use. Of the 103 participantswho had accessed OTseeker, 68.9% had done so infrequently, 63.1% agreed thatit had increased their knowledge and 13.6% had changed their practice afteraccessing information on OTseeker.

Conclusion

: Despite OTseeker being developed to provide occupational ther-apists with easy access to research, lack of time was the main reason why overhalf of the participants in this study had not accessed it. This exploratoryresearch suggests, however, that there is potential for the database to influenceoccupational therapists’ knowledge and practice about treatment efficacythrough access to the research literature.

Introduction

A new paradigm, evidence-based practice (EBP),has emerged over the past two decades, emphasizingthe importance of integrating research evidence

into clinical decision making.

1

While the medicalprofession initially drove EBP, the philosophy ofusing research evidence in clinical decision makinghas since influenced the policies and practices ofother health professions, including occupationaltherapy. However, like their counterparts worldwide,Australian occupational therapists have experiencedbarriers to embracing EBP, largely as a result ofdifficulties accessing and interpreting researchevidence.

2,3

Correspondence: Kryss McKenna, Division of OccupationalTherapy, School of Health and Rehabilitation Sciences,University of Queensland, Queensland, 4072, Australia. E-mail:[email protected]

1

Member of the OTseeker team.

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This paper begins by reviewing studies that haveidentified the barriers to occupational therapists’participation in EBP. It then provides a descrip-tion of an electronic database, OccupationalTherapy Systematic Evaluation of Evidencedatabase or OTseeker, introduced in 2003 by theauthors (KM, SB, TH, LT, AM) to help occupa-tional therapists integrate research evidence intopractice. The remainder of the paper reports theresults of a postal survey that explored a sampleof Australian occupational therapists’ use ofOTseeker and its impact on their knowledge andpractice.

Literature review

Despite the opportunities that EBP provides toimprove client outcomes, not all occupationaltherapists readily integrate scientific evidence intoclinical decision-making.

2,3

In a survey of 66British occupational therapists, 86% read researchstudies in professional journals, but only 11%indicated there was time to do so during workhours.

3

Other barriers that impacted on therapists’ability to undertake EBP were a lack of resourcesand a limited ability to critically appraise researchfindings.

In Australia, similar findings have beenreported. McCluskey

4

administered a question-naire to 67 participants before they attended anintroductory workshop on EBP and found that53% reported a low level of knowledge about andskills in critically appraising research literature.Most (79%) reported limited knowledge ofelectronic databases and only 15% had attendeda previous course on EBP. The six main barriersto implementing EBP reported were: lack of time(88%), large caseloads (67%), limited searchingskills (50%), limited appraisal skills (44%),difficulty accessing journals (44%), and lackof evidence to support occupational therapypractice (41%). In a randomly selected sampleof 649 members of OT AUSTRALIA, Bennettand colleagues

5

found that, while respondentswere positive about EBP, most relied more ontheir clinical experience (96%), continuing profes-sional development (82%) and colleagues (80%)than on published research findings (56%) whenmaking clinical decisions. Lack of time (91.8%)

was again the main reason why therapists were notusing an evidence-based approach to practice.

Background and aim of the study

In response to these difficulties, an online databasewas developed to provide evidence about theeffectiveness of interventions relevant tooccupational therapy.

5,6

The OccupationalTherapy Systematic Evaluation of Evidence(OTseeker) database contains the bibliographicdetails of relevant systematic reviews andrandomized controlled trials and, where publisherapproval has been obtained, abstracts aredisplayed. The randomized controlled trials areindependently appraised and scored by twotrained occupational therapists to help usersevaluate a study’s validity and its usefulness ininforming clinical decision-making. The PEDroscale

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is used to score the randomized controlledtrials. In OTseeker, scores on the PEDro scale aredisplayed in two categories: internal validity andstatistical reporting. Internal validity is expressedas a score out of eight, reflecting the extent towhich the trial meets the criteria of randomallocation; concealed allocation; similarity ofstudy groups at baseline; blinding of participants,therapists, and assessors; outcome measuresobtained from more than 85% of participants;and intention-to-treat analysis. Statisticalreporting is scored out of two, that is whether thepaper reported between-group statistical analysisand point measures with variability data. The data-base has been freely available at www.otseeker.comsince March 2003.

The current study explored whether OTseekerwas being accessed by Australian occupationaltherapists and whether it had impacted ontheir practice. The research questions addressedwere:

1

In a randomly selected sample of Australianoccupational therapists, what proportion hasheard of and accessed OTseeker?

2

Of those in the sample who have accessedOTseeker, what proportion state that theirknowledge and clinical practice have beenimpacted?

3

What are users’ perceptions of the utility ofOTseeker?

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Method

Design

This was a postal survey of two random samples ofAustralian occupational therapists.

Sample

Two sampling methods were used.

1

A national sample

. Members of the Australiannational occupational therapy association, OTAUSTRALIA, were randomly sampled in June2004. OT Australia has an approximatemembership of 4500. Using a random numberslist, a proportionate (by state/territory) randomsample of 400 members was selected. Thissample size was chosen on the basis of resourcesavailable for the initial survey mail out andfollow-up reminders.

2

A State sample

. Following a low response fromthe national sample, a second sampling strategywas implemented, focusing on occupationaltherapists from the two Australian states inwhich OTseeker team members were based(Queensland and New South Wales). It wasconsidered likely that occupational therapists inthese two states may have greater awareness ofthe database. Occupational therapists workingin 95 randomly selected facilities from acrossthese two states were invited to complete thesurvey questionnaire in November 2004. InQueensland, 59 (11.7%) of the 504 facilitieslisted in a directory of facilities employingoccupational therapists who are members of OTAUSTRALIA Queensland were selected usinga random numbers list. In New South Wales, 36(10%) of the 366 facilities listed in a university’sdirectory of facilities that provide fieldworkplacements for occupational therapy studentswere selected using a random numbers list.

Procedure

Approval to undertake this study was provided bythe School of Health and Rehabilitation Science’sResearch and Postgraduate Studies Committee atthe University of Queensland, Australia. Surveypackages consisted of a participant information

sheet, survey questionnaire and a reply paidenvelope. Consent to participate was assumed ifthe questionnaire was returned.

For the national sample, OT AUSTRALIAstaff conducted the sampling process and mail-outof the survey packages to maintain participantconfidentiality. For the State sample, facilitiesrather than individual occupational therapistswere targeted to preserve participant anonymity.An initial telephone call was made to the senioroccupational therapist at the facility to explain thepurpose of the study and to ascertain whetheroccupational therapists at that facility would bewilling to participate. The senior occupationaltherapist indicated the number of occupationaltherapists who worked at the facility and corre-sponding numbers of survey packages were sent.To increase the response rate, generic follow-upletters were sent to all potential participants in thenational sample at approximately 2- and 4-weekintervals after the initial mail out. In the statesample, a follow-up telephone call was made tothe senior occupational therapist approximately3 weeks after the survey packages were mailed toencourage their return.

The instrument

The survey questionnaire used in the study wasmodelled on two previous surveys. The first aimedto determine Queensland health professionals’awareness and use of the Clinicians’ KnowledgeNetwork (http://ckn.health.qld.gov.au). The secondsought to establish Australian occupational ther-apists’ knowledge, skills and involvement in EBP.

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The questionnaire contained three sections:(i) participants’ demographic information;(ii) participants’ awareness of and access to

OTseeker, reasons for accessing OTseeker, sourcesof information for clinical decision makingboth before and after OTseeker became avail-able, whether they had changed practice andif their knowledge about the effectiveness ofoccupational therapy interventions had increasedas a result of information on OTseeker;

(iii) participants’ perceptions of the utility of thedatabase including their understanding ofthe PEDro scale and usefulness of the tutorialand website links on OTseeker.

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Most questions could be answered usingdichotomous or multiple fixed-response catego-ries. Where appropriate, an ‘other’ category wasincluded. For the question regarding sources ofinformation used for clinical decision making,participants ranked fixed response categoriesfrom 1 to 10, with 1 being the source most reliedon. The questionnaire was piloted on three occupa-tional therapists who were not members of OTAUSTRALIA. Minor adjustments were madeto enhance the clarity of the wording of somequestions in response to pilot feedback.

Data analyses

Data were analysed descriptively using theStatistical Package for Social Science (SPSS) forWindows (version 11, SPSS, Chicago, IL, USA).

Results

Characteristics of participants

A total of 213 questionnaires was completed. Inthe national sample, of the 400 questionnairesdistributed, 124 were completed, representinga 31.0% response rate. Five questionnaires werereturned uncompleted because the participant wasoverseas (

n

= 3), no longer practising (

n

= 1), ordid not have time to participate (

n

= 1). In the statesample, based on the number of occupationaltherapists who worked in the facilities as indicatedby the senior occupational therapists, 326 surveypackages were distributed, 165 to the 59 facilitiesin Queensland and 161 to the 36 facilities inNew South Wales. Eighty-nine completedquestionnaires were returned and one questionnairewas returned uncompleted because the therapistdid not have time to participate. This represents aresponse rate of 27.3%.

When compared using chi-square analyses andan independent samples

t

-test, there were nostatistically significant differences between the twosamples in terms of their gender, work location,setting and role, postgraduate qualifications,participation in EBP training, awareness ofOTseeker and years worked as an occupationaltherapist. Therefore, the data from both sampleswere pooled. Most participants were female and

worked in a metropolitan area, full-time, as aclinician in the public sector in an adult physicalcaseload. Participants had been working for amean of 11.9 years (SD = 9.3, range < 1–44).Approximately one-quarter had postgraduatequalifications and almost three-quarters hadparticipated in EBP training. Table 1 providesparticipant details.

Access to OTseeker

Of the 183 (85.9%) participants who had heard ofOTseeker before receiving the questionnaire, 103(56.3%) had accessed the database. The reasonswhy participants who had heard of OTseeker hadnot accessed it are provided in Table 2.

Of the 103 participants who had accessedOTseeker, most did so at work (

n

= 79, 76.7%),with the remainder accessing the database at homeor university. Most who accessed OTseeker visitedthe site infrequently (less than monthly;

n

= 75,72.8%). Thirty-one (30.1%) participants accessedOTseeker occasionally (monthly) while three(2.9%) accessed the database frequently (daily/weekly).

Participants ranked their reliance on sources ofinformation that informed clinical decision mak-ing both before and after OTseeker became avail-able in March 2003. Based on the mean rank, thetop five sources of information before and afterOTseeker became available are presented inTable 3. After March 2003, OTseeker was thefourth ranked source of evidence. After OTseekerbecame available, participants’ reliance on journalarticles for evidence moved from third to first rank.

Incorporation of evidence into clinical practice

Of the 103 prior users, their reasons for accessingOTseeker are summarized in Table 4. Sixty-five(63.1%) participants indicated that accessingOTseeker had contributed to their knowledgebase. Of the other 38 who did not report anincrease in knowledge, 23 (57.5%) stated that therewas not enough information about their topic ofinterest on OTseeker, 15 (37.5%) indicated thatthey had not used OTseeker enough, and two(5.0%) responded that more useful informationwas available on other electronic databases.

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Fourteen (13.6%) of the 103 participants who hadaccessed OTseeker indicated that they had changedtheir practice, management, or teaching in the last3 months as a result of information on OTseeker.Examples of changes included using more econom-ical foam cushions to prevent pressure sores overmore expensive brands (clinical practice), incorpor-ating an EBP course into a 3rd-year occupationaltherapy university curriculum (teaching) and com-mencing an EBP in-service group (management). Ofthe other 89 participants who did not report practice

changes, most stated that this was as a result ofthere not being relevant or enough information onOTseeker (55, 53.4%), followed by changes topractice being constrained by work environment orpolicies (22, 21.4%) and information on OTseekerconfirming current practice (22, 21.4%).

Utility of OTseeker

Participants who had not accessed OTseekerbefore completing the questionnaire were asked to

Characteristics Number (%)

GenderFemale 203 (95.3%)Male 10 (4.7%)

Work location*Capital city 98 (46.0%)Metropolitan centre (population ≥ 100 000) 63 (29.6%)Large rural centre (population > 25 000) 33 (15.5%)Small rural centre (10 000–25 000) 11 (5.2%)Remote (population < 10 000) 5 (2.3%)

Employment statusFull-time 146 (68.5%)Part-time 62 (29.1%)Not currently employed 5 (2.3%)

Work roleClinician/consultant 185 (86.9%)Manager 17 (8.0%)Academic/researchers 4 (1.9%)Other† 7 (3.3%)

Area of practice*Adult physical 90 (42.3%)Mixed caseload 41 (19.2%)Other‡ 30 (14.1%)Child/adolescent physical 17 (8.0%)Adult mental health 15 (7.0%)Child/adolescent intellectual disability 12 (5.6%)Academic/researcher 3 (1.4%)Child/adolescent mental health 2 (0.9%)Adult intellectual disability 2 (0.9%)

Work setting*Public 149 (70.0%)Private 50 (23.5%)Other (charitable organizations) 13 (6.1%)Undertaken evidence-based practice training 152 (71.4%)Postgraduate education 48 (22.5%)Workplace computers with Internet access available 177 (83.1%)

*Some missing data; †managerial and clinical duties; ‡hand therapy and occupational rehabilitation.

Table 1 Participant demographic information (n = 213)

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do so to enable them to comment on the utility ofthe database. Most participants (91.9%) indicatedthat using the OTseeker search page was easy orrelatively easy. Participants were less uniform intheir perception of the ease with which the internalvalidity and statistical reporting components ofthe PEDro scale could be interpreted, with 29.6and 34.8%, respectively, finding these somewhatdifficult or difficult to understand.

Discussion

This study aimed to explore whether a sample ofAustralian occupational therapists had heard ofand accessed OTseeker, and its impact on theirknowledge and clinical practice.

Use of OTseeker

Most participants (86%) had heard of OTseeker.This finding may in part be because of theextensive promotion of OTseeker in journals,

5,6

at conferences and online, with links to OTseekerbeing provided by numerous occupational

therapy, health-service, library and EBP websites,as well as Australian health department intranets.Of the participants who had heard of OTseeker,over half (56.3%) had accessed it. The main reasonwhy participants had not accessed OTseeker waslack of time, despite the database being developedto provide quick and easy access to high-qualityresearch findings. Previous studies support thatlack of time is the main barrier to implementingEBP.

5,7

−

9

OTseeker has been designed to save users timewhen searching for evidence. It is freely availableonline, giving users fast access to research litera-ture. As in other studies,

4

most participants in thisstudy had access to a computer and the Internetat work, indicating their ability to access onlineresources. Studies have shown that clinicians tendto rely on electronic databases such as

,

or

when searching for clinicalinformation.

2,3,10

is available free onlinethrough PubMed, and therapists may have accessto

and

through institutionalsubscriptions.

10

These databases do not contain allresearch findings relevant to physiotherapy

10

and

Table 2 Reasons why participants who had heard of OTseeker had not accessed it (n = 80)

Reason Number (%)

Lack of time 31 (38.8%)No reason to use it 23 (28.8%)Did not know what it could offer 12 (15.0%)No access to OTseeker on a computer 5 (6.3%)No access to a computer 2 (2.5%)Other 4 (5.0%)Missing 3 (3.8%)

Table 3 Top five sources of information relied on for clinical decision making in practice

Rank Before OTseeker launch* After OTseeker launch

1 Colleagues Journal articles2 Experience with similar clients in the past Experience with similar clients in the past3 Journal articles Colleagues4 Short courses/continuing professional development OTseeker5 Textbooks Short courses/continuing professional development

*OTseeker was launched in March 2003.

Table 4 Reasons why participants accessed OTseeker (n = 103)

Reason Number (%)*

Clinical information 90 (87.4%)Preparation of teaching/in-services 62 (60.2%)Private study 59 (57.3%)Research 56 (54.4%)Assignment 40 (38.8%)Other 3 (2.9%)

*Participants could choose more than one reason.

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the same is likely to be true for occupational ther-apy. When searching these databases, cliniciansmay need to peruse many citations before findingpapers containing high-quality evidence that willassist in answering their clinical question.OTseeker contains research findings from multipledatabases, including

,

,

,

: Rehabilitation and Physical Medicine,AMED, PsycINFO, the Cochrane Library,CancerLit and Ageline

8

providing users with fastaccess to research relevant to occupational therapyfrom many sources. This feature decreases theneed for users to search multiple electronicdatabases, ultimately saving time. Only systematicreviews and randomized controlled trials arecontained on OTseeker so users can be assuredthat the articles they retrieve have the potential toprovide strong evidence about the effectiveness ofa given intervention.

11

Further, all randomizedcontrolled trials on OTseeker have been criticallyappraised for internal validity and statisticalreporting. This enables users to more easily inter-pret the quality of study conclusions and deter-mine applicability to clinical practice.

Although OTseeker has the potential to saveusers time when searching for high-qualityresearch, there are some limitations to the data-base. Due to copyright laws, abstracts of somepapers on OTseeker are not available. Users can-not then determine whether a study is applicableto their clinical question unless they locate theabstract elsewhere. A difficulty that applies to bothOTseeker and traditional databases is that, once astudy of interest has been identified, users mustretrieve the full-text paper either from the onlineor printed journal. Problems accessing journalarticles such as proximity to libraries have beenwell documented in previous studies investigatingoccupational therapists’ perceptions of EBP.

2,4,12

Another limitation that may deter use of OTseekeris that only papers regarding the effectiveness ofinterventions are contained on the database. Ifusers have questions about assessments or progno-sis, other databases need to be accessed.

Sources of evidence

Participation in EBP does not rely solely onaccessing research literature. It involves the

integration of clinical expertise and clientpreferences with the best available evidence.

13

When these three components are combined,clinicians are able to make informed decisions thatcan optimize client outcomes.

13

Participantsranked sources used to make clinical decisionsboth before and after the launch of OTseeker.After the introduction of OTseeker, participantsranked the database after journal articles, clinicalexperience, and colleagues, and before continuingeducation courses. After OTseeker becameavailable, reliance on journal articles as a source ofevidence rose from third to first rank. This findingsuggests a change in behaviour from past researchwhere occupational therapists placed greateremphasis on knowledge from clinical experienceand colleagues than on information fromresearch.

2,12

While reliance on the opinion of experiencedcolleagues for clinical decision making can bebiased by personal preferences and experiences,reference to the research literature can also beproblematic. Reading journal articles may notnecessarily provide clinicians with appropriateinformation on which to base clinical decisions.

14

A large proportion of published research eitherlacks relevance or the methodological rigour toadequately answer clinical questions. Criticalappraisal of key studies is essential to determinea study’s validity and applicability to practice. Inthis study, just over one-third of participantsexpressed difficulty understanding the criticalappraisal scores on OTseeker, despite explanationsof each criteria being provided in the help pages onthe website. McCluskey

9

found that criticalappraisal skills could be improved with training.Increasing clinicians’ understanding of research ter-minology such as ‘meta-analysis’ and ‘intention-to-treat’ can enhance their ability to determinethe quality of research and to further engage inEBP.

10

Changes to knowledge and practice

Almost two-thirds of participants who hadaccessed OTseeker reported that usinginformation from the database had changed theirknowledge, while only 13.6% indicated that thedatabase had impacted on their practice. There are

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a number of potential reasons why OTseeker didnot impact on the practice of more users. Forsome, the information contained on the databasemay confirm rather than increase their currentpractice. For others, the database may not containenough information relevant to their clinicalquestions. As OTseeker is a relatively newresource, there may be studies available that havenot yet been entered into the database. In addition,users may not have access to full-text articles toenable them to follow up on OTseeker searchyields. Occupational therapy is a diverseprofession with clinicians working in manypractice areas. Studies in specific areas of practicemay not yet exist, requiring clinicians to generalizefindings from less relevant research. Copyrightpermission to display abstracts of all citations hasnot been obtained. This limits users’ ability todetermine if a particular citation would be usefulin answering their clinical question.

A number of issues impact on a clinician’s abil-ity to change their clinical practice. Incorporatingevidence into clinical practice must take place atboth a system and individual level.

15

At the systemlevel, clinicians require administrative support,access to research literature and time to conductsearches.

16,17 At the individual level, cliniciansneed to prioritize time for research utilization9

have high-level critical appraisal skills to combineand synthesize research findings from multiplearticles,18 in addition to having confidence intheir ability to change practice. McCluskey4

reported that only 30% of participants in herstudy were confident in their skills and abilityto change clinical practice in response to newevidence.

Study implications

While OTseeker was developed to addressidentified barriers that limit occupationaltherapists’ participation in EBP, namely lack oftime, difficulty finding appropriate researchevidence, and difficulty critically appraising theresearch literature, OTseeker has not yet beenwholly embraced by Australian occupationaltherapists.

To raise therapists’ awareness of OTseeker, thedatabase will continue to be promoted nationally

and internationally. Future developments that areplanned for OTseeker including an alert systemand an online tutorial may assist therapists tooptimize use of the database. New studies are con-tinually being added to the database to increasethe quantity and range of available research. Ananalysis of search terms and strategies used byusers of OTseeker is currently underway to priori-tize the addition of future entries to the database.OTseeker displays only those abstracts of system-atic reviews and randomized controlled trials forwhich copyright permission has been obtainedfrom the publishers. In the future, a structuredsummary of the study, including an overview ofthe results, will be added to citations where anabstract is unavailable or does not contain adetailed synopsis of the article. This summaryfeature should help users to determine if a studyis relevant and likely to answer their clinicalquestion.

Limitations

The main limitation of this study was the lowresponse rate. Although the response rates in thisstudy are within the acceptable limits for a postalsurvey,19 they are still low and may have resulted ina highly select sample. A further limitation of thisstudy was sampling bias, with all participantsin the national sample and from Queenslandfacilities being OT AUSTRALIA members.Therefore, the results may not be representative ofnon-members or occupational therapists in othercountries. Participants were all volunteers. Thosewho were aware of and had accessed OTseekermay have been more likely to respond. Parti-cipants in the state sample may have been moreaware of OTseeker because OTseeker originatedfrom these states.

Conclusion

Although most participants in this study hadheard of OTseeker, only approximately half hadaccessed the database. Lack of time was the mainreason reported for not accessing the database,despite the database being specifically designedto address this very problem. Two-thirds ofparticipants reported that information on

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OTseeker had improved their knowledge.Participants’ reliance on journal articles as asource of evidence increased after OTseekerbecame available. Only a small proportion ofrespondents reported changes to practice as adirect consequence of accessing OTseeker. Asawareness of OTseeker increases and refinementsare made to the database, it may have a greaterimpact on clinicians’ practice and participationin EBP. Research is required to explore the useof OTseeker by occupational therapists in othercountries and its impact on their practice.

Acknowledgements

The support of OT AUSTRALIA in thedistribution of the survey packages is gratefullyacknowledged. A brief outline of the results fromthis study was presented at the OT AUSTRALIAQld 8th State Conference, Sunshine Coast, 16–18 September 2004. OTseeker is currently fundedby the Motor Accident Authority of New SouthWales, Australia, and OT Australia. LT was sup-ported by a National Health and Medical ResearchCouncil of Australia Capacity Building Grant(no. 252834) while this research was undertaken.

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2 Bennett, S., Tooth, L., McKenna, K., Rodger, S., Strong, J., Ziviani, J., Mickan, S. & Gibson, L. Perceptions of evidence-based practice: a survey of Australian occupational therapists. Australian Occupational Therapy Journal 2003, 50, 13–22.

3 Humphris, D., Littlejohns, P., Victor, C., O’Halloran, P. & Peacock, J. Implementing evidence-based practice: factors that influence the use of research evidence by occupational therapists. British Journal of Occupational Therapy 2000, 63, 516–22.

4 McCluskey, A. Occupational therapists report a low level of knowledge, skill and involvement in evidence-based practice. Australian Occupational Therapy Journal 2003, 50, 3–12.

5 Bennett, S., Hoffmann, T., McCluskey, A., McKenna, K., Strong, J. & Tooth, L. Introducing OTseeker (occupational therapy systematic evaluation of evidence): a new evidence database for occupational therapists. American Journal of Occupational Therapy 2003, 57, 635–8.

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Key Messages

Implications for Practice

• Information on OTseeker contributes toimprovements in knowledge of occupationaltherapy interventions and, to a small extent,changes in practice.

• Participants’ reliance on journal articles asa source of evidence increased after OTseekerbecame available.

Implications for Policy

• Lack of time persists as the main barrierto accessing research from databases suchas OTseeker. Further research is needed toaddress this issue.

• Ongoing marketing is needed to increaseawareness of OTseeker.

• Research is required to explore the use ofOTseeker by occupational therapists in othercountries and its impact on their practice.

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14 Davis, D. A., Thomson, M. A., Oxman, A. D. & Haynes, R. B. Evidence for the effectiveness of continuing medical education: a review of fifty randomized controlled trials. Journal of the American Medical Association 1992, 268, 1111–7.

15 Law, M. & Baum, C. Evidence-based occupational therapy. Canadian Journal of Occupational Therapy 1998, 65, 131–5.

16 Barta, K. M. Information seeking, research utilization, and barriers to utilization of pediatric nurse educators. Journal of Professional Nursing 1995, 11, 49–57.

17 Haynes, R. B. Some problems in applying evidence in clinical practice. Annals of the New York Academy of Sciences 1993, 703, 210–25.

18 Lloyd-Smith, W. Evidence-based practice and occupational therapy. British Journal of Occupational Therapy 1997, 60, 474–8.

19 Weisberg, H. F., Krosnick, J. A. & Bowen, B. D. An Introduction to Survey Research Polling and Data Analysis, 3rd edn. Thousand Oaks, CA: SAGE, 1996.

Received 17 March 2005; Accepted 14 June 2005