Research and practise – relevant?

This week I want to focus on research.  A couple of events brought this up for me:

I spent some time with Margaret Morrell, professional supervisor and trainer in supervision on Friday.  She raised the thought with me that many practitioners (from any field) don’t routinely question what they do and why. Her view is that supervision provides a forum for this to happen – so that people can continue to develop as a professional, and to routinely bring criticism and questioning into their practice to be the very best they can be.  I was a bit stunned when she said this – I can’t remember a time when I didn’t routinely question what I do, how I do it, why I do it and want to be challenged, but it seems that there are those therapists who simply follow the ‘rules’ and act more as technicians than professionals.

This is a real problem for patients who don’t know the practice style of the health professional they are seeing – how do they know if the therapist they are seeing is simply doing what he or she has always done, or whether their practice is routinely informed by recent research developments?

The second event to raise this issue with me was via the SomaSimple forum where someone pointed out that there are people who question their profession over and again, and there are people who are satisfied with doing what they’ve always done.  There are people who can’t answer the question ‘why does it work’ – and worse than that – they don’t care.  And this means our therapy can’t move past holding onto ‘comforters’ or things that seem reassuring even when they may not stand up to the cold hard light of day.  I wrote about this recently when talking about occupational therapy and the ‘myth’ of ‘activity is good’.   It may be that the belief that activity is good is demonstrated empirically to be sound, but until then it’s simply a belief.

By coincidence, I received a contents list from the journal ‘Rehabilitation Psychology’ which has a complete issue on Methodological Advances and Issues in Rehabilitation Psychology.  While this issue is mainly about psychology in rehabilitation, it has so much application to rehabilitation in general, I think it’s worth exploring.
Here’s the abstract from the editorial from the journal:

Scientific research plays an important role in advancing the knowledge base of rehabilitation psychology. Research contributes to theory building and provides the foundation for empirically supported rehabilitation psychology practices, and model-based diversity-sensitive evidence-based interventions help persons with disabilities to become fully integrated into the society. Objective: In this article, the guest editors present their rationale for developing this special issue on methodological advances in rehabilitation psychology. Conclusions: They suggest that rehabilitation psychology research needs to be theory driven using rigorous research designs, strategies, and techniques and describe their selection of articles designed to highlight some exciting new developments in rehabilitation psychology research and to stimulate thinking and facilitate discussion about incorporating these new techniques in theory-driven research programs.

You know, that doesn’t sound so very different from arguments about using research in any field of human endeavour.  Perhaps it’s tainted a little by the drive to have a theory-driven approach, using rigorous research designs – I mean, where is the place for human judgement and expert opinion??!  (sly reference to this post where I reported that psychometric data predicts more accurately than clinician opinion…)

Is research relevant to practise?  Well yes, of course – if you ask me.  Sadly, some others in my field of pain management might say ‘yes, but’… .

I mean it does take time to read the literature.  It does mean holding a lot of information in your head and comparing your current practice with what the literature is coming up with.  It does mean critiquing research to establish whether it has application beyond its study scope.  It means working out irrelevant from relevant information, it means never taking something at face value, it means being prepared to change practice from what was learned as ‘truth’ all those years ago in training.  It can mean being unpopular when it becomes important to disagree with people who are vocal or ‘senior’ or happy to do what is palliative and doesn’t challenge patients.  It is such hard work!!

Ask yourself today: have I reviewed the treatment of a patient recently?  Have I checked in with the latest evidence for or against the model I use in my practice? Do I use a model, or do I ‘follow the rules’ as a technician might?

More on research and practise – and some practical stuff too – tomorrow!

Professional maturity

What constitutes a mature profession?

  • One that calmly does what it does without constantly being fearful that someone is ‘poaching’ the role
  • One that is self reflective, and challenges itself to become more and better
  • One that knows its core purpose and uses whatever scientifically proven strategies support that purpose
  • One that has ‘jargon’ but doesn’t need to tout it about like a shiny new ring ‘Seen my occupational performance recently? Look how shiny it is!!’
  • One that takes a broader perspective on issues other than those immediately relevant to its core practice
  • One that can see there are other issues to comment on other than those immediately relevant to its core practice

Probably a heap of other things too – but those are some of my pet peeves.

There are times I feel like one of the first feminists – ‘Oooh! look, a woman can drive a car!’, ‘Oooh! Look an OT can teach doctors!’ It seems a bit of a novelty that an occupational therapist should educate people from outside the profession – and debate issues across professional boundaries as well! I ask – why not? The information is available in the scientific literature, and it’s up to each one of us to critically examine both our own and our team’s way of working to ensure the very best outcomes for our clients. Sometimes this means being critical of another’s practice – more often it means being critical of our own. It also relies on us as professionals being confident about our own skills – professional, scientific, interpersonal.

What do I do as an occupational therapist that defines my practice? I help people live their lives despite limitations so they achieve their potential in the real world.

In simple words, I help people ‘feel it, think it, do it, be it’.

Health professionals of every stripe have some core skills – common to anyone who works with people. In pain management, more probably than any other area of health care, interdisciplinary team work relies on professionals being comfortable enough within their own skin to allow another to do things that would normally be the province of a single discipline, and at the same time, be willing and able to pick up on skills that aren’t normally used by his or her own profession.

We can’t afford to be precious about what we offer – we really need to question, explore, examine and test our practice because so much of what we do in the name of therapy has been assumed to work, but doesn’t, or works in a different way from what we assumed. Why is this important? So we can refine it, learn more about mechanisms, and hopefully even prevent some of the disability occurring.

Rock on 2008 – it’s got to be a good one!

If you’re an occupational therapist, and want to debate professionalism and occupational therapy – head on over to the occupational therapists only section, get the password by emailing me, and join in!