[Adta] More research and EBP!

[Sherry Goodill]

2-19-07

Dear Listserve readers,

This is a very exciting discussion of research and evidence-based 
practice!  I'm adding to Robyn's summary and explanation with two other 
points from our 2006 ADTA conference panel:

    * Usually evidence is understood to mean knowledge derived from
      research about a) treatment efficacy and/or b) assessment
      validity, specificity and reliability.
    * Nursing models propose a three-step approach to EBP. We can easily
      apply a model like this to DMT:
          o 1. Pose the practice question: Find the other practitioners
            interested in the same question; form an interest group and
            divide up the work.
          o 2. Gather, assess and summarize the evidence: Use databases
            and the levels of evidence (see the list below) to guide
            your choices about what studies you will rely on. Read it
            and discuss it in your interest grouop.
          o 3. Translate that evidence into practice: Figure out whether
            and/or how you might change your way of doing things in
            treatment in response to the evidence you've found and
            discussed.

Even just in the last few days on the listserve it looks like groups are 
starting to form around general clinical areas of interest. So "step 
one" of developing evidence based DMT seems to be underway already!

Yours,
Sherry Goodill


Robyn Flaum Cruz wrote:

> I have been following the discussion with great interest and even 
> though I am truly overloaded, I just can’t go another minute without 
> chiming in!
>
>  
>
> Christine gave a great example of what evidence-based practice means 
> in her clinical setting.  I just want to add a little information from 
> the presentation Ilene Serlin, Sherry Goodill, and I gave at the 2006 
> ADTA Conference.
>
>  
>
> Evidence-based practice (EBP) is a term that grew out of 
> evidence-based medicine (EBM) – The goal of EBM is to improve clinical 
> and economic outcomes by reducing variation in optimal practice. 
> Variation is reduced by using research evidence about the most 
> effective methods of treatment to guide practice. (2000, Eastern 
> Association For the Surgery of Trauma).
>
>  
>
> The Institute of Medicine created this definition of EBP: 
> “Evidence-based practice is the integration of best research evidence 
> with clinical expertise and patient values.” (2001 Institute of 
> Medicine Report) and the American Psychological Association has 
> further refined this definition as “Evidence-based practice in 
> psychology (EBPP) is the integration of the best available research 
> with clinical expertise in the context of patient characteristics, 
> culture, and preferences.”
>
>  
>
> As with most “terms” EBP is thrown around by a lot of people 
> (including administrators in healthcare systems in which we work : )  
> in varying ways. 
>
>  
>
> As for levels of evidence, there are varying hierarchies about 
> evidence and Sherry Goodill supplied the hierarchy developed by David 
> Sackett below:  
>
>  
>
> Sackett’s Hierarchy of Evidence
>
> Level 1
>
> Systematic Review (SR) of randomized, controlled outcome studies.
>
> Randomized controlled Trials (RCTs): outcome studies with 95% 
> confidence interval.
>
> Prospective observational study (causal-comparative or correlational) 
> with 80% or better folllow up
>
> Level 2       
>
> SR of controlled outcome studies
>
> Controlled outcome studies or RCTs with < 80% follow up.
>
> Retrospective observational studies and SRs of these, if the samples 
> in the studies are homogenous, and variables are well controlled.
>
>  
>
> Level 3
>
> Individual retrospective causal-comparison, or case-control 
> observational study.
>
> Systematic Review (SR) of these, but when the measurements are not 
> always the same, and variables less controlled.
>
> Correlational “snapshot” studies, with smaller, limited, samples.
>
> Level 4
>
> Case-series, one-group prepost studies.
>
> SSD, or N = 1 studies, conducted with several patients.
>
> Poor quality (low N, uncontrolled variables) case-controlled 
> observational studies.
>
>  
>
> Level 5
>
> “Expert opinion without explicit critical appraisal.
>
>  Expert opinion based on “bench research, physiology” or “first 
> principles” (theory) alone.
>
>  
>
> There is an interesting article about EBP in CAT – Edwards (2005). 
> Possibilities and problems for evidence-based practice in music 
> therapy. The Arts in Psychotherapy, 32(4), 293-301.
>
>  
>
> I think that we can all agree that DMT has some evidence at all of 
> these levels, but that we need more, and we need to disseminate what 
> we have!  There have been wonderful ideas in this discussion so far 
> and I have found it truly exciting!  I hope we can keep this energy 
> going and develop some useful products from it.
>
>  
>
> I do have to add one caveat – I have recently noticed that across 
> diverse areas of specialization there is a lot of confusion about the 
> uses of research using traditional quantitative methods and research 
> that uses narrative, qualitative, or artistic type methods. While 
> quantitative research definitely in the words of Sam Kachigan 
> “sacrifices detail and nuance for parsimony and salience,” – when the 
> sample is representative of the population and other qualities of the 
> research are also good, these quantitative research results can be 
> generalized to and across populations (in fact the point of 
> statistical inference is that it allows us to infer that what was 
> found in the sample is true in the population from which the sample 
> was drawn). Qualitative research, on the other hand offers depth of 
> understanding, but can never be generalized to a population – instead 
> it informs and helps build theory (it just can’t be generalized to 
> other people).  Even if I interview 60 people, what I have is the 
> opinions of 60 people – which may give me very rich detail, but will 
> never tell me about people other than those 60.  
>
>  
>
> One last thing, let’s not forget that DMT is all over the world, and 
> research is taking place all over the world – a wonderful compilation 
> of some of the international DMT research was published in 2006 – 
> Koch, S., & Braeuninger, I. (Eds.) (2006) Advances in dance/movement 
> therapy: Theoretical perspectives and empirical findings. Berlin: 
> Logos Verlag.  Sorry to be so long winded….  Robyn Cruz
>
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>
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