Black OTs Matter: Changing Your OT Practice to Combat Racism, Address Racial Trauma, and Promote Healing



As I sit here in the quiet of a Sunday morning in the comfort of my home, I’m in quite a state. A state of numbness, a state of shock, a state of anger, a state of resignation, a state of…wonder.


Wondering if things in America will ever be different for black and brown people. Wondering if this morning is the last time I’ll talk to my dad on the phone and tell him I love him before getting That Call. Wondering if there’s any hope for a world in which black and brown people are treated as if our lives really do matter. And wondering if the people who know and love me know that I’m not okay.


For the past week, I’ve been going back and forth to work and keeping it together because I’m “essential” and that’s what I have to do. For myself, for my husband, for my patients. I’m one of two black people in my office, and one of a few black people in the rehab department at the hospital where I work. For those of you who don’t know, I work in a mental health setting serving people with a wide variety of mental health conditions. People always ask me how I keep from bringing my work home with me, wondering how I can keep all of the sadness and pain and trauma and heartache from saturating my life and affecting how I go about it.


What they should really be asking, to me and every other black practitioner out there, is how I keep all of my own struggles and trauma and emotional distress out of my work life.


The truth is, I’m crying for the first time since hearing the news about Ahmaud Arbery, Breonna Taylor, George Floyd, and remembering Philando Castile, Eric Garner, Trayvon Martin, and all of the other black and brown people whose lives have been cut short by forces outside their control as I write this right now.


After every tragedy, I find that I am unable to really process what I’m thinking and feeling to the full depth because I have to keep getting up and giving strength to other people and being strong for other people who are suffering. I just don’t have the mental resources to cry all the way to work and all the way home and still keep doing my job. Because if I started crying on the way to work I’d never stop.


Unlike my white colleagues, I live with the burden of being black in America every day. When I go to work, I often face microaggressions and assumptions about my abilities, backgrounds, interests, and experiences from when I walk in the door to when I walk out. On top of that, I go in with worries about whether my brother or my uncle or my dad or my cousins will be stopped on their way into work or while doing their jobs and have their lives cut short. I wonder if the black patients who I see will be restrained, ignored, marginalized, or judged based on the color of their skin and not their physical, emotional, or mental health challenges. I wonder if the black and brown teens who I work with will be around in five years to be able to change the world in the wonderful and wild ways they tell me they want to. And yet I still have to create groups, attend meetings, write documentation, and go about my business the same as everybody else. But I’m not the same.


Everyone keeps talking about “occupational injustice” and “occupational apartheid” like they’re these big, fancy concepts that only apply to people in prison or low income communities or war zones. The fact is, these concepts apply to me too! As a black OT, it’s an injustice for me to come to work and listen to people talking about their fun weekend or their sleep issues or their plans for the future while I’m struggling to reconcile all of the emotions and hatred that’s happening and have nobody check in and ask how I’m doing or consider how it might be impacting my occupational engagement and quality of life.


This week, I’ve gotten texts and phone calls from people I’ve known for all of my life and just a few years asking how I’m doing and wanting to know what I think about everything that’s going on. I’m thankful that I have people who care and who are willing to brave the awkwardness and brace themselves for an onslaught of emotional instability when they ask “How are you?” It’s honestly more than I’ve gotten in any place I’ve ever worked.


I don’t know if it’s because people feel like it’s not “appropriate” in the workplace to check in with their black and brown colleagues and patients or because they themselves don’t want to deal with what happens next. But that’s just another luxury that I don’t have – I don’t get to ignore what’s going on. I get to relive the generational trauma and endure another day of institutional racism in a place that doesn’t have room for the answer to be “I’M NOT OKAY!!!!”


A lot of people are mad about how AOTA isn’t putting out a statement or doing anything else to acknowledge everything that’s going on, but I honestly couldn’t care less about what they’re doing. Anyone can write up a stupid statement to slap on their website and claim that they are “with you.” Anyone.


What anyone CAN’T do is meaningfully engage and push others to engage with their friends, family members, colleagues, managers, subordinates, team members, and others who are black and living through a time when our legacy of pain is laid bare for all to see and even more to avoid.


So if you’re not satisfied with AOTA’s response, why don’t you take a look in the mirror and look at your own response? Who have you checked in with? How many black patients have you asked this week about what’s going on in their heads and hearts? How many people have you cried with, have you marched with, have you called, have you written to, have you hugged, have you held, have you held space for? Versus how many social media images have you shared, posts have you written, videos have you watched from the comfort of your own home? Think about it, and then let me know who’s really in the wrong.


If you are an OT practitioner or anyone else out there reading this, I want you to know, and I need you to know that I’m not okay. We’re not okay. We haven’t been okay for a long time and we probably won’t be for an even longer time until you start to speak up and share the burden. Until you understand that I can’t be productive when most of my day is spent avoiding my own mind and finding ways to stay busy and keep from crying in the bathroom for 8 hours straight until I can go home and do it all night. I can’t do my best work when I’m listening to a bunch of ignorant coworkers talking about riots and looting and ignoring the millions of ways in which they marginalize and bully and oppress and ignore the people in their “care.” I can’t achieve my full potential in a workplace that refuses to acknowledge or even ask about whether or not what’s happening in the world and in my life is affecting me. Answer: IT IS.


I need our profession to understand that we as black and brown people don’t have the same occupational rights as you do! I don’t have the same right to walk down the street, to go shopping, to go jogging, to drive my car, to go to work, to live, to love, to laugh without experiencing alienation and maybe even violence. I don’t even have the same human rights as you do. And the sooner you acknowledge it, the sooner we can start a dialogue and start making change.


As an OT, I know that context is such an important part of what is happening in anyone’s life and how they are able to engage in occupation. Why would that be any different for black OTs right now? The context of my life is different than that of a white clinician. Currently, my context is one of pain, misery, trauma, anger, defeat, confusion, and despair. And as a result, my occupational performance is suffering. My energy levels are down, my cognitive functioning has changed, my emotional resources are bottoming out, my spirits are weak, my motivation is low, my mood is grim, and yet…I’m expected to go and do the same as a white clinician who isn’t facing this barrier? Worrying for their family’s and their own safety every day? It’s insane that a profession that prides itself on caring about context is so blind and yet here we are.


Right now, I’m supposed to be participating in my typical Sunday routine of attending church, spending time engaged in spirituality, and communing with friends. But I can’t do that because I have too much emotional distress brewing to even focus on anything else. Consider that on a wide scale, and then think about why the people you work with as an OT might be having difficulty doing what you and everybody else is asking them to do.


You’ve probably noticed by now that this isn’t the type of thing I normally write, but that’s OK. At least, it is with me. Maybe it’s food for thought or maybe it’s just another link to share or skim or ignore, whatever. It’s what I needed to do for me, and maybe what somebody else needed too. I don’t know, and I won’t know.


What I do know is that as I continue to do work in mental health, physical rehab, or wherever else, I am not going to ignore the big, black elephant in the room. The experience of trauma is embodied, and impacts occupational performance. As best practice, I’m going to write about it, I’m going to document it, I’m going to talk about it, I’m going to acknowledge it, I’m going to cry about it, I’m going to scream about it, I’m going to do my best to provide interventions and support and resources and referrals for it and all this is so that I can do something about it.


If you’re a boots on the ground therapist, make it part of your everyday practice to stop ignoring the obvious and doing the difficult thing. Make an emotional check in part of your session and make space to listen and learn from your clients of color. Challenge the assumptions of your coworkers and other people who don’t see “why it’s a big deal” or say “it’s so sad” and change the subject. Acknowledge the pain of your black and brown coworkers and do your best to share the burden or allow them to stop pretending and unpack their minds for a few minutes or as long as it takes. And if you’re in leadership, make it your job to engage meaningfully with people of color in your workplaces and communities to understand their frustrations and learn how to make changes to make their lives more bearable.


I’m committed to being more open with the people around me, to allow them to be supports and to challenge them to be better and do more.


I hope you’ll join me.

How To Take a Virtual Tour of Potential OT Programs

FINAL Acute Care OT Series

If you are a prospective OT student, applying to degree programs in the middle of a pandemic probably isn’t the exciting experience you were envisioning. You may be stuck at home and unable to visit the programs of your choice due to travel restrictions, financial strain, family obligations, or other factors.

If that’s you – fear not! After reading this post, you will learn how to get the information you need from the comfort of your couch. Taking a virtual tour of prospective OT programs is a fun, flexible, and cost-effective way to get important information about the place where you might be spending the next two to four years.

By using my Four P’s of Virtual Touring and focusing on the Program, People, Places, and Payment for each academic institution, you can get an excellent sense of whether a program is a good educational, cultural, and financial fit. Start by reading the questions below to learn more about what to keep in mind when comparing each program using the Four P’s system. Then, highlight the questions that are most important to you, based on your personal needs and goals. For example, if your primary concern is saving money, focus on the financial aspects of each program. Or if you enjoy travel, consider choosing programs in areas near major transportation hubs rather than those in more rural settings. Would you rather attend a top tier program that will require you to live in a studio apartment with four roommates? Or would you rather attend a lower-ranked institution in a location with a more affordable cost of living? All things to consider as you coordinate your virtual tour! (If you REALLY want to get detailed, you can assign a point value for the responses to each question based on your preferences and tally the scores for each program to get a more “objective” look at how each one stacks up.)

Finally, use the infographic that follows to guide your virtual search through each program’s website, social media, LinkedIn, YouTube, and other resources. Good luck, and happy touring!

Continue reading

Earth Day Ideas for Occupational Therapists

Earth Day OT

Although many OT practitioners are providing services via telehealth, working reduced hours, or not working at all during the COVID-19 pandemic, there are thousands of therapists (including me) who are still going to a physical place of work every day. We are still seeing patients who expect us to come with a plan and a purpose, and to continue helping them to get well. And what better way to foster wellness than with a day of fun, non-pandemic-related treatments?

I love incorporating holidays into my treatment sessions because I LOVE themes and getting creative! (Seriously. My husband bought me one year’s worth of holiday-themed socks for a wedding gift and I wear them ALL. THE. TIME.) With Earth Day approaching on Wednesday, April 22, OT practitioners have the opportunity to bring a joy, foster skills development, and provide education by using earth-inspired occupations as interventions.

Read on to learn how you can celebrate Earth Day with occupational therapy clients of all ages!

Continue reading

Book Review: Yoga for Amputees

FINAL Acute Care OT Series (1)

Wondering how you can mix up your OT practice, improve your clients’ health and wellbeing, and learn something new? I was able to accomplish all of this after reading the book Yoga for Amputees by Marsha Therese Danzig. Read on to learn more about why this book is a wonderful find for OTs.


Marsha Therese Danzig, the author of Yoga for Amputees, is an amputee herself. In the early pages of the book, she describes how she lost her lower left leg to bone cancer in 1976. Danzig was a teenager whose main concerns were “boys, clothes, and getting into a good college” when she became an amputee and the devastating impact it had on her mentally, physically, and socially. She also describes how she eventually found yoga, which helped her develop a new sense of self, continue her recovery, and grow to become a skilled yogi and educator. As an OT, reading her story gave me fresh insight into how challenging it can be to live with limb loss or chronic impairment – and the powerful impact that interventions such as yoga, meditation, physical mobility and strengthening, and spirituality can have on a client’s life.

Y4A Book Continue reading

Expanding Occupational Therapy’s Role in Acute Care

Acute Care OT Series 2

This is the second post in a series about occupational therapy in acute care. Read the first post in here.

One of the constant refrains of my occupational therapy program’s faculty was that we were all “change agents” with the power – and responsibility – to see and do things differently in order to achieve optimal outcomes for our patients and our profession. As a change agent, I make an effort to give my best and make positive change wherever I work, even when it’s easier to stick with the status quo. This is especially true in the acute care setting, where time, financial, and resource restraints can be huge barriers to holistic, occupation-based OT practice.

To be perfectly honest, I’ve had more meetings with management than I care to admit during my brief tenure at the hospital, typically to discuss my goals and plans of care for patients with needs that were deemed “not appropriate” to address within the acute care setting or goals that other team members “wouldn’t be able” to address after my initial evaluations (apparently because they weren’t BADL or exercise-based goals…). It hasn’t been easy, and each meeting is a valuable learning opportunity for me to learn what others think OT is or should be – and a platform for me to provide education and advocate for my profession and scope of practice. Without going into too much detail, I’ll simply say that I think there is a long way to go before truly holistic, progressive, and occupation-based occupational therapy is the norm – rather than the ideal – in most hospital settings.

Continue reading

Acute Care Occupational Therapy: A Dying Art?

This is Part 1 of a series about OT’s role in the acute care setting.

Acute Care OT Series.png

In August 2018, I had my one year anniversary as an OT working in an acute care hospital setting. If you’d asked me two or three years ago where I thought I’d be working, I NEVER would have thought I’d be in acute care! Ironically, my first-ever OT fieldwork experience was with an acute care OT at a large teaching hospital, and while I enjoyed the learning experience I was certain that the setting was not for me. I disliked the hectic pace, limited opportunities for occupation-based practice, and short time spent treating clients. Ultimately, I felt that I was better suited for a setting where I would be able to do things with clients that initially drew me to the profession – such as cooking, leisure activities, home modification, and community outings – and acute care didn’t seem conducive to any of these goals.


Fast forward three years, and I found myself working with a small team of OTs and one OTA at a 650 bed community hospital on an interdisciplinary acute rehab team. Initially I spent much of my time on the ortho floor, evaluating and treating patients after hip, knee, and shoulder surgeries. From there, I branched out into providing care for patients on the neuro, general medicine, oncology, bariatric, intensive care, and cardiac units. It has been a whirlwind experience, and I am learning something new every day – including what my managers, coworkers, and teammates believe is “within the scope” of OT practice in the acute care setting. I don’t always see eye-to-eye with them about what types of OT interventions are appropriate in the acute care setting, but our ongoing discussions and my desire to learn more inspired me to dig into the literature, talk with professional mentors, and reach out to other acute care OTs to learn how how I could serve hospitalized patients while still practicing in a way I know is skilled and demonstrating my distinct value as an occupational therapist.

Read on to learn more about the precarious position of acute care occupational therapists in today’s demanding healthcare environment.

Continue reading

Evidence Based OT Practice, Part IV: Fact or Fad? A Case Study with Bal-A-Vis-X


This post is part of a series on evidence-based practice in OT. Read the previous posts in the series here, here, and here.

Many rehab therapists have fallen prey to using fad treatments that have little or no evidence to support them. There continue to be many lively Facebook debates and polarized opinions about various occupational therapy interventions. Those who believe the intervention is effective make a point of highlighting the many clients they’ve treated who have experienced significant gains, and non-believers turn their noses up and ignore on any evidence presented by those on the other side. As I’ve stated in previous posts about evidence-based practice, the issue in these cases is not whether to use new interventions without a ton of research evidence behind them, but the lack of clinical judgment and application of evidence-based practice principles when choosing and using OT interventions.


For example, in one setting where I worked I witnessed a department of over 50 experienced and intelligent clinicians buy into the promises of an intervention with only weak evidence to support it due to its extreme popularity in the pediatric professional sphere. No matter that this intervention required costly trainings and materials, was unlikely to be generalizable outside of a highly specific context, and was barely occupation-based – therapists wanted to learn it anyway! I was shocked that the department was spending limited continuing education funds on a popular pseudoscience program rather than a well-researched, evidence-based training that could help clinicians obtain better functional outcomes for young clients. Unfortunately, this is the case in many settings and with many practitioners.


The goal of this post is to closely examine one such program and break down how principles of evidence-based practice can be used to help make a determination about the validity, clinical applications, and utility of this program for occupational therapy practitioners. Read on to learn more about whether the widely-used Bal-A-Vis-X program is an evidence-based intervention or a highly-flawed fad!

Continue reading

Evidence Based OT Practice, Part III: How to Become an Evidence-Based OT Practitioner

Evidence Based Practice Series (1)

Current literature indicates that many healthcare practitioners – including OT practitioners – are failing to identify or utilize high-quality, up-to-date sources of evidence and are instead relying on personal experience, popular media, and outdated treatment protocols to provide intervention.


I have observed firsthand the difficulty of integrating evidence into practice during my OT education and employment experiences. During one of my fieldwork placements, a veteran fieldwork educator with 15+ years of experience gave the same home exercise program (HEP) to every client she saw, despite their diverse diagnoses and abilities. Although one could argue that upper body strengthening may be generally helpful for any person who is recovering from illness or injury, I began to wonder whether or not giving the same handout and Theraband to every client was actually benefiting them. In short, what was the evidence supporting this practice?


The fieldwork educator certainly wasn’t harming any of the clients by giving them a generic home exercise program. But not causing harm isn’t a particularly good reason to use a treatment or intervention. By that logic, you could provide any treatment whatsoever as long as you aren’t hurting your patients! It seemed to me like this supervisor had simply included “home exercise program” as part of her routine, rather than carefully considering each person’s condition, learning style, or level of health literacy and incorporating this information into her plans of care.


I don’t fault my fieldwork educator for her actions; since joining the workforce I’ve experienced firsthand how challenging it can be to ensure that the interventions I provide are evidence-based. It’s exhausting to spend all day treating patients, answering emails, talking with interdisciplinary team members, documenting, and going to meetings – some days it feels like Googling an unfamiliar diagnosis is the most than I have the time or energy to do. Despite this, I push myself every week to read an article, pick a coworker’s brain, talk with a mentor, or find another way to continue incorporating evidence into my everyday practice. And I’ve found that while it’s not always easy, it is always worth it to find evidence to support the interventions I provide and grow my knowledge base and clinical skills.


Why Is It So Hard to be an Evidence-based OT?

There are a plethora of reasons why many occupational therapists struggle to consistently utilize evidence within their daily practice, such as:

Continue reading

Barriers to EBP: A Social Media Study

Evidence Based Practice Series.png

According to AOTA, “Evidence-based practice (EBP) is based on the integration of critically appraised research results with the clinical expertise, and the client’s preferences, beliefs and values” (American Occupational Therapy Association, 2017). Essentially, it is a complex balancing act between the clinician’s knowledge and experience, high-quality research, and client factors. Maintaining equilibrium between these three factors is crucial to ensuring high-quality, evidence-based occupational therapy practice.

EBP Pyramid Diagram


  • By focusing too closely on research results, a clinician risks ignoring client preferences and discounting the value of their own clinical expertise.
  • By relying too heavily on personal and professional experience, a clinician may fail to remain abreast of relevant research and acknowledge client opinions and preferences.
  • By concentrating too much on client factors, a clinician may reject or ignore clinical experiences or evidence that doesn’t precisely match the client’s background or health condition.


Although the definition of evidence-based practice is clear, the implementation of evidence-based practice is much more difficult.


Barriers to Evidence-based OT Practice

In the book Evidence-based Practice for Occupational Therapists (2007), author M. Clare Taylor perfectly summarizes the challenge that evidence-based practice presents. She wrote:

“There is a growing body of evidence (e.g. Wiles & Barnard 1998; Upton 1999b; Welch & Dawson 2006) that therapists are less willing to act on research evidence than they are to act on other forms of evidence to review or change their practice. Upton (1999b) found, in descending order of willingness to act, that therapists would act on information from the follow sources:

  • own practice and experience
  • colleagues from the same profession
  • line manager
  • journal articles
  • clinical effectiveness facilitator
  • colleagues from different professions
  • the internet

when reviewing or changing their practice. From this evidence there would appear to be a mismatch between the accepted hierarchy of evidence for EBP and the value therapists place on various sources of evidence.

Perhaps one of the biggest challenges to the development of [evidenced-based OT] is this reliance upon experiential knowledge. However, the definition of [evidence-based OT] cited earlier emphasizes the use of three strands of evidence when making intervention decisions. The evidence-based occupational therapist should draw on her or his own experiential evidence, on evidence and information from the client and on a critical review of the research evidence…the skill is to synthesize all of this evidence and to make sure that all three strands are utilized rather than [relying] on experiential evidence alone.”

Taken together, the data from professional literature, published studies, and my own professional and clinical experience suggest that while many therapists understand the value of evidence-based practice, they do not consistently use an evidence-based approach to practice. It is also apparent that there are many therapists who do not appear to understand the meaning or importance of EBP, and these individuals may be damaging our professional reputation – or worse, clients – by using unproven interventions with unpredictable outcomes.


This struggle between overreliance on experience and the skilled integration of multiple types of evidence in OT practice that Taylor described is exemplified in the following social media “case study” that will be the focus of this post.


Evidence Based OT Practice: A Social Media Study

The screenshot below was originally shared in the Pediatric Occupational Therapy Facebook group, and it was the spark that ignited a heated discussion about evidence-based practice – specifically, what constitutes “evidence,” the use of evidence in OT practice, and the importance of fact-checking and clinical reasoning when making treatment decisions. The resulting dialogue demonstrates just how charged and complex the conversation about EBP continues to be in everyday practice and professional circles.


Although it is only a single discussion thread, this online debate was a largely accurate representation of the current state of evidence-based practice in occupational therapy and many other health professions. Additionally, it provides eye-opening, concrete examples of the aforementioned barriers to evidence-based practice from the perspectives of everyday practitioners.


Note: I have preserved the sequence and overall flow of the discussion while removing some unrelated comments for the ease of reading.

EBP Facebook Original Post

After the link was posted, the first commenter stated:

“I would be cautious in recommending this intervention. It is not considered evidence-based. If a family is considering doing it, it is our duty as the professional to let them know it is considered experimental. Maybe this has to do with the lack of training courses as well.”


In response, another individual referenced several other controversial, newer, or minimally-researched treatments that are considered by many OT professionals to be “experimental” and cited their widespread use as a reason to continue using them:

“Same with [Masgutova], the Astronaut Program, [The Alert Program], [Interactive Metronome], [Integrated Listening Systems], I could go on and on. I am always on this thread saying evidence based! But, Wilbarger does have a long history of practice and I have met so many therapists, teachers, and families swearing by it and I have seen it work myself. Unfortunately in OT, there is very little of what we do, especially in [pediatrics] with research to back it. If we used that rationale all the time, there would be very little treatment modalities.


Another practitioner appeared to agree with her, saying “I find the research comment that comes up almost comical. When I was in school 20 years ago there wasn’t enough research to even support the effectiveness of OT interventions in many ways…I find minimizing new therapy techniques due to lack of specific research techniques to be limiting to our field.


Unfortunately, these commenters and several others clearly demonstrated the way in which many OT practitioners fail to use a well-balanced, evidence-based approach to OT intervention and choose instead to place more confidence in personal experiences or anecdotes than high-quality research or other reputable sources.


Advocating for Evidence-Based Practice: Advancing Patient and Professional Outcomes

At this point, another group member acknowledged the limitations of research in OT but argued that it is still crucial to use the best evidence available to make treatment decisions:

“…A lack of evidence is not evidence the intervention is lacking, only that its efficacy has not yet been tested or established by research methods. You are right in that if we only ever used [clinical research] evidence based interventions we would have a very narrow practice. But to suggest weak evidence is strong is very wrong. And to suggest peer review gives credit is also dangerous. We need to combine evidence (at all levels) with our clinical wisdom.


As the conversation continued, more therapists chimed in with reasons why the treatment in the original post was not evidence based and why the original poster and others should be wary:

  • “If you look deeper [into a research article linked on the Masgutova website], this is not strong evidence in a respected journal. Many are published in ‘pay to publish’ journals. Just because something is published or peer reviewed doesn’t mean the conclusions it comes to are sound.”
  • I’m EXTREMELY skeptical about a link that takes me right to a sales page. Reminds me of a day-long Brain Gym training that was nothing but a thinly disguised sales pitch for much more costly trainer training.”
  • We need to be critical consumers of research to continue to move our profession forward. Many of the articles presented in that link are theoretical, not actually something that contributes to establishing an evidence base. And there appears to be minimal research into efficacy that (1) addresses functional performance changes related to occupational performance and (2) have been done by independent researchers who aren’t affiliated with Masgutova. Those two things should be red flags for OTs…in the meantime, we can say we’ve seen results anecdotally, but we can’t say that the intervention is evidence based.
  • “Please be aware that what is presented [on the Masgutova website] is heavily self-promotional and a marketing tool (while looking scientific). Very few [studies] appear peer reviewed – the [study] on EEG findings makes sweeping statements based on a single case, [and] the rest are postings of non-published cases, anecdotes, and heavily biased blog material.”
  • “Most sites touting reflex integration have few or no primary research references and mainly blog articles, magazine references, infomercials, or just anecdotes. We need to support our role [in] OT treatment with critical analysis and current science.”


Soon the discussion turned toward the complexity of evidence-based practice and individual clinicians’ understanding of what that meant for everyday practitioners. It was encouraging to see the number of important points commenters made about how complex evidence-based practice can be:

  • “[The original post and ensuing discussion are] a real case in point for how establishing evidence is a complex and skilled process, we need to critically evaluate the methods, the review process, [and] how it fits with other relevant research.”
  • Evidence-based practice has to include our clinical experience as well. All levels of evidence have a place. Research is important and should influence practice in a thoughtful way. I would not exclude trying a new approach that could help a client for lack of research nor would I persist with a new method that doesn’t work for my client, no matter how much research indicates efficacy.”
  • “I’m far more cautious about a new approach that touts an evidence base which is weak, than a clinically well tried approach which is poorly researched and that fact is acknowledged.”


As the discussion wound down, it became clear that there was a divide between clinicians who continued to believe in the efficacy of the treatment based on the website’s provided “literature” and personal anecdotes and those who remained highly skeptical of it. However, the well-reasoned and intelligent statements from multiple clinicians advocating for a multi-pronged approach to evidence-based practice demonstrate that it is crucial to understand the complexity and value of multiple types of evidence for providing high-quality, patient-centered, and effective OT services.

Ignoring Evidence-based Practice: The Potential to Cause Patient and Professional Harm

Disappointingly, despite the many comments advocating for a more evidence-based approach to practice, other participants in the conversation continued to cite the “lack of evidence and research in OT” to support their continued use of treatments that have limited evidence for their effectiveness.


It is not the use of “untested” interventions that is the most alarming in these scenarios – every treatment has been “untested” at some point, and clinicians can collect valuable data on outcomes for clients who receive new or emerging interventions that can help inform practice. Rather, it is these clinician’s seeming inability to critically analyze evidence, overreliance on personal experience and outdated information, and outright dismissal of available evidence or cautionary advice to justify their use of fad “interventions” with little or no proven impact on functional performance that is most distressing and potentially dangerous.

In addition to relying too heavily on anecdotal experience, individuals who appear to be unfamiliar with the multifaceted nature of evidence-based practice frequently used a bandwagon approach (“Everyone is using it, so it must be OK”) and the “lack of evidence for OT” excuse (which I disprove here) as the basis for clinical decision-making regarding the use of reflex integration, Astronaut Training, the Masgutova method, and other controversial interventions.

It’s true that dismissing new approaches or interventions simply because they are new and as-of-yet untested can limit treatment options that may be beneficial for clients. However, it is important to recognize that many healthcare interventions are not “minimized” because they are new, but because they are untested or unproven. Just as physicians and public health officials are cautious when recommending newly-developed drugs or treatments, occupational therapy practitioners should take a measured, evidence-based approach to using any interventions without sufficient evidence to determine clear risks and benefits to clients.

New treatment approaches should never be outright dismissed, but it is the practitioner’s responsibility to educate patients about the emerging nature of the treatment, carefully review all available evidence, and monitor closely for negative outcomes and functional outcomes linked to changes in occupational performance. By ignoring this responsibility, OT practitioners are taking a dangerous approach to professional practice with potential ramifications at the individual, population, and even policy levels as our professional credibility is damaged or diminished by the use of ineffective or sham interventions.



In the Facebook discussion above, multiple clinicians relied too heavily on personal experience and weak evidence to support the use of unproven occupational therapy interventions. However, the conversation also highlighted other professionals’ use of a more evidence-based approach to intervention that incorporated all three elements of the evidence-based practice triad – high-quality research or clinical evidence, solid clinical reasoning, and knowledge of client factors:


Again, this isn’t to say that clinicians should never try new treatments with clients just because they don’t have multiple research studies backing them up. However, it is important to implement the principles of evidence-based practice when trying new interventions – by conducting a thorough review of available information and literature, thinking critically about the intervention’s mechanisms and goals, and considering how it will impact a client’s occupational performance before and after implementing it.


This discussion highlights major hurdles to evidence-based practice that exist among OT professionals with a wide variety of experience, practice settings, and education backgrounds. The following are several recommendations for improving your and others’ understanding of and implementation of evidence in practice:

  • Have ongoing, open dialogue with colleagues and others about their practice decisions
  • Increase awareness about what constitutes high-quality evidence versus marketing materials or propaganda
  • Improve education about implementing evidence-based practice effectively (i.e. blending clinical reasoning, patient values, and quality research evidence)
  • Reduce or eliminate the use and promotion of interventions that deviate greatly from the foundational values of OT and do not significantly impact patient participation in or return to meaningful roles, routines, and occupations


In the future, I hope to see more occupational therapy practitioners taking the time and effort to identify, analyze, and apply high-quality evidence across practice settings and patient populations. Ultimately, dialogues like the one above indicate that we are making progress towards this goal, but that we still have a ways to go.