Biomedical subjects

David L Nelson

Publications and source records attributed to David L Nelson.

57 records · Page 4Linked to original sources

PubMedDate not supplied

Randomized controlled trials to investigate occupational therapy research questions.

The randomized controlled trial (RCT) has become the most widely accepted research design for testing the efficacy of health care interventions. The purposes of this paper are to (a) introduce the essential elements of RCTs, and (b) discuss some of the special problems faced by occupational therapists in conducting and interpreting RCTs. The CONSORT (Consolidated Standards of Reporting Trials) statement is recommended as an introduction to the components of RCT quality. Problems pertinent to the study of the efficacy of occupational therapy and related interventions include the importance of: theory, background, and rationale; treatment fidelity; theory-based outcomes; management of non-masked (non-blinded) interventionists and participants; and multiplicity of statistical analyses. This paper can help practitioners judge the quality of an RCT, and it can help the profession work toward the development of a cadre of qualified researchers who can adapt the well-established methods of RCTs to the study of occupation-based interventions.

Evidence-Based Medicine↗

PubMedDate not supplied

Evaluating the quality of reporting occupational therapy randomized controlled trials by expanding the CONSORT criteria.

CONTEXT: Well-reported randomized controlled trials (RCTs) are necessary for evidenced-based practice in the field of occupational therapy. OBJECTIVE: The primary purpose of this study was to analyze the quality of reporting in selected RCTs relevant to occupational therapy by using the Nelson-Moberg Expanded CONSORT Instrument (NMECI). The interrater reliability of the NMECI was also tested. METHOD: The 201-sub-item NMECI was developed by the authors to clarify the 22-item CONSORT Statement, each item of which raises several issues. Fourteen RCTs obtained through the OTseeker database were analyzed independently by the authors. RESULTS: The 14 articles complied with slightly more than half of the sub-items of the NMECI (M = 104.2, SD = 32.9 for the main rater). The only area of full compliance involved reporting of objectives and hypotheses; areas of frequent noncompliance included reporting of adverse events, randomization, and blinding. The intraclass correlation coefficient assessing level of interrater agreement on the total NMECI score was .95, indicating strong agreement overall. For the 176 kappas that could be computed on individual sub-items, the median kappa was .85, with an inter-quartile range from .58 to 1, indicating high levels of agreement for most items. However, 29 kappas fell below the moderate level of agreement (.40). CONCLUSIONS: The field of occupational therapy needs increased sophistication in conducting and reporting RCTs. The NMECI shows promise in evaluating the quality of RCTs, given refinements to some items.

Evidence-Based Medicine↗

PubMedDate not supplied

Critiquing the logic of the domain section of the Occupational therapy practice framework: domain and process.

The Occupational Therapy Practice Framework: Domain and Process (also known as the Framework), an official document of the American Occupational Therapy Association, advocates terminology and a classification system for concepts that are central to the profession of occupational therapy. Its use has been advocated in practice, research, education, and communications with those who wish to know more about occupational therapy. Given its importance to the profession and to society, the Framework deserves intense scrutiny and sustained scholarly inquiry. This article investigates the logic of Occupational Therapy Practice Framework: Domain and Process, with a focus on domain. Are definitions and classifications within the domain logically coherent? The Framework repeatedly violates two rules of logical definitions: (a) a unique term must be applicable to certain particulars and must not be applicable to others (the rule of precision); and (b) the particulars assigned to one term must not be assignable to another term unless there is a logical explanation (the rule of parsimony). The Framework also repeatedly violates two rules of logical classification: (a) a lower-level category must be classifiable only within its assigned higher-level category (the rule of exclusivity); and (b) all relevant particulars must be classifiable (the rule of exhaustiveness). The profession of occupational therapy needs one or more logically coherent conceptual frameworks, but the Framework is not recommended as a logical basis for practice, education, research, and external communications. Specific recommendations are made in support of the development of a logical framework and the refinement of existing frameworks.

Logic↗