Contemporary occupational therapy practice: the challenges of being evidence based and philosophically congruent

Several authors have written of the need to embrace occupation and use it to energise our practice, research and education for the benefit of the profession, individual occupational therapists and ultimately, and most significantly, our clients. However, Wilcock (1999) best summarises the issues and the work that must be done, calling for the profession to adopt a consistent professional philosophy. This approach is entirely congruent with the paradigm approach proposed by Kielhofner (2009). Reinforcing the ideas of Doris Sym, Wilcock (p. 192) states that ‘the first essential for each individual in any profession is the acceptance of a philosophy that is the profession’s keystone.’ Wilcock is clear that such a philosophy should not be adopted and enacted in a rigid way, but it should be dynamic so as to enable the profession to respond to research and theories, and changes in the world. In essence, a professional philosophy should guide research, education and practice and be a touchstone when considering potential changes to practice. It is our suggestion that occupational therapists, individually and collectively, need to use our occupational philosophy, currently best operationalised by the Contemporary Paradigm, to inform EBP. In conclusion, we again find ourselves at a cross road for the profession with the occupational philosophy of the Contemporary Paradigm at times challenged by the adoption of research evidence into practice. We would encourage all occupational therapists to engage in EBP but do so ever mindful of its complexity. We would suggest that evidence-based decision making is viewed through the lens of the occupational therapy philosophy, with occupational therapists critically questioning whether or not the ‘procedure’ for which there is evidence is consistent with the Contemporary Paradigm. This is a complex matter, with many remaining issues to be explored. We would encourage all occupational therapists to interrogate the ways in which they implement EBP and consider the extent to which the profession’s philosophy guides practice decisions.