DOI:10.1111/j.1471-1842.2010.00877.x

OTseeker helps library and allied health professionalsto find quality evidence efficientlyAnnie McCluskey*, Sally Bennett†, Tammy Hoffmann† & Leigh Tooth‡*Postdoctoral Research Fellow, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW 1825, Australia,

†Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane,

Qld 4072, Australia and ‡School of Population Health, The University of Queensland, Brisbane, Qld 4072, Australia

Abstract

Background: Research is essential for evidence-based practice yet many health professionals do not have

enough time to find research. Studies relevant to occupational therapists can be particularly difficult to find.

Most search engines are broad and return a large number of irrelevant articles. Occupational Therapy System-

atic Evaluation of Evidence (OTseeker) is an occupational therapy database available at http://www.

otseeker.com. Developed by Australian occupational therapists, the resource aims to increase access to

research and support clinical decision making. This discipline-specific database contains pre-appraised

information from a variety of sources and decreases the time required to locate best evidence.

Objectives: The aims of this paper are to: (i) describe how health librarians can use OTseeker to help

allied health students, researchers and practitioners, particularly in occupational therapy, to find quality

evidence; (ii) provide a teaching resource for health librarians based around the OTseeker evidence data-

base; and (iii) highlight new features contained on the OTseeker database.

Methods: A case study is provided which focuses on searching for evidence on the effectiveness of upper

limb rehabilitation after stroke using OTseeker.

Conclusion: This paper may increase the knowledge, skills and competencies of health librarians, helping

them to access evidence-based databases, and educate other professionals.

Keywords: bibliographic, databases, education, evidence-based medicine, health, students

C

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Key Messages

Implications for Practice

d By helping students and academics to access OTseeker, health librarians can promote the use of

journal articles as a source of evidence about occupational therapy interventions, thereby promoting

evidence-based practice.d Health librarians can help students to understand the methodological quality of studies (internal

validity) and the significance of results when reading articles, thus increasing their appraisal skills.d Information on OTseeker may contribute to improvements in knowledge about occupational therapy

interventions and changes in the practice of occupational therapists.d Learning about OTseeker can contribute to the professional development of health librarians.

Implications for Policy

d OTseeker provides free and efficient access to abstracts of studies from over 900 journals, which

would otherwise be very time-consuming for individuals to search.d Familiarity with OTseeker and similar databases may become a necessary competency of health

librarians.

orrespondence: Annie McCluskey, Faculty of Health Sciences, The University of Sydney (Cumberland Campus, Blg J), PO Box 170, Lidcombe,

SW 1825, Australia. E-mail: annie.mccluskey@sydney.edu.au

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Using OTseeker to find evidence efficiently, Annie McCluskey et al. 107

Introduction

Occupational Therapy Systematic Evaluation of

Evidence (OTseeker) is a web-based resource

developed in 2003 and available at http://www.

otseeker.com. The overall aim of OTseeker is to

improve the quality of occupational therapy care

and enhance the health outcomes for consumers of

occupational therapy services.1 OTseeker is the

only database providing evidence of the effects of

occupational therapy-relevant interventions, and

has thus become an internationally important

resource. OTseeker was modelled on the physio-

therapy equivalent, PEDro (Physiotherapy Evi-

dence Database; http://www.pedro.org.au/). This

article aims to describe how OTseeker can be used

by health librarians to find quality evidence, and

includes a teaching resource and case study which

can be used during library tutorials. We start by

providing a brief overview of OTseeker and the

rating scale used to appraise randomised trials.

OTseeker: an overview

As described previously in this journal,2 the OT-

seeker database contains bibliographic details,

abstracts and quality ratings of over 4650 rando-

mised controlled trials (RCTs), and citation records

of over 1390 systematic reviews. These methodol-

ogies were selected for inclusion in the OTseeker

database because they provide the strongest evi-

dence about the effects of interventions.3 In 2009,

OTseeker provided free access to over 6000

records relevant to occupational therapy, sourced

from over 900 journals. The database was devel-

oped by a group of Australian occupational ther-

apy researchers, and contains international research

intended for use by an international audience.

Occupational therapists, service users, health

librarians, purchasers and others can use the infor-

mation contained on OTseeker to make better

informed clinical decisions about occupational

therapy treatment, rehabilitation, care and support.1

OTseeker has also been used to identify and

inform research priorities by determining where

gaps exist in the literature.4–7

The web-based resource also contains a tutorial

on critical appraisal and rating of RCTs, and links to

other sites about evidence-based practice. As part of

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a new initiative, OTseeker now contains an injury

management resource webpage (http://www.

otseeker.com/homeIMR.aspx). This webpage is

accessed separately from the main search function,

and contains information to answer clinical ques-

tions about the treatment of people with a spinal

cord or traumatic brain injury, burns and musculo-

skeletal conditions. In addition to research about the

effect of interventions, this injury management

resource includes research about assessments, prog-

nosis, consumer’s experiences and concerns (quali-

tative research) and clinical guidelines. This new

resource may be useful to health librarians who are

asked to provide continuing education and updates

on evidence in these practice areas.

Information sources and rating strategies used

on OTseeker

Records of systematic reviews and RCTs contained

on OTseeker are located using searches of the

following databases: Medline, CINAHL, ERIC,

EMBASE Rehabilitation and Physical Medicine,

AMED, PsycINFO, the Cochrane Library, Cancer-

Lit, Ageline and the TRIP database.8 Fifteen dif-

ferent search strategies covering different topic

areas relevant to occupational therapy were devel-

oped and tested by a group of occupational thera-

pists in consultation with librarians at The

University of Queensland. In addition to content-

specific search strings, these search strategies

include terms for locating RCTs and systematic

reviews. The OTseeker team is notified by auto-

alert strategies when new trials are added to the

Medline, CINAHL, EMBASE, AMED, ERIC,

PsycINFO and TRIP databases. The OTseeker

team also exchanges content with the developers

of the PEDro database and the Rehabilitation and

Related Field of the Cochrane Collaboration.8

Content is further shared between two similar data-

bases, PsycBITE (http://www.psycbite.com) and

speechBITE (http://www.speechbite.com). Thirteen

occupational therapy journals are also hand-

searched every 2–3 years. Approximately 50 new

records are uploaded to the database each month.

To be eligible for inclusion in OTseeker, the

study must meet several criteria. First, the study

must compare at least two interventions (which

could include a therapy technique, equipment,

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Using OTseeker to find evidence efficiently, Annie McCluskey et al.108

prevention, management or education strategies)

using either an RCT or crossover design.

Second, the study must be published in a

peer-reviewed journal. Third, at least one of the

interventions must currently be part of occupa-

tional therapy practice, or could become part of

occupational therapy practice in one or more

country, although studies do not need to be con-

ducted by an occupational therapist, nor does the

intervention need to be exclusive to occupational

therapists. Fourth, the intervention must be

applied or used with human participants who

might be seen by an occupational therapist (i.e.

humans with a health condition or disability.

Fifth, the trial should involve random allocation.

Systematic reviews included in OTseeker must

contain at least one RCT that meets the criteria

listed above and also contain a methods section.

Although randomised trials are considered

strong evidence, not all RCTs are well designed or

well reported. Many RCTs contain substantial

methodological biases. The OTseeker database is

designed to help users determine the methodologi-

cal rigour, biases and validity of RCTs. All RCTs

contained on the OTseeker database are rated using

the PEDro scale partitioned into two sections.9

The first section addresses eight criteria relevant to

the internal validity of study methods: random

allocation; concealed allocation; similarity of study

groups at baseline; blinding of participants; blind-

ing of therapists; blinding of assessors; outcome

measures obtained from more than 85% of partici-

pants; and intention-to-treat analysis. The criteria

in the second section rate interpretability of statisti-

cal reporting and focus on the interpretation and

presentation of results: between-group statistical

analysis (e.g. P-values) and point measures with

variability data (e.g. confidence intervals).8

The rating is based on information presented in

a publication. If a methodological feature such as

concealed allocation is not reported, it is recorded

as not being met.10 The rating for each RCT is

displayed on the database indicating the number of

internal validity criteria met (out of a possible 8),

and the number of statistical reporting criteria

demonstrated (out of 2). RCTs that report on more

of the internal validity criteria may be less suscep-

tible to bias than those reporting fewer criteria.

However, the final decision about internal validity

Journal compilation ª 2010 Health Libraries Grou

and methodological quality will be influenced by

which criteria are met, not simply by the number

of criteria met.11 For example, two apparently sim-

ilar RCTs may both meet four of the eight internal

validity criteria; however an RCT that reports

using concealed allocation, blinding of subjects,

blinding of assessors and intention-to-treat analysis

will potentially be less susceptible to bias than an

RCT that reports using concealed allocation, hav-

ing groups that were comparable at baseline, using

blinding of assessors and having follow-up of

more than 85% of subjects allocated to groups

depending on the specific nature of the trial. The

statistical reporting criteria allow users to deter-

mine if a published RCT contains information

about the statistical and clinical significance of

study findings. For more information about rating

RCTs, see McKenna et al.2

Use of OTseeker by health librarians

Health librarians are already using OTseeker. A

recent online survey of all users of OTSeeker found

that 4% of the 498 respondents were librarians.12

Although this percentage is small, it is apparent that

the OTseeker database has the potential to be a use-

ful resource for health librarians. Reasons given by

users for accessing the database included respond-

ing to student needs, seeking clinical information, as

well as seeking original research and conducting

research syntheses. A small proportion of respon-

dents also used OTseeker for teaching and training

purposes or professional development.

Librarians may be required to demonstrate the

use of OTseeker during undergraduate or postgrad-

uate student tutorials. Alternatively, students may

approach a health librarian with specific questions

about the use of OTseeker, or require help to

optimise their search. Research involving recent

occupational therapy graduates in the United States

identified formal library sessions and informal

contact with librarians as important ways by which

they developed information literacy skills.13 Two

health librarians from the University of Sydney

reported anecdotally that they are often approached

by allied health students for help with searching.

Typical problems include difficulty determining the

main concepts of a search question before com-

mencing a search. Following is a clinical scenario

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Using OTseeker to find evidence efficiently, Annie McCluskey et al. 109

which demonstrates the application of OTseeker

for health librarians, particularly during tutorials.

Clinical scenario: searching OTseeker using a

PICO question

A librarian is employed in a health sciences library

to help students (and staff) search for information

on various topics. The librarian notes that a sub-

stantial number of occupational therapy students

need help to search for information about the

effectiveness of upper limb rehabilitation as a

treatment for people with stroke. The librarian

decides to run a lunch-time tutorial session focus-

ing on searches across databases on this topic.

Because the students are interested in the effective-

ness of an intervention, the librarian should ini-

tially assist them to locate systematic reviews of

RCTs or individual RCTs. While students could

search multiple databases, such as the Cochrane

Library, Medline, Embase, CINAHL or TRIP data-

bases, an alternative is for the librarian to start by

showing students how to search OTseeker, as this

database is particularly relevant to occupational

therapy practice. The librarian could begin by

helping the student to focus their research ques-

tion. The method of structuring a clinical question

using the PICO format is presented in Table 1.3

All possible keywords for the question should

be identified, along with possible synonyms and

related terms. The ‘population’ row of Table 1

consists of the number of systematic reviews and

RCTs which were located when the keywords

stroke and ‘cerebrovascular accident*’ were used

individually, then combined with the Boolean logi-

cal operator ‘OR’. The librarian could also demon-

strate use of the drop-down menu containing

diagnoses and select ‘stroke’ rather than use the

above keywords. Table 1 highlights how use of

this drop-down menu increases the total number of

records located, retrieving extra studies.

The ‘intervention’ row of Table 1 represents the

number of systematic reviews and RCTs located

when ‘stroke’ was selected using the drop-down

menu containing diagnoses, and an intervention was

entered as a keyword. For example, the phrase

‘upper limb*’ can be used to cover any intervention

that might be classified as part of upper limb reha-

bilitation, and the term ‘Bobath’ used to locate a

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Journal compilation ª 2010 Health Libraries Group. Health Inform

specific rehabilitation intervention. Again, interven-

tions with more than one name can be entered as a

keyword then combined with the Boolean operator

OR, such as Bobath OR ‘neurodevelopmental treat-ment*’ OR ‘neurodevelopmental therap*’. Table 1

illustrates how combining synonyms for an inter-

vention in this way can increase search outcomes.

Students can be shown how to narrow search

outcomes without searching for a particular upper

limb rehabilitation method, by excluding irrelevant

interventions. For example, if a student was inter-

ested in all upper limb rehabilitation interventions

except electrical stimulation, they might be advised

to narrow their search then combine with the Bool-

ean operator NOT, such as ‘upper limb*’ NOT‘electrical stimulation’ while selecting ‘stroke’ in

the drop-down menu. At the time of writing, this

search resulted in 14 systematic reviews and 57

RCTs being identified using OTseeker. Students

need to be reminded that by excluding apparently

irrelevant interventions, they may lose studies that

compare an intervention of interest with an

excluded intervention.

As with many other databases, OTseeker supports

the use of a truncation symbol. As shown in

Table 1, the symbol * can be used to find alternative

endings to a search term. As an example, the librar-

ian could demonstrate use of the word ‘stretch*’

which instructs the database to search for terms such

as ‘stretches’, ‘stretched’ and ‘stretching’.

If a student was interested in comparing two or

more upper limb rehabilitation techniques (‘com-

parison’), they can be shown how to use the Bool-

ean logical operator AND to join the intervention

keywords, such as Bobath AND ‘proprioceptiveneuromuscular facilitation’ while selecting ‘stroke’

in the drop-down menu. At the time of writing

there was only one systematic review and one

RCT on the OTseeker database that compared

these two interventions.

If a search had to be narrowed further, the

librarian could demonstrate how ‘outcome mea-

sures’ can be included in a search. For example,

two systematic reviews and four RCTs were

located when ‘electrical stimulation’ AND impair-

ment were entered as keywords, and ‘stroke’ was

selected from the drop-down menu of diagnoses.

Only three RCTs addressed the effectiveness of

electrical stimulation for improving participation in

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Table 1 The formation of a clinical question using the PICO format3

Possible keywords

Systematic

reviews sourced†

RCTs

sourced†

Population Stroke 140 520

‘cerebrovascular accident*’ 1 22

Keywords combined 140 531

Diagnostic Drop-Down Menu Stroke 138 549

Intervention ‘Stroke’ selected from the Diagnosis

Drop-Down Menu and combined with

each of the following keywords:

‘Upper limb*’ 25 77

Bobath 3 16

Bobath OR ‘neurodevelopmental

treatment*’ OR

‘neurodevelopmental therap*’

5 20

‘Proprioceptive neuromuscular facilitation’ 1 1

‘Electrical stimulation’ 16 44

‘Virtual reality’ 3 3

‘Constraint-induced movement therapy’ 6 27

Stretch* 1 16

Intervention Drop-Down Menu

Hand therapy 3 14

Positioning 3 16

Positioning with ‘Upper limb*’ as

keyword phrase

1 8

Comparison (if relevant) Bobath AND ‘Proprioceptive

neuromuscular facilitation’ with

‘Stroke’ selected from the

Diagnosis drop-down menu

1 1

Outcome measure ‘Stroke’ selected from the Diagnosis

Drop-Down Menu combined with each

of the following keywords ⁄ options:

‘Electrical stimulation’ AND impairment 2 4

‘Electrical stimulation’ with ‘Basic

Activities of Daily Living’ selected in

intervention drop-down menu

1 3

Bobath AND limitation 1 1

†Number of records located as of August 2009.

Using OTseeker to find evidence efficiently, Annie McCluskey et al.110

basic activities of daily living. The latter search

outcome was achieved by entering ‘electrical stim-ulation’ as a keyword, and selecting ‘Basic activi-

ties of daily living’ from the drop-down menu

containing interventions, and ‘stroke’ from the

drop-down menu containing diagnoses.

Clinical scenario: helping students to interpret

search findings

A student may be interested in researching the

effectiveness of the Bobath approach for reducing

Journal compilation ª 2010 Health Libraries Grou

upper limb impairments post-stroke. By typing

Bobath OR ‘neurodevelopmental treatment*’ OR‘neurodevelopmental therap*’ in the keywords

field and selecting ‘stroke’ from the diagnosis

drop-down menu, a list of 24 articles were dis-

played at the time of searching in August 2009

(see Fig. 1). A larger number of articles are likely

to appear in future searches using these search

terms.

By clicking on any of the highlighted titles

shown, a detailed results page will be displayed.

In many cases, an abstract will appear if copyright

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Using OTseeker to find evidence efficiently, Annie McCluskey et al. 111

permission has been granted by the publisher of

that journal. The librarian could select a systematic

review of interest (e.g. ‘Outcomes of the Bobath

concept on upper limb recovery followingstroke’,14 published in 2004, which provided an

abstract at the time of writing. That review com-

pared the Bobath approach with other approaches

such as proprioceptive neuromuscular facilitation

and cryotherapy; the original authors concluded

that no single approach was superior over another

for reducing upper limb impairment, activity limi-

tations or participation restrictions after stroke.

However, the review raised concerns about the

methodological rigour of some studies. For exam-

ple, some studies used outcome measures which

were not sensitive to change, delivered the therapy

using untrained Bobath therapists and recruited

heterogeneous samples.

Individual RCTs listed on OTseeker can also be

appraised. One study from 2000 examined whether

the Motor Relearning Programme or the Bobath

approach resulted in different rehabilitation out-

comes for people with a recent stroke.15 That trial

found that people with stroke who received the

Motor Relearning Programme stayed fewer days in

hospital than those treated using Bobath princi-

Figure 1 Example of a results page when searching OTseeker, se

typing keywords Bobath OR ‘neurodevelopmental treatment*’ O

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Journal compilation ª 2010 Health Libraries Group. Health Inform

ples (mean 21 days versus 34 days, P = 0.008).

Improvement in motor function (the primary out-

come of interest) was considerably better for

stroke patients who received the Motor Relearning

Programme. However, there were no significant

differences between the groups for life quality, use

of assistive devices, functional performance (based

on the Barthel Index scores) or discharge destina-

tion. In conclusion, rehabilitation treatment involv-

ing the Motor Relearning Programme was more

effective than treatment involving the Bobath

approach for people early after stroke. That con-

clusion differs from the conclusion reported in the

systematic review in 2004 published by Luke

et al.14 Although OTseeker often provides an

abstract for individual RCTs, as in this case, it is

essential that health professionals and users of

OTseeker read the full article before making

clinical decisions.

In our scenario, the librarian could help the stu-

dent to determine the methodological quality of

the RCT using the record details. The RCT from

2000 on the effects of two different stroke rehabili-

tation approaches15 met four of the eight criteria

for methodological quality or internal validity, and

two of two criteria for statistical reporting. The

lecting ‘stroke’ from the drop-down diagnosis menu and

R ‘neurodevelopmental therap*’

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Using OTseeker to find evidence efficiently, Annie McCluskey et al.112

study randomly allocated stroke patients to one of

two intervention groups, thereby maximising the

chance that both known and unknown confounders

were equally distributed. However, allocation into

groups was not concealed; thus the person who

performed the allocations could have influenced

the randomisation schedule. The groups were com-

parable at baseline and outcome measurements

were reported for over 85% of the participants,

thus minimising follow-up bias. While the authors

were unable to ‘blind’ the people with stroke or

treating therapists to the treatment being provided,

they ensured that the assessors who measured out-

comes were unaware to which group participants

had been allocated. ‘Blinded assessors’ help to

reduce measurement biases. When examining the

statistical reporting, the study contained informa-

tion on between-group (as opposed to ‘within’-

group) comparisons and point estimates, so that

the student and librarian know that if they read the

full article they will be able to find differences

between control and treatment groups reported.

Conclusion

This scenario has illustrated how OTseeker might

be used by a health librarian to help students and

others to locate and then interpret research. OTsee-

ker provides fast and free access to evidence of

the effectiveness of occupational therapy

interventions. OTseeker can be used for clinical

decision-making, as well as by researchers when

performing systematic reviews of RCTs. Thus

OTseeker has the potential to be a useful resource

for health librarians when answering clinical ques-

tions and conducting tutorials.

Conflict of interest

The authors are the developers of the OTseeker

database.

Acknowledgements

OTseeker is currently funded by the Motor

Accidents Authority of New South Wales (Ref. ID

07 ⁄705) and the Occupational Therapists Registra-

tion Board of Queensland, Australia.

Journal compilation ª 2010 Health Libraries Grou

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Received 18 August 2009; Accepted 5 November 2009

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