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: [email protected]
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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,
ation and Libraries Journal, 27, pp.106–113
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
ª 2010 The authors
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
ation and Libraries Journal, 27, pp.106–113
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
ª 2010 The authors
p. Health Information and Libraries Journal, 27, pp.106–113
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
ª 2010 The authors
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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