Five Finger Framework

A five finger model will help new occupational therapists make evidence-based decisions.

New occupational therapists starting in practice already know about the value of Evidence-Based Practice, to make sound decisions in the assessment and treatment of their clients. But it can be difficult for them to remember and appreciate the value of all possible sources of evidence to inform their decision-making. 

Senior Lecturers Helen Jeffery and Kim Reay with former colleague Associate Professor Linda Robertson have been researching what people consider Evidence-Based Practice to be. The team held focus groups with experienced clinicians and with final year Bachelor of Occupational Therapy students, and interviewed lecturers. The results revealed five discrete sources of evidence that are relevant and valid for clinical decision-making:

  • Research and literature, for example textbooks and journal articles;
  • The context and environment (both the client's and the therapist's), for example relevant policies and guidelines;
  • The client, who is the expert on themselves, for example to identify treatment options that are meaningful for them and which they are more likely to persevere with;
  • Expertise of other people, for example talking to colleagues, going to conferences, and valuing also people's lived experience; and
  • The therapist who is making the decision, their own knowledge and skills and experience. This also includes their values and professional style, and is developed through learning from genuine reflective practice.

The team adopted the five finger model to provide a framework that would help students to apply Evidence-Based Practice after they graduate. The thumb represents the fifth source of evidence, the therapist, which can touch every other finger: clinical decision-makers should be using all five sources of evidence, not just one or two. The model has been presented to occupational therapists who are already in practice and has been implemented in the Bachelor of Occupational Therapy programme. 

August 2021

Image credit: "Mattias", sourced from Flickr, public domain