What is Evidence-Based Practice (EBP)?

 

ASHA defines evidence-based practice as “the integration of research evidence with practitioner expertise and client preferences and values into the process of making clinical decisions.” Highlighted in that statement are 3 important considerations that clinicians need to make when selecting treatments for patients:

  1. As a clinician, you have a responsibility to use treatments that are backed by research
  2. It is necessary to use your own clinical expertise to judge the validity of evidence
  3. You are responsible for factoring your client into your decision. Are the cost benefit trade offs reasonable for this client? What do you know about the client that may make them receptive or not receptive to a treatment? Can their families properly support them throughout a specific treatment?

 

Why Speech-Language Pathologists (SLPs) Need Evidence-Based Practice

 

Evidence based practice is still relatively new to speech pathology, as well as to other therapies such as physical and occupational. Nevertheless, those who hold a Certificate of Clinical Competence (CCC) are required by the ASHA code of ethics to engage in EBP. The code states that services should only be performed if it is reasonable to expect a benefit. The code also states that clinicians must strive to perform their best, which cannot be done without effectively evaluating treatment plans.

Even if you are not a CCC-SLP, EBP is still important for you and your patients. Those who turn to evidence-based practices find that not only are their methods effective, but that they can confidently back them up to clients and their families. It is especially necessary to have facts to rely on when a treatment is little known or controversial. When you use evidence-based practice to take care of your patients, you are also taking care of yourself because you can always defend your choice of treatments.

 

Common Barriers to Accessing Evidence-Based Research

 

If you are not currently using EBP in your practice, you are not alone! Only 20% of speech pathologists currently factor journal research into their clinical decision making.

There are several reasons why many speech pathologists aren’t currently relying on the research. They may worry that staying on top of current research requires consistent time and effort that they can’t fit into their already busy days. They may assume that the only way to access research is by purchasing expensive peer reviewed journal articles. Honing your ability to scrutinize research takes time and can be daunting at first.

 

Barriers % of SLPs
Time 79%
Money 59%
Evidence Availability 53%
Lack of Supervisor Support 47%
Difficulty Interpreting Literature 40%
Data from ASHA

 

Luckily, many of these perceived barriers have gone away with the recent availability of online resources dedicated to making access to research affordable and efficient. The largest real barrier out there is knowing how to engage in the EBP process. The best way to overcome this is practice. To help you learn how to access information in a time and wallet friendly manner, we have compiled this guide full of steps you can take and resources where you can find the research you need.

 

How to Use Evidence-Based Practice as a Speech-Language Pathologist

 

Therapy evaluation is a multi-step process that is continuously repeated as the speech pathologists learns more and new research continues to become available. The availability of evidence-based information doubles every decade, so there is always new research to stay on top of. The process is as follows:

 

Define What you Want to Know

Define what you are trying to find out in the form of a research question. A good question has all aspects of the acronym PICO (Population, Intervention, Comparison, Outcome):

  • What type of disorder are you looking at among what age group?
  • What treatment for this disorder are you evaluating?
  • Are you interested in a before and after comparison or a comparison to other treatments?
  • What is the goal of implementing this treatment in terms of specific improvements?

 

Locate and Evaluate Evidence

Remember PICO as you look for evidence that most closely applies to the questions you are asking. Not all evidence is created equal! While you will always have to take a critical look at any kind of evidence, a first step in your quest for strong evidence should be knowing what type of research is strongest:

 

Several Study Consensus

Use research that considers data from several studies whenever possible. Gathering a wide reaching consensus irons out contradictions between individual studies and improves critical validation.

  • Systematic Review- A rigorous summary of existing evidence
  • Meta-Analysis- Statistical analysis of the results of several studies that examines weighted significance of the treatment

 

Single Study

When systematic reviews are not available, rely on any individual studies you can find. Individual studies may contradict each other, so you will need to use your critical evaluation skills to determine which studies appear strongest. From strongest to weakest, here are the types of studies to look for:

  • Randomized Controlled- Randomization is thought to best eliminate bias.
  • Non-Randomized Controlled
  • Quasi-experimental
  • Non-experimental studies observing cases or correlation

 

Consensus

It is typically advised that you rely on data rather than expert consensus. However, at times when evidence is hard to find or contradictory, expert consensus may be all that you have. Though part of EBP is continuously integrating research with the results you see in your own clients, data gathering is especially important when you are relying on expert consensus rather than studies.

 

Evaluate Evidence for Credibility and Real Life Practicality

Credibility: Depending on the question you have posed, existing evidence may be strong or weak. Always use your judgment when evaluating studies. Look for the possibility that other factors had an impact on the study’s results. Make sure that the evidence relates to the clients you are looking to treat (PICO). Are possible limitations disclosed? Are there potential conflicts of interest? Are the results important? Does the author’s rationale make sense?

If you are not used to evaluating trials and reviews, Oxford University has some great appraisal sheets to help you get used to looking for the right things. Over time, the process will become more natural.

Real Life Practicality: Implementing treatment needs to be reasonable. It should be easy enough to replicate in your own practice and be affordable as well. Is this treatment in any way unreasonable for the patient or family? Dartmouth has created a simple worksheet for evaluating this.

 

Design and Implement Treatment Protocols

Put the evidence to the test. Design a protocol using the evidence you found in combination with your clinical expertise and the patient’s needs and values. Use your protocol on the client. Take data on your client before and after treatment.

 

Evaluate Effectiveness

Use your data to determine the effectiveness of the treatment. Did you achieve the outcomes defined in your research question? Based on your findings, you will choose to adopt, modify, or reject the treatment method.

 

Go Back to Step One

Remember, EBP is a continuous process!

 

Evidence-Based Practice Resources for Speech Pathologists

 

These resources for speech pathology evidence-based practice make finding evidence easy and affordable!

 

Evidence Summaries

ASHA Practice Portal– ASHA has compiled a database with information on about 3 dozen speech, language, and hearing disorders. For each topic, there is information on evidence-based assessment and treatment recommendations. These resources take dozens of clinical research papers and synthesize them into one easy to digest guide to the condition you are assessing and treating.

ASHA Evidence Maps– This resource from ASHA allows you to sift through speech-pathology research summaries to find exactly what you need. You can sort by whether you are looking for assessment or treatment information, bilingual, populations, and recency. Each piece of research is also clearly flagged for the type of research that it is- guideline, systematic review, etc. Quality, description, and conclusions from the research are all concise.

ASHA Systematic Reviews– The systematic review is the king of all research as it takes a look at several studies on a topic. ASHA has a simple list of linked reviews for you to peruse, organized by topic.

Pearson EBP Briefs– A wide range of reviews, from literature reviews to systematic, on a variety of speech topics.

The Informed SLP The Informed SLP website combs through the new research so you don’t have to. It is an efficient way to get up to date information on the latest pediatric speech-language pathology research. There is a $7 monthly membership fee to access the evidence you can use section, but well worth it considering the time you save and the importance of staying current on your research. The blog and Q&A are free for everyone. (Pediatric)

Cochrane Database of Systematic Reviews– This database of medical systematic reviews includes many reviews that are specific to speech-language pathology. (Medical)

 

Using Continuing Education and Conferences for Evidence-Based Practice

Continuing education is a great opportunity for speech pathologists to get new evidence-based information. Remember that using CE as an opportunity to learn new research isn’t a given- presenters are encouraged but not required to cover evidence-based practice. Before signing up for your CE, make sure the topic is integrating research!

  • One great resource for hundreds of great evidenced-based online speech CEUs is Medbridge. You can filter by population, setting, topic, and more.
  • Conferences also give you the opportunity to sit in CEU sessions where the latest research is discussed.

 

Evidence-Based Speech Pathology Apps

Tactus Therapy– A whole range of apps (over 200!) for adult speech therapy, including apraxia, dysphagia, comprehension, and more

Smarty Ears– Wide range of pediatric speech, language, and communication apps

Constant Therapy– Evidence-based speech pathology app for aphasia/brain injury recovery

Not sure whether an app is research-based? Scroll through it and do some research to see if it cites research. Some apps may not cite research but your knowledge of EBP may help you determine that the app falls in line with proven rationale. Here is a great resource for assessing an app when it is unclear as to whether or not it is evidence-based.

 

What if There isn’t Good Evidence Available?

 

When there is not enough evidence on the efficacy of a treatment to interpret (or evidence is low quality) rely on Practice Based Evidence (PBE) instead. It would be a disservice to patients to not treat them because you couldn’t find strong, non contradictory evidence that applied to them and their treatment needs. PBE involves clinicians collecting their own data to evaluate treatment efficacy. While clinicians should consult available evidence first, PBE is there for you when that is not possible.

It is important to be systematic in the development, implementation, and evaluation on any non-evidence-based treatments you turn to.

  • Start by referring to the same clinical question that you asked as you tried to look for evidence
  • Create a treatment plan to generate your own data
  • Formulate hypotheses and run an experiment
  • Analyze outcomes and keep track of them. Use your data to guide future treatment

 

Still Have Questions?

 

Evaluating evidence is a skill that you hone over time, and the process requires different sets of decision making skills along the way. ASHA has a lovely resource for learning more about mastering each specific step of the process.