Guest Article by Donna Boudreau, PhD '97

Donna Boudreau
Guest Author Donna Boudreau, SLHS Graduate, PhD '97

Evidence-Based Practice – The Critical Importance to Our Field

It is difficult to circulate in any speech and language environment these days -whether deciding on a conference to attend, reading a journal article, or flipping through the ASHA Leader- without coming across the initials EBP. The ubiquitous use of this term might make clinicians wary of EBP as being the “hot topic” of the moment; one that will fade over time when leaders in our field find a new area of interest. However, evidence based practice (EBP) is a not a new concept to the field of speech-language pathology – what may be less familiar to some clinicians is the use of this specific terminology associated with the practice of looking for empirical evidence to support our clinical decision making process...(continued) The term EBP is not just semantics, however; its use aligns the field of speech language pathology to the medical community in important ways. ASHA’s recent position statement on evidence-based practice defines EPB as “the conscientious, explicit, and judicious use of current best evidence in making decisions about individual patient care [by] integrating individual clinical expertise with the best available external clinical evidence from systemic research” (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996, p. 71)

There are varied levels of evidence that may be available on a topic of interest, and clinicians will want to seek out the highest level of support available. Five themes contribute to the rating of evidence (ASHA, 2007). They include:

1. Independent confirmation and converging evidence
2. Experimental control
3. Avoidance of subjectivity and bias
4. Effect sizes and confidence intervals
5. Relevance and feasibility

As clinicians, we can feel most confident when we are using practices that have been adequately researched at each of these levels. For example, has a suggested clinical intervention been empirically evaluated? Has research been completed with persons other than the original authors? Has more there been more than one study completed that supports the benefits of this intervention strategy? Did the study(s) compare outcomes of the experimental group with a control group that did not receive treatment, or received different treatment? Are effect sizes reported for the changes that occurred from before and after the intervention took place? And are effect sizes sizeable (e.g. are the effect sizes large enough to make this intervention worth our time, energy and resources?) These are all important questions to ask as a way of measuring the degree of evidence available about a suggested practice. The more times we as clinicians can answer “yes” to the above questions, the more confident we can be in utilizing a suggested clinical treatment in our own intervention practices.

So where does our own experience and clinical skill fit in with the discussion of EBP? Does all of this conversation about EBP mean that clinical experience is rendered unimportant? It does not. The definition of EPB utilized by ASHA and many others suggests the need to integrate clinical expertise with evidence from systematic research. The knowledge and experience of clinicians is particularly critical in the area of speech-language pathology, given the fact that the amount of empirical research evaluating treatment efforts to date is relatively small. Clinicians may well experience frustration as they attempt to find answers to questions related to best practice for various disorders. Until that point in time when we have an adequate basis of evidence to draw from across varied communication disorders, clinicians will have to rely heavily on their clinical experience when best practice decisions.

Other constraints for clinicians in their efforts to provide evidence-based practice may also include access to the information needed. This may be a function of the amount of time a clinician has in a given work day to seek out EBP information – how often do employers provide the amount of time we need for planning, never mind completing the background research needed - as well as difficulties in accessing the appropriate resources (e.g. journal articles etc.). Fortunately, resources are emerging that clinicians can draw upon to support ASHA's mandate to provide EBP whenever possible. One resource is ASHA sponsored conferences and journals. As ASHA has moved to providing electronic copies of journal articles on-line, clinicians can quickly and easily complete a search on a topic of interest. Additionally, practioners can find information about EBP on ASHA’s website: Evidence based practice in communication disorders: an introduction.

In addition to resources provided by ASHA, journals dedicated to EBP are beginning to emerge. For example, Pearson Publishers has recently launched an on-line series dedicated to EBP in speech-language pathology. Articles consist of a review of empirical literature on a topic of interest by leaders in the field, and a summary of findings is provided. To learn more about this excellent resource on EBP, clinicians can go to the Pearson website: www.speechandlanguage.com/ebp.index.asp.

In conclusion, we as clinicians need to do all that we can to ensure we are utilizing treatment strategies that are most likely to result in change. Although our basis of empirical research from which to draw upon is relatively small, the continued attention our field is paying to the concept of EBP is likely to increase this pool in years to come. This is good news for clinicians and patients alike.

For further information on evidence-based practice, clinicians can look to the following sources:

ASHA (2007). Evidence based practice in communication disorders: An introduction. (http://www.asha.org/docs/pdf/TR2004-00001.pdf ).

Dollaghan, C.A. (2007). Handbook for Evidence-Based Practice in Communication Disorders. Baltimore, MD: Brookes Publishing.

Dollaghan, C. (2004, April 13). Evidence-based practice: Myths and realities. The ASHA Leader, pp. 4-5.
Evidence-Based Practice Briefs. www.speechandlanguage/com/ebp/index.asp

Justice, L.M. & Fey, M.E. (2004, Sept. 21). Evidence based practice in schools: Integrating craft and theory with science and data. The ASHA Leader, pp.4-5.

http://www.utdallas.edu/library/callier/SLPEBM.htm- This website includes a summary of articles addressing evidence-based speech and language research.

For a calendar of EBP events, go to: www.asha.org/members/ebp/calendar.htm