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Evidence Based Practice -how We Do It And How We Could Do It Better

Evidence Based Practice -how we do it and how we could do it better

A 1-hour seminar given at ASHA 2017 Los Angeles, presented data on a large web based survey of SLP’s regarding knowledge of and critical application of EPB. Results demonstrate significant weaknesses in the current knowledge base underlying EBP in the profession – across topics and education levels.

Speakers : Giselle Carnaby MPH, PhD, CCC-SLP, FASHA and David Gregorio MS

Background: A hallmark of evidenced based practice (EBP) is making the best decisions about patient care based upon the most current knowledge produced by well-designed clinical research (Sackett 1996). Numerous studies have suggested that evidenced based care can significantly reduce patient complications and decrease healthcare costs. As a result of these studies the Institute of Medicine issued a report calling for health professional education programs to include evidenced based care among their five central competencies (IOM 2003). Unfortunately issues have routinely arisen around the training, practice and conduct of EPB within health professions (Brownson 2012).

EBP at its core is a process requiring 5 distinct steps;

  1. Formulating an answerable question regarding practice needs
  2. Tracking down the best available evidence to answer that question
  3. Critically appraising the scientific rigor, validity and usefulness of the evidence
  4. Integrating the critical appraisal of the data with one’s clinical expertise and client values and circumstances and then applying it to practice decisions
  5. Critically evaluating outcomes.

Theoretically, EBP promotes utilizing knowledge from many sources and, through critical evaluation of these data, making informed decisions (in conjunction with the client) on the most effective course of treatment/intervention (Gambrill 2007; Gilgun 2005). This approach is advocated at both the client level along with at a broader agency/program level.

While conceptually the EBP approach provides a gold standard for research consumption and competence by many disciplines, its actual implementation and practice in Speech Language Pathology (SLP), similar to other health professions, has been haphazard at best. While much support is noted among the professional governing body (ASHA) and Universities as a whole, its training and implementation by speech pathologists in the field is questionable. This is important as ineffective EBP implementation has been shown to limit positive implementation outcomes (change in clinician behavior) and intervention outcomes (benefits to clients) (Fixsen, 2005). It appears that the difficulties arise in attempting to actualize the EBP approach or in other words problems in “doing EBP and Doing it Right”.

The usefulness of research and its ability to contribute to an EBP process is limited by a number of factors. Not only the practitioner’s ability to search for and locate evidence, but to be able to appraise and critically consider the strengths and weaknesses of the data found. Practitioners may have not received formal EBP instruction within their speech pathology training, while others may have only received a basic familiarization education regarding research design and statistics. Such cursory educational exposure may not include instruction in the skills that would enable them to engage in critical consideration and evaluation of research for EBP. Moreover for practitioners urged to develop these skills post-graduation, in their own time, these skill sets can be intimidating if not totally overwhelming.

SLP clinician opinion leaders and supervisors are respected for the knowledge they hold. If well trained in EBP, they can provide a well source for training peers and supervising the application of EBP practice. However, previous studies have only surveyed SLP attitudes and beliefs, and have not critically evaluated the specific ability to consume and employ research skills (Zilpoi 2005, Dollaghan 2004). Before any improvement in SLP EBP can occur key ingredients for training such as underlying research knowledge base, EBP instruction methods, EBP demonstration methods, practice of key skills, feedback on practice, and peer and organizational support need to be present. Currently much of this data on EBP in SLP is lacking.

In order to evaluate the issues associated with applying an EBP best practices framework in Speech Language Pathology, information on how SLP’s consume and evaluate research is needed. Data surrounding the ability to accurately locate literature, identify critical components of research, identify valid methods of assessment and outcome, and evaluate the rigor /level of precision of research is critical to our understanding of the potential breakdowns in the EBP education/ implementation process (Bloch 2006).

To address this knowledge gap, we present data from a large web based survey of SLP’s perception of research and application of research knowledge. This study was conducted with SLP volunteers (n = 325) from 19 special interest divisions. Participants completed a 29 item online survey including perceptions of research availability, their use of research resources, identification and location of specific research components (e.g. inclusion criteria), and selfrated capability in research evaluation. Participants were also asked to complete a problem based evaluation section where respondents critically evaluated research statements drawn from a variety of published SLP research literature across disciplines. Data from this large survey revealed a significant mismatch between SLP self-rated EBP capability, and the ability to both identify research components (knowledge of research) and critically evaluate research exemplars (critical evaluation). Overall the skills required for critical appraisal were limited in this cohort (regardless of degree level or past experience in formal research). Further, data revealed that research knowledge declined significantly with increased time since completing clinical certification. (CCC-SLP). Similarly, a significant difference in research knowledge and evaluation skill was noted by workplace site. These data underscore the need for a new approach to teaching and training research skills in Speech Language Pathology across the continuum of professional service.

References:

Sackett, D. L., Rosenberg, W. M. C., Gray, J. A. M., Haynes, R. B. and Richardson, W. S. 1996: Evidence Based Medicine: What It Is and What It Isn’t, in: British Medical Journal, 312, 71-72.

Institute of Medicine. (2003). Greiner, AC & Knebel, E (Eds.). Health professions education: A bridge to quality. Washington, DC: National Academies Press.

Brownson, R.C., Colditz, G.A., & Proctor, E.K. (2012). Dissemination and implementation research in health: Translating science to practice. New York: Oxford University Press, Inc.

Gambrill, E. 2007: Views of Evidence-Based Practice: Social Workers’ Code of Ethics and Accreditation Standards as Guides for Choice [Special Section: Promoting and Sustaining Evidence-Based Practice], in: Journal of Social Work Education, 43, 447-462

Gilgun, J. F. 2005: Four Cornerstones of Evidence-Based Practice, in: Research on Social Work Practice, 15, 52-61.

Zipoli R, Kennedy M. 2005: Evidence-Based practice among Speech Language Pathologists: Attitudes, utilization and barriers. American Journal of Speech Language Pathology.14, 208- 220.

Dollaghan, C. A. 2004: Evidence-based practice in communication disorders: What do we know, and when do we know it? Journal of Communication Disorders, 37,391–400.

Bloch, R.M., Saeed, S.A., Rivard, J.C. and Rausch, C. 2006: Lessons Learned in Implementing Evidence-Based Practices: Implications for Psychiatric Administrators, in: Psychiatric Quarterly, 77, 309-318.

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