Evidence Based Practice - Sai Bangera The Voice Evidence Based Practice - Sai Bangera

In order to meet HCPC standards of proficiency, Speech and Language Therapists are expected ‘to engage in evidence-based practice, evaluate practice systematically and participate in audit procedures as well as evaluate research and other evidence to inform their own practice’ (HCPC Standards of Proficiency, 2014). Examining the evidence base for intervention programmes by evaluating research findings prior to clinical decision-making, and implementing evidenced interventions is the hallmark of Evidence-Based Practice (EBP). Applying research findings to clinical practice is the core of EBP, thereby ensuring that high quality services are provided to the client population in question.

Bearing the above in mind, an attempt has been made here to describe the underlying principles of Evidence-Based Practice (EBP), what research evidence entails and to highlight the significance of EBP in Speech and Language Therapy. Some barriers to EBP and possible solutions have also been discussed.[/Intro]

Evidence-Based Practice: Description and Rationale

The most common definition of Evidence-Based Practice (EBP) by Dr. David Sackett;

The conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.

(Sackett, 1996)

EBP is the integration of clinical expertise, patient values, and the best research evidence into the decision-making process for patient care. Clinical expertise refers to the clinician’s cumulated experience, education and clinical skills. The patient brings to the encounter his or her own personal preferences and unique concerns, expectations, and values. The best research evidence is usually found in clinically relevant research that has been conducted using sound methodology (Sackett, 2002). Figure 1 is a depiction of evidence-based practice adapted from Sackett’s definition by Dollaghan (2007), which includes external evidence (best research evidence), internal evidence (clinical expertise) and client/patient preferences.

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Figure 1: Evidence-based practice by Dollaghan, 2007


Research Evidence:

Research evidence is often illustrated in a hierarchy (Figure 2) with expert opinions forming the base, and systematic reviews/meta-analysis (synopsis of results of RCTs) as the tip of the evidence pyramid. Every step of this pyramid provides valuable evidence and complements the others (for e.g. results from case studies provide direction for Randomised Control Trials in order to determine further corroborative evidence). Although Randomised Control Trial (RCT) is considered as the ‘gold standard’ for research evidence, methodological issues and clinical applicability should be taken into consideration for demonstrating efficacy of interventions and treatments. Hence, appraising the evidence through a critical lens and enhancing critical awareness becomes extremely essential before making clinical judgements.

Figure 2: Hierarchy of research evidence

Figure 2: Hierarchy of research evidence

At the Royal College of Speech and Language Therapists (RCSLT) conference in 2012, Professor Vicky Joffe highlighted the significance of turning routine clinical work into EBP. More recently in September 2014, bridging the gap between clinical practice and research was the highlight of the RCSLT conference (some of these presentations are available here).

It is evident that Speech and Language Therapy (SLT) service makes a significant difference in the lives of individuals with speech, language and communication needs. However, in order to avoid cuts in SLT services, it is vital to provide research findings for the efficacy of this service, which would subsequently influence commissioners in their decision-making process (Joffe, 2012).

Additionally, understanding the clinical rationale for the selection of a particular intervention by examining the evidence-base, and adapting clinical knowledge, is the hallmark of self-reflective practice. It becomes necessary to consider the body of knowledge and resources in order to make clinical decisions based on supportive evidence. This is the key for ensuring that service users benefit optimally, duty of care being the central focus of SLT services.


Barriers to EBP and possible solutions:

If SLTs are expected to embed research into their work and inform their clinical practice, then this research should be ‘useable knowledge’ (Justice, 2008) i.e. the evidence from research must provide clear clinical direction. Dollaghan (2007) has clearly explained how the balance of different forms of evidence as well as client’s well-informed judgements, provides a strong case for EBP in Speech and Language Therapy.

As such, it is not atypical to encounter common barriers (time constraints, training and skills, work culture and context, accessing research evidence etc.) to EBP in Speech and Language therapy (Skeat and Roddam, 2010), which need to be addressed at the individual level as well as a profession as a whole.

Some possible solutions/recommendations for overcoming barriers in SLT practice are listed below:

  • Improving knowledge and skills by becoming familiar with basic tenets of research and evidence-based practice, qualitative and quantitative research designs.
  • Critically evaluating research papers using CASP or other frameworks that will ensure accurate interpretation of empirical research findings.
  • Enhancing critical awareness by critical thinking.
  • Sharing current trends and research findings at Study days/Journal clubs/regional hubs/workshops.
  • Open access to research papers on therapeutic interventions and dissemination of clinical developments.
  • Academicians/researchers liaising with clinicians on a regular basis to share knowledge and expertise, which in turn could inform research as much as research informs clinical practice, and make it feasible for clinicians to participate in research.
  • Shifting perspectives on an individual level as well as the profession as a whole.

To ensure that there is a positive impact as well as substantial and sustainable measurable outcomes, Speech and Language Therapy must entail creative work firmly grounded by science. An in-depth understanding of EBP, its principles, rationale and purpose is essential for SLT students, NQPs or others who are passionate about making a significant difference to their service users. Hence it becomes imperative to apply the EBP process in therapy: posing a clinical question, examining the evidence for interventions, considering client preferences, determining therapy outcomes and engaging in self-reflection.

If there is evidence, find it, read it, understand it, evaluate it, and use it if appropriate, if there is no evidence, create it!

Professor Joffe (2012)


References:

Dollaghan, C (2007). The Handbook for Evidence-Based Practice in Communication Disorders. Maryland: Paul H. Brookes.

Duke University (2014) Introduction to Evidence-based practice. Retrieved March 2014

Grimshaw, J. (2011). Bridging the gap between knowledge and practice: an introduction to KT. Retrieved April 2014

Haynes, B., & Haines, A. (1998). Barriers and bridges to evidence based clinical practice. BMJ317(7153), 273-276.

Health and Care Professions Council (2014). Standards of Proficiency for Speech and Language Therapists. Retrieved March 2014

Joffe, V., Cruice, M., & Chiat, S. (Eds.). (2008). Language Disorders in Children and Adults: New Issues in Research and Practice. John Wiley & Sons.

Joffe, V (2012). Turning routine clinical work into evidence-based practice. Retrieved March 2014

Justice, L. (2008). Evidence-based terminology. American Journal of Speech-Language Pathology17(4), 324-325.

Law, J, Garrett, Z., & Nye, C. (2010) Speech and language therapy interventions for children with primary speech and language delay or disorder. Retrieved March 2014

Law, J., Lee, W., Roulstone, S., Wren, Y., Zeng, B, & Lindsay, G (2010) ‘What works’: Interventions for children and young people with speech, language and communication needs. Department for Education Research Report DFE-RR247-BCRP10 and 10A (produced by the Better Communication Research Project for the Department for Education). Retrieved March 2014

McCurtin, A., & Roddam, H. (2012). Evidence‐based practice: SLTs under siege or opportunity for growth? The use and nature of research evidence in the profession. International Journal of Language & Communication Disorders,47(1), 11-26.

 Roddam, H., & Skeat, J. (Eds.). (2010). Embedding evidence-based practice in speech and language therapy: International examples. West Sussex: Wiley-Blackwell.

Upton, D., & Upton, P. (2006). Knowledge and use of evidence-based practice by allied health and health science professionals in the United Kingdom. Journal of Allied Health, 35, 127-133.