ESSAY

The current emphasis in health care and education on accountability and efficiency, and
the reality of a climate of reduced resources, prompts speech-language pathologists and
audiologists to respond to new pressures for delivering services to those with
communication disorders. This may be viewed as a positive influence in that
practitioners have an opportunity to consider and implement service delivery from an
evidence-based perspective.

Describe your understanding of evidence-based practice. Include your ideas about how
audiologists and speech-language pathologists should become aware of and utilize
evidence-based protocols in practice.

Evidence-based practice is an approach to clinical care that is founded upon
empirical data from systematic reviews. Its purpose is to identify the best possible
avenue of care by combining scientific evidence, practitioner expertise and client
opinion. Studies have shown that evidence-based practice can lead to higher quality
patient care and many professionals acknowledge the value of EBP. Still, healthcare
professionals, including speech-language pathologists and audiologists, hesitate to
regularly utilize scientific evidence when creating their treatment plans. In fact, a 2005
study led by Zipoli and Kennedy on the attitudes of SLPs toward EBP, showed that
speech-language pathologists observed more barriers to EBP than other therapists.
While there is certainly a shortage of scientific data on communication disorders,
a lack of evidence is not the central issue. In 2005, ASHA created an EBP compendium,
which organizes systematic reviews by categories and can be viewed on their website.
The greater problem exists in applying existing research findings to clinical practice.
Zipoli and Kennedys study interviewed 592 therapists of which 66 were speech-
language pathologists. These participants reported the following as the most significant
barriers to incorporating EBP into their work: research findings not being consolidated in
one place, insufficient reading time and difficulty understanding statistical analysis
(Zipoli & Kennedy, 2005).
Most audiologists and SLPs understand the importance of statistical analysis,
especially since data collection and interpretation is a driving force for the speech and
hearing field. As a student, I too have been taught the value of scientific research and
the statistical information it presents. However, while I have taken both treatment
courses and statistics courses, I have never taken a course that teaches the direct
application of statistics to treatment. Additionally, in my discussions with fellow
students, I have observed that the majority wants to focus on clinical work while a few
express a desire to do research. Graduate programs similarly market themselves to us as
either clinically focused or research based. In doing so, they treat research and
clinical emphases as two separate elements. Rather than identifying with one or the
other, graduate programs should emphasize the importance of combining both
components. More importantly, programs should teach students the practical
application of research to treatment to better equip them as practitioners.
Studies show that exposure to research and EBP during the clinical fellowship
year also correlates with positive attitudes towards EBP amongst SLPs (Zipoli &
Kennedy, 2005). Furthermore, Connolly et al. (2001) suggests the importance of
directly observing research being applied in clinical settings during the formative
months of professional practice. In order to instill the habit of using of EBP in new SLPs,
clinical fellowship supervisors must be able to guide their mentees in the practice.
Supervisors are usually seasoned with experience and have been licensed for longer
than their mentee counterparts. However, according to Jette et al. (2003), both factors
actually decrease a therapists likelihood to rely on EBP. Therefore, there is a need to
educate both student and veteran clinicians alike in using EBP in the clinic.
One way to educate therapists of all experience levels is by employing the aid of
technology. Technology is playing an increasingly greater role in clinical audiology and
speech-language pathology, as patients and therapists are now relying on applications
on computers, tablets and phones for portable therapy. In the same fashion, a mobile
application would be an ideal platform for consolidating EBP information since it can be
opened on multiple gadgets (i.e. computer, tablet, cell phone) from any location. It is
important that the information is not only accessible by website, as ASHA has made
possible, since outside of the United States, mobile phones are more often prevalent
than computers. Also, when therapists are at work, they are more likely to have a phone
or tablet within reach rather than a computer.
The program I am proposing aims to address the following elements: 1) provide
easy access to a breadth of information, 2) be user friendly and community based and
3) encourage further research.
First, evidence from all relevant systematic reviews must be collected and
organized in a manner that makes searching for a specific study easy. The application
should present a concise summary page of every study. This is perhaps the hardest part
in developing the application, but research shows that a lack of short summaries of best
evidence is a potential barrier to EBP (Worrall and Bennet, 2001). The summaries of
each study should include a brief explanation of context (i.e. retired non-fluent aphasia
patients), clinical methodology (i.e. constraint-induced aphasia therapy), study
conclusions and feedback by clinicians who have used tried using the method.
The distinguishing component of my proposal perhaps lies in the feedback given
by clinicians. I believe that creating a program that not only provides information but
also acts as a social network will increase its use among clinicians. After all, audiologists
and speech-language pathologists are members of a close-knit community of
professionals whose jobs focus on communication. Giving a space for feedback
regarding the scientific studies and enabling communication amongst users will provide
clinicians with support from their colleagues. A study by Rappolt and Tassone (2002)
found that most therapists used informational consultations with their peers as their
first educational resource. This program would give clinicians the opportunity to not
only consult a large network of peers, but also a chance to view the interactions
between other colleagues, all while directly addressing EBP.
Obtaining feedback from clinicians will be a challenge. Clinicians may be
reluctant to fill out feedback forms, as they are already under pressure to complete the
paperwork for their therapy sessions. However, there are steps that can be taken to
encourage feedback. First, all licensed therapists should be given access to the
application program. Although it is impossible to force all therapists to use it, creating a
larger, unified network of users can increase the credibility of the program and
clinicians reliance on it. Second, each user should have a profile that logs which
research based treatment methods he/she attempts. At the end of an attempt, a very
brief survey that asks a limited number of closed-ended questions will be prompted.
Providing a dropdown menu of answer choices hopefully will encourage users to give
feedback without spending too much time. Of course, a space for comments will be
available, as well as a separate forum for discussions. Users will be allowed to post
questions or comments to specific studies, which the authors of the study can view.
These questions will hopefully initiate further research projects. Lastly, since not all
therapists are comfortable with using mobile applications, workshops teaching the
technical aspects of the program will be offered both in person and on the web.
One of the biggest challenges of using technology is the gap between human and
computer interface. A similar gap exists between scientific research and clinical therapy.
However, by creating an on-line community and encouraging as much human
involvement in the mobile app as possible, I believe the distance between research and
clinical practice can be diminished. Evidence-based practice is a necessary part of the
speech and hearing field, yet it is perceived to be intimidating and incomprehensible.
The goal of this program is to promote EBP in a simple, engaging manner so that
clinicians can be empowered with the tools to provide the highest quality of care.