Evidence-based practice guidelines and systematic reviews: little bit of reading, whole lot of reward!
What’s the #1 thing SLPs cite as a barrier to knowing the research evidence? Time constraints (Hoffman et al., 2013; Nail-Chewetalu & Ratner, 2006). And of course we can't magically gift ourselves several extra hours per week. But even saving a little time, with things like EBP guidelines (Fey, 2006), can help! Overall, reading EBP guidelines and systematic reviews is a whole lot more manageable than trying to learn something new by approaching the topic cold, attempting to search databases, and digging for relevant articles.
So, without further ado—our favorite resources for EBP Guidelines & Systematic Reviews:
The Clinical Research for SLPs group on Facebook is growing fast! Let's take a look at what it has to offer:
Also, there's a weekly chat feature, where we invite experts to come give us great info and answer questions. Here's a small sample of folks we've invited:
You can go BACK to conversations you may have missed by searching these #week__ hashtags within the group (once you join). See the full schedule of past guests under the Files section of the group.
Oh, and if you're wondering who "we" is? We have several group admins, a mix of SLPs and scientists, from different parts of the country and different universities. Learn about us here.
Well, I mean… The Informed SLP's Monthly Reviews are helping with that in that we’re reading a huge pile of articles every month, throwing out everything that’s not immediately clinically applicable, then reviewing just the “good stuff” for you. TISLP is a massive time-saver for busy clinicians. But—nonetheless—it isn't enough. Our reviews alone don't cover EVERYTHING; particularly when you have a specific question in mind.
So, how on earth am I supposed to be reading these articles and staying up-to-date on the evidence?
Option #1: Kiss your social life, family time, and leisure time goodbye, and spend your evenings and weekends reading research articles... NO! Don’t do this. Forget that. Nobody does that. We can do better…
Option #2: Advocate for plan time. I know, I know... you don’t like this option either, because many of you are in situations where you feel like this is a non-option. But—here’s the thing—it IS an option. It IS an option to demand a certain amount of desk time each week, and use that time to access evidence and problem-solve for your clients. We help our clients by providing the best quality therapy we possibly can. Efficient therapy, even. The only way to make that happen is to take just a *little* time to look into the evidence-based options.
Option #3: Tackle it as a team. Baker & McLeod (2011) provide evidence that an EBP group can be a productive way to connect SLPs to research and increase their confidence in applying research to their caseload. As a group, the SLPs would develop a clinical question, but then have one skilled person perform the literature search, a small group critique the research, and then the whole group participate in an “EBP meeting” where they cover the evidence, then go out and individually apply it to clients. Divide and conquer can be a pretty good option, because lack of time is a legitimate barrier.
Option #4: Identify one person in your local SLP team (e.g. one person from your school district, or one person in a local group of private practitioners), and pay them (not you—your boss, obviously) to access and read research evidence for you. Or give this person a caseload release to do it. Don’t laugh. This exists, and you need to be asking for it!
Effective and efficient therapy is good for the clients/students, but also good for organizations’ bottom line, because it can lead to better treatment and kids not hanging out on school-based SLPs’ caseloads for years. So—truly—it’s not impossible to talk administrators into this. Particularly if the entire group of SLPs gets behind the idea, and sells the concept to those in charge.
We all know that ethical treatment of our clients results from using evidence-based practice (EBP). So how do we make that happen?
First, recall that evidence-based practice isn’t just about using the research, but considers client values and clinical expertise as well (which results from accumulated experience collecting client data and objectively analyzing it). How much weight you put on each EBP component varies case-by-case, but we’ll focus on research evidence for the moment.
In grad school, you simply follow your professors’ recommendations. And that’ll last you for a bit. But what about when you’re 3, 5, 10 years out of grad school?
Some SLPs think that by participating in Continuing Education (CE) courses to maintain our ASHA CCCs and state licenses, that’s enough. Sometimes it's enough. And it certainly helps. But not all CE courses are based on research evidence. <Yikes!> There are many CE courses out there that have little to no research backing. So if you’re choosing mediocre CE, year after year, there’s a good chance you’re not implementing EBP.
So, what then? Try this:
Now, (1) and (2) above are the bare minimum you should be doing in order to ethically practice as a Speech–Language Pathologist. If you’re not doing these two things (or an equivalent substitute), you're probably not using EBP.
So, start there. THEN, I would suggest that all good SLPs are additionally doing some of the following. Perhaps more in some years, less in others, but they're regularly trying to:
So, to reiterate:
It’s not enough to just show up for your clients. You must also be aware of good science in our field and beware pseudoscience. The best evidence will make your job easier— so you may treat clients more efficiently, and with better outcomes.
And, on a final note, evidence-based practice is only part of the solution. Yes, clinicians must access and use research evidence. But our scientists also must provide us with practice-based evidence. SLPs need relevant studies that are real-world applicable. And communication between clinicians and scholars about each other's work is essential to the health of our field. ASHA is working on EBP and Implementation Science initiatives for us, and communication between clinicians and scientists seems to get better and better all the time. Let's contribute to that!