How can SLPs embed
Evidence-Based Practice
(EBP) into their routine
clinical practice?
Dr Hazel Roddam
Dr Jemma Skeat
Dr Paula Leslie
Disclosure Statement
We have no financial or nonfinancial interest in any
organization whose products or
services are
described, reviewed, evaluated
or compared
in the presentation.
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Learning Outcomes
At the end of this presentation, attendees will
be able to:
1. Explain a range of initiatives that support
EBP
2. Identify a factor in their own workplace that
restricts EBP
3. Integrate ideas from others’ experiences to
facilitate EBP within their own services
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What are the challenges?
• What is EBP – and what is it not?
• Is our routine clinical practice evidence-
based?
• Is our education evidence-based?
• Is the training we deliver to others evidence-
based?
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Workshop aim …
To facilitate participants to explore the
implications for SLT professional education
and professional practice,
through highlighting international examples.
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Workshop outline …
• What do we mean by Evidence-Based Practice?
• What are the challenges?
• Where are the opportunities?
– Professional Associations
– Educators
– Clinicians
• Consideration of factors promoting/constraining EBP
• Discussion of good practice examples
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Where are we as a profession?
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What are the international
drivers for EBP?
• Political
• Professional
• Clinical
– Things are not working
– Facing unfamiliar territory
Skeat & Roddam, 2010
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What is EBP?
“It is not expected that all clinicians will
be research-active,
but it is expected that all clinicians will be
active users of research”
Supporting Research and Development in the NHS
A.Culyer, 1994
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What is not EBP?
• Anecdotes /testimonials
“The plural of anecdotes is not evidence”
(Reilly 2010)
•
•
•
•
•
Media headlines
Cost savings
Expert opinion
Intuition
Pseudo-science
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What do we mean by
pseudo-science?
•
•
•
•
Lack of critical evaluation
Un-testable/not open to testing
Belief-based
Reliance on
–
–
–
–
Unjustified claims for effectiveness
Authority figures
Generalised claims
Dramatic claims
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How does pseudo-science
threaten our practice?
• Risk of harm to patients
• Waste of client’s and clinician’s time
• Not effective
• Denigration of scientific basis of the
profession
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Most used definition of EBP
Research
“The conscientious,
explicit, and judicious
use of current best
evidence in making
decisions about the
care of individual
patients’”
Sackett et al 1997
Clinician
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Client
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What does research evidence
give us?
• Answers specific questions
• Rigour
• ‘greatest strength lies in the fact that
it removes bias’
Reilly 2004: p30
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Research evidence challenges
• Absence of evidence
An approach such as EBP relies on the
clinician being able to locate high quality
research to inform clinical decision
making. Elman 2006.
• Ease of use
• Clinical applicability
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What counts as evidence?
• Highest level of rigour Systematic Reviews, Metaanalyses, well designed randomised controlled studies
• Well designed controlled study without randomisation
• Well designed non-experimental studies
• Expert committee report, conference, consensus,
case series
• Lowest level of rigour Clinical experience of
respected authorities, single cases
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Mismatch in research agendas
• Under-representation in clinical trials of
certain populations of patients, including
those with severe problems or co-morbidities
(Elman 2006)
• Only a small proportion of articles pertaining
to the efficacy of treatments used for
individuals with developmental disabilities
(Koenig & Gunter 2005)
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Practitioners perceive……
• researchers do not appreciate the
nature of their daily work
• research lacks utility
McGinnis Kuster & Poburka 1998
• treatments being deemed as evidence
based required adherence to strict
treatment protocols
• thus also requiring attendance at
sessions in a manner that is not realistic
Nelson et al 2006
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The 5 step model of EBP
1. Frame a clinically-focused question
2.Search for the best quality evidence
3.Appraise the evidence
4.Implement changes – if appropriate
5.Evaluate effectiveness of practice
Sackett, 1997
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What do we mean by
“embedding”
Evidence-Based Practice?
• Package of care for each client/patient
• Planning for service delivery &
developments
• Therapy resources: assessment tools
and intervention approaches
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What are the challenges to
embedding EBP?
•
•
•
•
•
Skills and confidence
Construction of EBP
Resources and facilities
SLT culture
Research evidence base
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Implications for every SLP
“The first step is to become
reflective and critical reviewers
of our own practice”
Professor Pam Enderby, 2010
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Skills & Confidence in EBP
• Low levels of understanding about EBP itself among
allied health professionals (Upton and Upton 2006)
• Research related competencies (Kajermo et al 2000,
Haynes 2002 McCluskey 2003, Kahmi 2006)
• Lack of skills to conduct computerised searches, and
low levels of knowledge about electronic databases
(Rappolt & Tassone 2002, McCluskey 2003)
• SLTs report research as difficult to read and
interpret (Pennington 2001, O’Connor & Pettigrew
2009)
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• Recency of training, including higher degree involving
exposure to EBP and research, predicted better
attitudes to EBP among SLTs (Zipoli & Kennedy
2005), physiotherapists (Jette et al 2003, Turner
2001) and OTs (Bennett et al 2003)
• The most experienced practitioners expressed the
least favourable attitudes about EBP, age and years
since graduation predicting the tendency to use EBP
(Aaron 2004).
• Familiarity with, and confidence in search strategies,
use of databases and critical appraisal tend to be
associated with younger therapists with fewer years
since graduation (Jette et al 2003)
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Exposure to research & EBP
Exposure to research and EBP during training
Experience
Desire for learning
Bridges et al 2007;
Zipoli & Kennedy 2005; Roddam, Skeat & Leslie 2010
Aaron 2004; Turner 2001
Highest degree held
Practicality
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Impact of resources
• Large caseloads
• Difficulty accessing
journals McCluskey
Time
2003
• High staff turnover,
Clinician staff shortages
Perceived
lack of
evidence
skills
Curtin & Jaramazovic
2001
• Organizational
structures Upton
Resource
issues
&Upton 2006
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But most of all………Time
• Lack of, McCluskey 2003, Bennett et al 2003, Curtin &
Jaramazovic 2001
• Only 8% were happy with the time they had to
do this Pollock et al 2000
• To keep abreast GP have to read on average 19
articles a day, 365 days of the year Sackett et al
1997
• 30 years - 20,000 articles Bernstein-Ratner 2006
• GPs (89%) Hospital docs (91%) would do if more
time Upton & Upton 2006
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“EBP requires change
to habits, routines,
and sometimes
personal and philosophical
preferences and ideals”
(Skeat & Roddam 2010)
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Strategies to support EBP
• Taking time to reflect
• Developing effective personal reading
routines
• Maximising the use of pre-appraised sources
• Learning and practising EBP skills
• Communicating with colleagues
• Involving clients in practice
• Evaluating the impact of changes in clinical
practice
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Participants’ examples
• What are we already doing well?
• What could we do better?
• How can that be achieved?
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Where are the opportunites
to promote embedding EBP?
•
•
•
•
Pre-licence professional education
Continuing professional development
Clinical skills training opportunities
Development of therapy resources &
approaches
• Delivery of training to others
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Who has responsibility for
embedding EBP?
• Professional associations
• Educators
– Academic Faculty & Clinical supervisors
• Individual therapists
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The challenges for the future
of our profession
If we are committed to embedding EBP,
we need to recognise the implications for
• the training we receive
• our practice behaviour
• the training we provide to others
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Useful References
Bury & Mead, 1998, Evidence-Based Healthcare: A Practical Guide for
Therapists. Oxford: Butterworth-Heinemann
Dopson, Fitzgerald, Ferlie, Gabbay & Locock, 2002, No magic targets!
Changing clinical practice to become more evidence-based. Health Care
Management Review 27(3): 35-47
Estabrooks, Floyd, Scott-Findlay, O’Leary & Gushta, 2003, Individual
determinants of research utilization: a systematic review. Journal of
Advanced Nursing 43 (5): 506-520
Roddam & Skeat, 2010, Embedding Evidence-Based Practice in Speech
and Language Therapy: International Examples
Vallino-Napoli & Reilly, 2004, Evidence-based health care: A survey of
speech pathology practice. Advances in Speech and Language Pathology
6 (2): 107-112
Zipoli & Kennedy, 2005, Evidence-based practice among speechlanguage pathologists: Attitudes, utilisation and barriers. American
Journal of Speech-Language Pathology 14: 208-220
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Contact us …
• Dr Hazel Roddam, University of Central
Lancashire, Preston, UK [email protected]
• Dr Paula Leslie, University of Pittsburgh, USA
[email protected]
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