Mindy Middlebrooks
& Heather Clark
March 17, 2003
WHAT IS EVIDENCE-BASED PRACTICE?
Evidence-based practice according to ASHA entails the use of the current
best research results to make clinical decisions about patient care; i.e. the
application of research data, scientific evidence, to clinical decision making.
An example of how to use evidence-based practice would be when a clinician bases
their practice on the evidence using a systematic approach when selecting assessment
and treatment procedures. "Evidence-based practice de-emphasizes subjectivity
in clinical decision making, but does not necessarily preclude the art of caring…today,
it might better be called the science of caring" (Millenson, 1997). Based
on the evidence from a comprehensive literature search and review of published
research studies, practice guidelines are developed to assist clinicians and
patients in choosing the appropriate care for specific conditions. Guidelines
are designed to address a specific issue in areas such as screening, diagnosis,
or treatment. Ideally, they should be systematic, logical, defensible, practical,
feasible, understandable, and include both the clinician and patient in the
decision-making.
WHY IS EVIDENCE-BASED PRACTICE
IMPORTANT?
As a profession the way in which we view communication disorders has changed.
Now we focus on the multidimensional aspects of communication and communication
disorders rather than focusing in on one aspect. Additionally we try to focus
our treatment on functional outcomes for our patients. This broader perspective
that we have adopted has created an increased need for data to assist us in
making clinical decisions and monitoring change. The data that is available
when considering evidence-based practice revolves around clinical outcomes,
efficacy, effectiveness, and efficiency. When a clinician uses evidence-based
research to determine assessment and treatment methods, that clinician is using
the research to determine the best mode of assessment and treatment for their
client.
WHAT DETERMINES APPROPRIATE LITERATURE?
Typically, research evidence is rated or classified according to levels based
on the type of research completed and the research design quality. The following
is an example of a research classification system: Class I evidence comes from
at least one well-designed, randomized controlled clinical trial. Class II evidence
is from at least one well-designed observational, clinical study with concurrent
controls. Class III evidence is provided by expert opinion, case studies, and
studies with historical controls. Practice guidelines are developed using a
classification system such as the one described above. It is important to note
that guidelines differ from Practice Standards and Practice Options. These differences
include: Standards are accepted principles of patient care based on a high degree
of certainty and Class I or strong Class II evidence. Guidelines reflect a moderate
degree of certainty, are not fixed protocols or rigid treatment rules, and are
typically based on Class II evidence. Options are possible treatment strategies,
but are based on limited certainty or conflicting evidence or opinion. In some
arenas, the strict adherence to levels of evidence is problematic. For example,
in the area of neurological communication disorders, it may be difficult to
find a large enough group of subjects with a particular disorder to complete
a randomized controlled trial, often the preferred type of study. Some advocate
for an approach to the available literature that allows for review of the relationship
of intervention and outcome when direct evidence is not available. The American
Psychological Association developed a series of questions to ask when considering
the merits of research. These questions include: How well are the subjects described?,
How well is the treatment described?, What measures of control are imposed in
the study?, Are the consequences of the intervention well described?
POTENTIAL RESOURCES
ADDITIONAL INFORMATION ON EVIDENCE BASED PRACTICE