Evidence-Based Practice in Speech-Language Pathology: Where Are We Now?

Clinical practices in Swedish speech-language pathology for children with (developmental) language disorder

In Sweden, treatment for children with (developmental) language disorder ((D)LD) is traditionally carried out at a speech-language pathology (SLP) clinic, and based on formal language tests, which may not entirely represent the child's everyday language and communication skills. SLP services that include video recordings have shown positive outcomes in terms of providing information about children's linguistic and communicative abilities in everyday life, but little is known about the use of video in clinical practice. The aim of this study is therefore to investigate how Swedish SLPs link their clinical practices (assessment, treatment, and evaluation of treatment outcome) to the everyday language and communication abilities of children with (D)LD. A further aim is to explore SLPs' utilisation of video recordings as a part of their clinical practices with the target group. A web-based questionnaire was distributed to SLPs in Sweden, who work with children with (D)LD. Results demonstrate that Swedish SLPs perceive that their intervention is in alignment with children's everyday language and communication needs to a fairly high degree. However, an exception is assessment, which is considered to have a weaker alignment with children's everyday communication abilities. The use of video recordings for clinical purposes is very limited. It is suggested here that incorporating video recordings from children's everyday life would be an easy and time-efficient way to strengthen the ecological validity of SLP practices for children with (D)LD.

Stakeholders' priorities in the development of evidence-based practice competencies in rehabilitation students: a nominal group technique study

PURPOSE

Clinically integrated teaching (CIT) is an effective approach for promoting evidence-based practice (EBP) competencies among medical students. Challenges towards the implementation of CIT in rehabilitation curricula include educators' different conceptualizations of EBP, the perceived complexity of EBP and the boundaries between the academic and the clinical setting. This study aimed to identify tailored strategies to implement in rehabilitation programs and their affiliated clinical sites to support the development of EBP competencies among students in occupational therapy (OT), physical therapy (PT) and speech-language pathology (S-LP).

MATERIALS AND METHODS

Nominal group technique (NGT) with stakeholders from three rehabilitation programs in Canada, offering the professional master's in OT and PT (n = 35 participants) and in S-LP (n = 8).

RESULTS

The top two strategies identified in the OT/PT NGT were: 1) Developing a flexible definition of EBP that recognizes its complexity; 2) Providing clinicians with more access to the teaching content by pairing faculty with preceptors. The top two strategies identified in the S-LP NGT were: 1) Providing students with opportunities for decision-making with experienced clinicians; 2) Increasing interactions between faculty and preceptors using formal group meetings.

CONCLUSION

Findings laid foundations for future integrated knowledge translation projects to collaboratively implement, and test identified strategies.

Evidence-based practice - implementation level and attitude among physical, occupational, and speech and language therapists in Germany: status quo

INTRODUCTION

Evidence-based practice (EBP) is an important component of clinical practice in public health. Its implementation involves interpreting scientific studies and then applying this knowledge to clinical decision-making. In Germany, the therapy professions are often trained in non-academic medical schools, and only a small number of therapists are university graduates.

AIMS

This study assessed the current status of EBP among physiotherapists, occupational therapists, and speech and language therapists and to determine whether academization influences the implementation of EBP in Germany.

METHODS

To assess the EBP implementation level and therapists' attitudes toward EBP, a cross-sectional study was conducted using the German version of the Evidence-Based Practice Inventory (EBPI), which consists of five dimensions: attitude; subjective norm; perceived behavioral control; decision-making; and intention and behavior. The structural validity and internal consistency of the EBPI survey were also tested.

RESULTS

Of the 2,412 responses, only 557 were eligible. There were statistically significant differences between academically educated vs. non-academically educated therapists in four of the five EBPI dimensions. Furthermore, four of the five dimensions had sufficient unidimensionality and internal consistency.

CONCLUSION

There are differences between academically educated and non-academically educated therapists regarding EBP knowledge, attitudes, and implementation. Academically educated therapists are more likely to use EBP than non-academically educated therapists. There are still barriers to clinical application that need to be addressed.

SPANISH ABSTRACT

http://links.lww.com/IJEBH/A195.

Global State of the Art and Science of Childhood Dysphagia: Similarities and Disparities in Burden

Feeding/swallowing and airway protection are complex functions, essential for survival, and continue to evolve throughout the lifetime. Medical and surgical advances across the globe have improved the long-term survival of medically complex children at the cost of increasing comorbidities, including dysfunctional swallowing (dysphagia). Dysphagia is prominent in children with histories of preterm birth, neurologic and neuromuscular diagnoses, developmental delays, and aerodigestive disorders; and is associated with medical, health, and neurodevelopmental problems; and long-term socioeconomic, caregiver, health system, and social burdens. Despite these survival and population trends, data on global prevalence of childhood dysphagia and associated burdens are limited, and practice variations are common. This article reviews current global population and resource-dependent influences on current trends for children with dysphagia, disparities in the availability and access to specialized multidisciplinary care, and potential impacts on burdens. A patient example will illustrate some questions to be considered and decision-making options in relation to age and development, availability and accessibility to resources, as well as diverse cultures and family values. Precise recognition of feeding/swallowing disorders and follow-up intervention are enhanced by awareness and knowledge of global disparities in resources. Initiatives are needed, which address geographic and economic barriers to providing optimal care to children with dysphagia.

Evidence-based practice and clinical practice in child language: an online survey with Brazilian speech-language pathologists

PURPOSE

To characterize the knowledge, skills, opinions, and main barriers perceived by speech-language pathologists, in child language in Brazil, regarding evidence-based practice (EBP).

METHODS

The study was conducted between August 2021 and July 2022 using an online questionnaire. In addition to sociodemographic and field data, 22 items related to EBP were considered and subdivided into "knowledge", "skills", "opinion" and "barriers". Each item had five response options (strongly disagree, disagree, not decided, agree, strongly agree). A total of 122 speech-language pathologists who work with child language answered the questionnaire. Their responses were described by the percentage of frequency distribution. The time since graduation and the level of proficiency in English were considered to compare the distribution pattern of the answers.

RESULTS

Although most speech-language pathologists report having learned the basics of EBP in their academic training, there are weaknesses in their knowledge and lack of mastery of search strategies and critical evaluation of scientific articles. Although most agree that EBP's use is necessary for speech-language practice and consider the need to increase the use of scientific evidence in their daily practice, the lack of articles, difficulties related to the practical application of scientific results and lack of collective support among colleagues are identified as barriers.

CONCLUSION

This study alerts the academic community to the urgency of considering EBP in the context of Brazilian Speech-Language Pathology.

School-Based Speech-Language Pathologists' Engagement With Evidence-Based Practice: An Update With Implications for Implementation Research

PURPOSE

We replicated a prior survey study (Hoffman et al., 2013) to document current evidence-based practice (EBP) patterns as reported by school-based speech-language pathologists (SLPs) during the 2021-2022 school year.

METHOD

Via an online survey, SLPs reported their training experiences and needs, workplace resources, and frequency of engagement in EBP activities.

RESULTS

A total of 889 SLPs in 50 states participated in the survey. Results revealed that 19% of seasoned SLPs (with more than 10 years since last degree) had no formal training in EBP, 22% of SLPs worked in school districts with official EBP procedural guidelines, and 36% had scheduled time in their work week to support EBP activities. Early career (EC) professionals were more likely than seasoned career (SC) professionals to pose and research one or more EBP questions per year and to read journal articles about assessment and treatment. The gap in article use by experience groups was larger than a decade ago. Like prior survey results, the majority of SLPs read zero to four American Speech-Language-Hearing Association (ASHA) journal articles on assessment or intervention per year, with similar results for reading non-ASHA journal articles.

CONCLUSIONS

Although the past decade has fostered some positive increases in the use of EBP resources and engagement in EBP activities, there continues to be a need for additional training and support for school-based SLPs to fully implement EBP. Training and implementation support should account for differences in training preferences and workplace resources and address differentiation of reported practices by EC versus SC professionals. Further implications for implementation science in schools are provided.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23152817.

Factors Impacting Implementation of Universal Screening of Developmental Language Disorder in Public Schools

PURPOSE

Developmental language disorder (DLD) is an underidentified neurodevelopmental disorder that affects, on average, one out of 11 kindergarten-age children (ages 4-6 years). Children with DLD can face academic, behavioral, psychiatric, emotional, and social challenges. Universal screening is seen as an effective way for public school districts to increase DLD identification rates. However, little is known about factors impacting implementation of school-based universal screenings for DLD. We partnered with a large suburban school district in the Intermountain West region of the United States to gather detailed perspectives from school personnel regarding the barriers and facilitators to the implementation of universal screening in their district.

METHOD

Using a two-phase mixed-methods design, we first conducted focus groups to identify potential barriers and facilitators to universal screening. We then used the qualitative data from the first phase to develop a 20-item survey to assess agreement with the focus group results among a wider group of district speech-language pathologists and kindergarten teachers from the school district.

RESULTS

Our survey showed moderate levels of agreement with our focus group results. In particular, school personnel showed high levels of support for universal screening for DLD, with interesting interplay across various factors: (a) the negative impact of unmanageable workload on personnel under both referral- and universal-based identification formats, (b) the preference for paraprofessionals to administer screenings, (c) the role that Response to Intervention programs may play in offsetting workloads associated with universal screenings, and (d) the need for increased awareness and education about child language development and impairment among general education teachers and the public.

CONCLUSION

Recommendations for incorporating these factors into more useful and applicable collaborative research-based efforts are presented.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23661876.

Socio-Economic Status and Language Development in Hearing Loss: A Critical Appraisal

The impact of language input on children's speech, language, and brain development was borne out of Hart and Risley's famous "30-million-word gap". A perspective bolstered by many studies in the last decade relates higher socio-economic status (SES) to better qualitative and quantitative differences in children's speech. The logic chains found in these studies suggest that literacy development depends on language and brain development. Thus, brain building develops based on environmental experience and language input depends on the brain's perception of the auditory information. This essay uses the latest published peer-reviewed research to outline the current landscape of the role of SES in the development of speech and language skills among children with hearing loss (HL) who are enrolled in auditory-driven habilitation programs. This essay argues that low SES families may provide sufficient input for their children. The outcome of auditory-driven programs implemented by speech-language pathologists (SLPs) seems to be detached from SES. The role of SES on this developmental trajectory remains unclear, and clinical practice may be related to other validated and robust parameters related to hearing loss.

Psychometric properties of questionnaires to assess evidence-based practice among occupational, physical and speech therapists: A systematic review

INTRODUCTION

Evidence-based practice (EBP) is an important aspect of healthcare work, but the clinical implementation is complex. To be able to facilitate EBP implementation, valid measurement of the "EBP status quo" is essential. Therefore, we aimed to identify valid tools for EBP status assessment among occupational, physical and speech therapists in Germany.

METHODS

The databases PubMed, Cochrane Library, PsycINFO, and CINAHL were systematically searched from August 2011 until July 2022. Methodological quality and evidence level were scored by two independent raters via: i) the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist, ii) updated criteria for good measurement properties, and iii) modified GRADE criteria.

RESULTS

Overall, 57 reports describing the development or validation of 31 EBP questionnaires were included. Six questionnaires showed "sufficient" evidence for content validity, three questionnaires showed "sufficient" evidence for reliability, two questionnaires showed "sufficient" evidence for structural validity as well as internal consistency, and nine questionnaires showed "sufficient" evidence for construct validity. Most questionnaires demonstrated moderate or low-quality evidence for the psychometric properties tested.

DISCUSSION

Overall, the present review found a lack of sufficient evidence on the psychometric properties of most questionnaires. The Evidence-Based Practice Inventory (EBPI), the Evidence-based Practice Confidence (EPIC) scale and the Health Sciences-Evidence-Based Practice (HS-EBP) questionnaire were the only questionnaires with "sufficient" content validity and, in addition, "sufficient" reliability or "sufficient" internal consistency.

CONCLUSION

Although a lack of high-quality psychometric properties of EBP tools became apparent, the EBPI, the EPIC scale and the HS-EBP questionnaire currently appear to be the best validated tools to assess EBP behavior/attitude and implementation in occupational, physical and speech therapists.

The perspectives of Australian speech pathologists in providing evidence-based practices to children with autism

BACKGROUND

Bridging the research-practice gap in autism communication services is an identified priority for improving services. Limited research has investigated the views of practitioners regarding this research-practice gap. Investigation of the barriers experienced and facilitators used in clinical practice may assist to identify scalable and sustainable strategies to increase use of evidence-based practices (EBPs) in the delivery of communication services to children with autism.

AIMS

To elucidate how Australian speech pathologists engage with external evidence and how communication outcomes are measured to demonstrate the effectiveness of service provision to children with autism.

METHODS & PROCEDURES

A total of 15 Australian speech pathologists, with experience ranging from less than 1 to more than 16 years, participated in three focus groups. Data from focus groups were analysed using reflexive thematic analysis within an interpretive phenomenological paradigm.

OUTCOMES & RESULTS

Seven themes were identified. Participants reported on the diversity of individuals with autism, their experiences of resource constraints, seeking collegial advice and accessing a diverse range of evidence sources, the role of clinical expertise in translating evidence to practice, the barriers experienced in outcome measurement and use of stakeholders to facilitate data collection to demonstrate outcomes.

CONCLUSIONS & IMPLICATIONS

Individual practitioner skill and beliefs are facilitators to translating research to practice. Interventions to improve clinician use of EBP should address the skill and belief barriers, aiming to increase a clinician's EBP self-efficacy and increasing their expectation that investing in EBP activities will result in improved services for children with autism. Modelling and reflective practice are two strategies that may have an application as interventions to improve EBP use in clinical practice.

WHAT THIS PAPER ADDS

What is already known on the subject Constrained resources, especially lack of time, is a barrier to routine uptake of best available evidence in clinical services for children with autism. What this paper adds to existing knowledge In this study, the perception that speech pathologists lacked time to engage in EBP activities was linked with the speech pathologist's research skill and their beliefs about the benefits of engaging in EBP. Speech Pathologists reported using a range of information sources, as "evidence" but also reported feeling uneasy when using evidence of disputable, or unknown quality. Accessibility and relevance to their individual client were highly prioritised in selecting evidence. Clinical expertise was an essential skill for research translation. What are the potential or actual clinical implications of this work? Interventions which target professional beliefs and research translation capability are requisite for motivating speech pathologists to improve their use of EBP. Modelling of EBP use, individual reflective practice and collegial active listening to facilitate reflective practice, might be useful strategies which target beliefs and capability of individual speech pathologists; thereby changing their EBP use.

Clinicians' Perspectives of Treatment for Lateralization Errors: A Quantitative and Qualitative Study

PURPOSE

This mixed-methods study aimed to obtain information regarding speech-language pathologists' (SLPs) perspectives about treatment of lateralization errors (LEs), challenges to implementing evidence-based LE treatment practice, and the sources SLPs' use to find evidence to treat LEs. This information can assist our understanding of ways to facilitate the uptake of evidence-based practice into the everyday treatment of clients with this disorder.

METHOD

A convergent parallel mixed-methods design was used to collect data from SLPs (N = 214) using 24 questions from an online survey distributed through electronic mailing lists and Speech and Hearing State Associations. Quantitative data were analyzed using frequencies and averages; themes and subthemes of qualitative data were analyzed using a content analysis approach with no a priori codes. Quantitative and qualitative results were compared and integrated.

RESULTS

Participants believed that LEs required individualized treatment before the age of 5 years, were largely caused by structural and neuromuscular factors, and required an understanding of orofacial and dental structure and function. Challenges to implementing LE treatment included a lack of skills and knowledge specific to LEs, competing demands on clinicians' time and resources, and a research-practice gap. Sources of evidence frequently used to obtain information about LE treatment were colleagues, trainings, workshops, and American Speech-Language-Hearing Association journals.

CONCLUSIONS

Clinicians believe that LE treatment is challenging and requires skill training. Future research in LEs will need to consider the real-world decisions clinicians must make when treating this disorder as well as clinicians' everyday constraints and challenges.

How to Interpret and Evaluate a Meta-Analysis in the Field of Speech-Language Pathology: A Tutorial for Clinicians

PURPOSE

This tutorial will provide speech-language pathologists with practical considerations and pragmatic tools for interpreting and critically evaluating a meta-analysis. Meta-analysis, which is a statistical procedure that involves combining research data across multiple high-quality research studies, is often considered the highest level of research evidence. Although meta-analyses are commonly deployed in clinical research after completing a systematic review, few clinicians or clinician scientists within the field of speech-language pathology receive formal training to conduct, interpret, or assess meta-analyses to determine the effectiveness of a treatment or procedure for evidence-based practice.

CONCLUSION

Clinicians within the field of speech-language pathology may use the foundational knowledge and practical guidelines outlined in this tutorial about meta-analyses to expand their knowledge of research methods and to shape their clinical practice.

Critically Appraising Systematic Reviews in the Field of Speech-Language Pathology: A How-to Guide for Clinician Readers

Purpose This tutorial will provide speech-language pathologists with foundational knowledge about systematic reviews and their importance in everyday practice. It will also assist clinicians in developing critical appraisal skills so that current research can be translated judiciously to clinical environments for patient care. Systematic reviews are often regarded as the highest level of research evidence for implementing best evidence-based practice, because they synthesize research findings from multiple high-quality research studies, identify methodological weaknesses and biases from the studies included, and assist in illuminating areas for future research work based on current gaps in the literature. While systematic reviews can provide comprehensive knowledge to inform clinical practice, few speech-language pathologists receive training on appraising and applying the findings from systematic reviews appropriately within clinical settings. Conclusion Clinicians within the field of speech-language pathology can use the framework provided in this tutorial to evaluate systematic reviews as a preliminary step for determining appropriate assessment and treatment methods for implementing evidence-based practice within clinical settings.