The challenges in making speech pathology practice evidence based

Exploring attitudes about evidence-based practice among speech-language pathologists: A survey of Japan and Malaysia

Purpose: To investigate speech-language pathologists' current perceptions, previous training experiences, resources, barriers, and training needs in terms of evidence-based practices (EBPs) in two Asian countries.Method: Their knowledge and attitudes about EBP were explored using an online questionnaire. A descriptive analysis was conducted with consideration of the effect of demographic variables on knowledge and attitudes about EBP.Result: Malaysian speech-language pathologists (n = 98) displayed more positive attitudes toward EBPs, with a significantly higher (t (143) = 5.91, p < .01) total mean score (Mean = 120.7, SD = 11) compared to the Japanese speech-language pathologists (n = 47, Mean = 107.8, SD = 13.5). Malaysian practitioners who were female, worked full-time, and worked in government settings reported higher motivation to develop EBP skills. Japanese practitioners who worked in private sectors reported higher EBPs training needs than those in government settings. In both countries, speech-language pathologists with higher education levels tended to express fewer perceived barriers towards EBP.Conclusion: Findings could help local governance and speech-language pathologist associations to understand the current practices and professional development needs of speech-language pathologists, leading to more effective training programs and educating employers and managers who can reinforce EBP among practitioners.

What Influences Speech-Language Pathologists' Use of Different Types of Language Assessments for Elementary School-Age Children?

Purpose This study reports on data from a survey of speech-language pathologists' (SLPs) language assessment practices for elementary school-age children. The objective was to investigate the regularity with which SLPs use different types of assessments (described across data types, task types, environmental contexts, and dynamic features). This study also investigated factors that influence assessment practice, the main sources from which SLPs obtain information on language assessment and the main challenges reported by SLPs in relation to language assessment. Method A web-based survey was used to collect information from 407 Australian SLPs regarding the types of assessments they use. Factors that influenced the regularity with which different types of assessments were used were investigated using regression analysis. Results Most SLPs regularly used assessments that are norm-referenced, decontextualized, and conducted in a clinical context and less regularly used other types of assessments. Service agency, Australian state, and SLPs' years of experience were found to influence the regularity with which some types of assessments were used. Informal discussions with colleagues were the most frequently identified source of information on assessment practice. Main challenges related to limited time, lack of assessment materials, and lack of confidence in assessing children from culturally and linguistically diverse backgrounds. Conclusions SLPs could improve current language assessment practice for elementary school-age children through more regular use of some types of assessments. Actions to facilitate evidence-based assessment practice should consider the contextual differences that exist between service agencies and states and address challenges that SLPs experience in relation to language assessment. Supplemental Material https://doi.org/10.23641/asha.14378948.

Developing an evidence-based reading intervention for early brain injury rehabilitation

Introduction:

Providing evidence-based services in areas with emerging or low-level evidence is a challenge for many clinicians. The aim of the current study was to apply a newly designed novel methodology to develop and describe a new intervention for cognitive-communication reading comprehension deficits in early acquired brain injury rehabilitation.

Methods:

An emergent multi-phase mixed methods design allowed phases of different research activity to build an evidence base of quantitative and qualitative data. A pragmatic clinical framework was developed to combine these traditional research findings with principles from knowledge translation and implementation science, evidence-based practice and intervention development models, clinical contextual practice guidelines and the Medical Research Council’s guidelines for developing and evaluating complex interventions, to create an evidence-based contextually driven clinical intervention.

Results:

The resulting reading comprehension intervention and service delivery model is presented and involves a multiple-strategy intervention across increasing level of reading comprehension complexity. In areas where traditional methodologies provide low-level evidence, this method provides an alternate way to conduct evidence-based clinical research.

What Does Evidence-Based Practice Mean to You? A Follow-Up Study Examining School-Based Speech-Language Pathologists' Perspectives on Evidence-Based Practice

Purpose The current investigation is a follow-up from a previous study examining child language diagnostic decision making in school-based speech-language pathologists (SLPs). The purpose of this study was to examine the SLPs' perspectives regarding the use of evidence-based practice (EBP) in their clinical work. Method Semistructured phone interviews were conducted with 25 school-based SLPs who previously participated in an earlier study by Fulcher-Rood et al. 2018). SLPs were asked questions regarding their definition of EBP, the value of research evidence, contexts in which they implement scientific literature in clinical practice, and the barriers to implementing EBP. Results SLPs' definitions of EBP differed from current definitions, in that SLPs only included the use of research findings. SLPs seem to discuss EBP as it relates to treatment and not assessment. Reported barriers to EBP implementation were insufficient time, limited funding, and restrictions from their employment setting. SLPs found it difficult to translate research findings to clinical practice. SLPs implemented external research evidence when they did not have enough clinical expertise regarding a specific client or when they needed scientific evidence to support a strategy they used. Conclusions SLPs appear to use EBP for specific reasons and not for every clinical decision they make. In addition, SLPs rely on EBP for treatment decisions and not for assessment decisions. Educational systems potentially present other challenges that need to be considered for EBP implementation. Considerations for implementation science and the research-to-practice gap are discussed.

Speech-Language Pathologists' Knowledge and Consideration of Factors That May Predict, Moderate, and Mediate AAC Outcomes

The aims of this study were to examine speech-language pathologists' (SLPs) knowledge and consideration of factors found in research when making clinical decisions regarding AAC for children with Autism Spectrum Disorder (ASD), and to reveal additional factors identified based on SLPs' clinical practice. A 20-question mixed-methods survey was completed internationally by 187 certified SLPs. Overall, SLPs showed some familiarity with the research and considered factors found in research when making clinical decisions. SLPs also identified 20 factors that were not identified in the most recent systematic review that may predict, moderate, and/or mediate outcomes. This information may contribute to advancing clinical services regarding AAC as well as guide future research investigating the mechanisms by which children with ASD respond to AAC interventions.

Parent-implemented home therapy programmes for speech and language: a systematic review

BACKGROUND

Parent-delivered home programmes are frequently used to remediate speech and language difficulties in young children. However, the evidence base for this service delivery model is limited.

AIMS

The aim of this systematic review is to investigate the effectiveness of parent-implemented home programmes in facilitating the development of children's speech and language skills, and to evaluate the cost-effectiveness and feasibility of this service delivery method.

METHODS & PROCEDURES

A systematic search of the PsycINFO, CINAHL and ERIC databases was conducted. Quality appraisal of individual studies was conducted. Findings from each of the studies were then integrated to report on outcomes for the child, the parent and the service.

OUTCOMES & RESULTS

There is preliminary evidence that home programmes can lead to growth in a child's speech and language skills and are more effective than no intervention, provided the home programmes are used with high dosage rates and direct parent training.

CONCLUSIONS & IMPLICATIONS

Home programmes are a potentially useful service delivery model, but caution should be exercised when considering their use to address broader service delivery challenges. Further high-level evidence is needed across all facets of this service delivery model.

Reflective processes of practitioners in head and neck cancer rehabilitation: a grounded theory study

PURPOSE

This study systematically examined how experienced Speech-Language Pathologists (SLPs) use the processes of reflection to develop knowledge relevant for practice in the context of head and neck cancer (HNC) rehabilitation.

METHOD

In-depth, semi-structured interviews were conducted with 12 SLPs working in HNC rehabilitation in North America. Grounded theory methodology was adopted for data collection and analysis.

RESULT

The findings inform a preliminary reflective practice model that depicts the processes of reflection used by practitioners interviewed. Nine categories of reflective processes were identified by participant SLPs in terms of the processes of reflection: ongoing questioning, experimenting through trial and error, integrating knowledge from past cases, embracing surprise, thinking out of the box, being in the moment, consulting with colleagues, putting oneself in the patients' shoes, and discerning ethical issues. These findings provide empirical evidence that supports Schön's theory of reflective practice and contribute to knowledge about the ways in which SLPs use processes of reflection in the context of HNC rehabilitation.

CONCLUSION

The findings of this study have implications for how SLPs perceive and consider their role as knowledge-users and knowledge producers in their day-to-day clinical work, as well as for building capacity for reflective practice.

What do speech-language pathologists think parents expect when treating their children with autism spectrum disorder?

PURPOSE

Despite the importance of Speech-Language Pathologists (SLPs) collaborating with parents in the treatment of children with Autism Spectrum Disorder (ASD), few studies have examined the nature of this working relationship and how best to facilitate collaboration. To explore what SLPs think parents of children with ASD expect of them when it comes to the delivery of evidence-based interventions.

METHOD

The participants were 22 SLPs from Australia who specialised in ASD and who each participated in a semi-structured interview. Recordings were transcribed and analysed according to the procedures outlined by Braun and Clarke.

RESULT

The SLPs expressed strong support for evidence-based practice (EBP) and indicated that they thought parents expected their children would be provided with evidence-based interventions. However, SLPs identified factors that influenced the way and the extent to which they were able to share information as part of a collaborative decision-making process, including the parents' education level and the amount of time since their children's diagnoses.

CONCLUSION

The results highlight the challenges that SLPs face when engaging with parents in the delivery of EBP. Strategies that the SLPs had developed to cater to the individual needs of each parent are discussed, along with implications for clinical practice.

Information behaviour of French-speaking speech-language therapists in Belgium: results of a questionnaire survey

BACKGROUND

Speech-language therapists (SLTs) are encouraged to implement evidence-based practice (EBP). Nevertheless, EBP use by practitioners can be questioned.

OBJECTIVES

The objective of this study was to explore Belgian French-speaking SLTs' information behaviour and their awareness of EBP. The collected data allow one to determine how far they have embraced this approach.

METHODS

The two Belgian French-speaking SLT professional associations promoted an online questionnaire survey by email. Additionally, clinical supervisors of students were asked to participate. In March 2012, 2068 emails were sent.

RESULTS

The participation rate was at least 20% (n = 415). The reported information needs mainly concerned treatment or diagnosis. Most of the time, to attempt to fulfil their information needs, SLTs relied on their own resources (personal experience and libraries) and on colleagues in the workplace. When they searched on the Internet, they preferred to use a general search engine rather than a specialised bibliographic database. Barriers to obtaining scientific information are highlighted. Only 12% of the respondents had already heard about EBP.

CONCLUSION

This study provides the first overview of the information behaviour of SLTs working in the French community of Belgium. Several recommendations are suggested for SLTs and librarians.

The impact of workplace factors on evidence-based speech-language pathology practice for children with autism spectrum disorders

Although researchers have examined barriers to implementing evidence-based practice (EBP) at the level of the individual, little is known about the effects workplaces have on speech-language pathologists' implementation of EBP. The aim of this study was to examine the impact of workplace factors on the use of EBP amongst speech-language pathologists who work with children with Autism Spectrum Disorder (ASD). This study sought to (a) explore views about EBP amongst speech-language pathologists who work with children with ASD, (b) identify workplace factors which, in the participants' opinions, acted as barriers or enablers to their provision of evidence-based speech-language pathology services, and (c) examine whether or not speech-language pathologists' responses to workplace factors differed based on the type of workplace or their years of experience. A total of 105 speech-language pathologists from across Australia completed an anonymous online questionnaire. The results indicate that, although the majority of speech-language pathologists agreed that EBP is necessary, they experienced barriers to their implementation of EBP including workplace culture and support, lack of time, cost of EBP, and the availability and accessibility of EBP resources. The barriers reported by speech-language pathologists were similar, regardless of their workplace (private practice vs organization) and years of experience.

Evidence-Based Speech-Language Pathology Practices in Schools: Findings From a National Survey

Purpose

This study documented evidence-based practice (EBP) patterns as reported by speech-language pathologists (SLPs) employed in public schools during 2010–2011.

Method

Using an online survey, practioners reported their EBP training experiences, resources available in their workplaces, and the frequency with which they engage in specific EBP activities, as well as their resource needs and future training format preferences.

Results

A total of 2,762 SLPs in 28 states participated in the online survey, 85% of whom reported holding the Certificate of Clinical Competence in Speech-Language Pathology credential. Results revealed that one quarter of survey respondents had no formal training in EBP, 11% of SLPs worked in school districts with official EBP procedural guidelines, and 91% had no scheduled time to support EBP activities. The majority of SLPs posed and researched 0 to 2 EBP questions per year and read 0 to 4 American Speech-Language-Hearing Association (ASHA) journal articles per year on either assessment or intervention topics.

Conclusion

Use of ASHA online resources and engagement in EBP activities were documented to be low. However, results also revealed that school-based SLPs have high interest in additional training and resources to support scientifically based practices. Suggestions for enhancing EBP support in public schools and augmenting knowledge transfer are provided.

The implementation of evidence-based practice in the management of adults with functional voice disorders: a national survey of speech-language pathologists

This study examined Australian speech-language pathologists' (SLPs) use of evidence-based practice (E(3)BP) when treating adults with functional voice disorders (FVDs). It was hypothesized that SLPs would report using the available evidence to care for their clients but may be limited by time and skills. Fifty-eight SLPs completed a 26-item survey. A combination of indirect and direct voice therapy was most frequently reported, with hum and nasal consonants, pitch extension, elimination of glottal attack, and diaphragmatic breathing being the most frequently used techniques. In the absence of higher levels of evidence, 98% of respondents reported they relied on clinical experience to guide their clinical decision-making. Despite a lack of research evidence supporting this decision, SLPs also reported simultaneously using a combination of direct voice therapies to cater to the needs of their individual clients. Barriers to EBP were lack of time, specialty training and high quality evidence. To improve SLPs' management of adults with FVDs, it is suggested that SLPs need both greater access to voice training and to use practice-based evidence by actively collecting and reporting clinical data.

Sport, scales, or war? Metaphors speech-language pathologists use to describe caseload management

Professionals' experiences, perceptions, and attitudes may be reflected in the metaphors they use to describe and discuss important professional issues. This qualitative study explored speech-language pathologists' experiences of caseload management through metaphorical analysis. Metaphors provided a lens for reflecting participants' lived experiences and professional knowledge construction. Data was obtained from 16 practising speech-language pathologists during individual work place interviews. Participants included new graduate and experienced speech-language pathologists who were employed in hospital and community settings. Metaphors for caseload management were identified from participants' transcribed narratives, then coded and organized into themes. Participants produced a total of 297 metaphors during professional practice narratives. Thematic analysis indicated that participants used three salient metaphors of sport, measuring scales, and war when they addressed caseload issues. Metaphors of sport, scales, and war reflected speech-language pathologists' concerns about managing clients efficiently, perceived caseload burdens, and the conflict they experienced when resources were inadequate. These metaphors may also represent a continuum in speech-language pathologists' personal and professional responses to caseload demands. Shared metaphors may contribute to the professional socialization of individuals entering a profession and to changing or maintaining workplace culture. Hence, speech-language pathologists need to consider the impact of using metaphors of sport, measuring scales, and war during interactions with clients and colleagues.

Assessing methodological quality of randomized and quasi-experimental trials: a summary of stuttering treatment research

The purpose of this study is to provide a detailed analysis of the methodological quality of experimental and quasi-experimental group designed studies in the area of stuttering intervention. A total of 23 randomized controlled trials (RCT) and quasi-experimental studies of treatment in the area of stuttering were identified and retrieved from an electronic search of nine databases and 13 individual journals. Using the Downs and Black Checklist each study was coded for reporting, external validity, internal validity, and internal validity confounding. Results of the coding indicated that while overall reporting was reasonably complete, the quality of the external and internal validity scores was found to be substantively incomplete. This lack of clarity and completeness of reporting issues related to the external and internal validity makes the interpretation of the findings of individual study results problematic and seriously effects the replicability of the individual study. Implications of these findings are suggested for both researchers and clinicians.

Evidence, expertise, and patient preference in speech-language pathology

A consideration of evidence-based practice has led many to debate the nature of evidence. Rejecting the idea that randomized controlled trials should be the only legitimate source of evidence, writers have argued that other types of research and knowledge should be considered legitimate sources of evidence. This paper suggests that one should draw on systematic research, including qualitative research, for evidence, and that other types of knowledge such as craft and practice knowledge are part of the profession's expertise. This paper argues that evidence and expertise are both required for evidence-based practice to occur. Finally, a consideration of patients' values and expectations is explored as a third component of evidence-based practice. The paper argues that all three components are necessary for evidence-based practice.

The Kirkpatrick model: A useful tool for evaluating training outcomes

BACKGROUND

Services employing staff to support people with disability usually provide training in a range of areas including communication and managing challenging behaviour. Given that such training can be costly and time-consuming, it is important to evaluate the evidence presented in support of such programs. Efficacy in clinical practice is measured using evidence-based practice. However, there is currently no model that is widely used to compare and evaluate training programs despite the large number of training programs reported each year.

METHOD

Six studies published in the last decade that reported the outcomes of communication-based training and six that reported on the outcomes of challenging behaviour training were evaluated using the 4-level Kirkpatrick model.

RESULTS

Comparison of the levels of evidence is made for these 12 studies.

CONCLUSION

The Kirkpatrick model provides one technique for appraisal of the evidence for any reported training program and could be used to evaluate whether a training program is likely to meet the needs and requirements of both the organisation implementing the training and the staff who will participate.

Preparation, clinical support, and confidence of speech-language pathologists managing clients with a tracheostomy in Australia

PURPOSE

To describe the preparation and training, clinical support, and confidence of speech-language pathologists (SLPs) in relation to tracheostomy client care in Australia.

METHOD

A survey was sent to 90 SLPs involved in tracheostomy management across Australia. The survey contained questions relating to preparation and training, clinical support, and confidence.

RESULTS

The response rate was high (76%). The majority of SLPs were pursuing a range of professional development activities, had clinical support available, and felt confident providing care of clients with tracheostomies. Despite these findings, 45% of SLPs were not up-to-date with evidence-based practice, less than 30% were knowledgeable of the advances in tracheostomy tube technology, and only 16% felt they worked as part of an optimal team. Only half were confident and had clinical support for managing clients who were ventilated. Most (88%) believed additional training opportunities would be beneficial.

CONCLUSIONS

The current data highlight issues for health care facilities and education providers to address regarding the training and support needs of SLPs providing tracheostomy client care.

Intervention for dysarthria associated with acquired brain injury in children and adolescents

BACKGROUND

The term 'acquired brain injury' (ABI) incorporates a range of aetiologies including cerebrovascular accident, brain tumour and traumatic brain injury. ABI is a common cause of disability in the paediatric population, and dysarthria is a common and often persistent sequelae associated with ABI in children.

OBJECTIVES

To assess the efficacy of intervention delivered by Speech and Language Pathologists/Therapists targeting dysarthric speech in children resulting from acquired brain injury.

SEARCH STRATEGY

We searched CENTRAL (Issue 4, 2006), MEDLINE (1966 to 02/2007), CINAHL (1982 to 02/2007), EMBASE (1980 to 02/2007), ERIC (1965 to 02/2007), Linguistics Abstracts Online (1985 to 02/07), PsycINFO (1872 to 02/2007). Additional references were also sought from reference lists studies.

SELECTION CRITERIA

The review considered randomised controlled trials (RCTs) and quasi-experimental design studies of children aged 3-16 years with acquired dysarthria grouped by aetiology (e.g., brain tumour, traumatic brain injury, cerebrovascular accident).

DATA COLLECTION AND ANALYSIS

Each author independently assessed the titles and abstracts for relevance (100% inter-rater reliability) and the full text version of all potentially relevant articles was obtained. No studies met inclusion criteria.

MAIN RESULTS

Of 2091 titles and abstracts identified, full text versions of only three (Morgan 2007; Murdoch 1999; Netsell 2001) were obtained. 2088 were excluded, largely on the basis of not including dysarthria, being diagnostic or descriptive papers, and for concerning adults rather than children. Morgan 2007 and Murdoch 1999 were excluded for not employing RCT or quasi-randomised methodology; Netsell 2001 on the basis of being a theoretical review paper, rather than an intervention study. Five references were identified and obtained from the bibliography of the Murdoch 1999 paper. All were excluded due to including populations without ABI, adults with dysarthria, or inappropriate design. Thus, no studies met inclusion criteria.

AUTHORS' CONCLUSIONS

The review demonstrates a critical lack of studies, let alone RCTs, addressing treatment efficacy for dysarthria in children with ABI. Possible reasons to explain this lack of data include i) a lack of understanding of the characteristics or natural history of dysarthria associated with this population; ii) the lack of a diagnostic classification system for children precluding the development of well targeted intervention programs; and iii) the heterogeneity of both the aetiologies and resultant possible dysarthria types of paediatric ABI. Efforts should first be directed at modest well-controlled studies to identify likely efficacious treatments that may then be trialed in multi-centre collaborations using quasi-randomised or RCT methodology.

Getting started in evidence-based practice for childhood speech-language disorders

PURPOSE

Evidence-based practice (EBP) entails a critical mindset and rigorous methods that foster the judicious integration of scientific evidence into clinical decision making. The purpose of this tutorial is to present strategies, resources, and examples to help speech-language pathologists get started in EBP for childhood speech and language disorders.

METHOD

The tutorial begins with an overview of key principles of EBP, including potential benefits and challenges, and other initial considerations. Five recommended steps for implementing EBP are then presented: posing a question, locating the evidence, appraising the evidence, making and implementing clinical decisions, and evaluating those decisions. Included is a compilation of synthesized evidence resources, such as systematic reviews/meta-analyses and EBP guidelines. Finally, illustrative examples are provided to assist practitioners with integrating research evidence into clinical decision making in childhood speech-language disorders.

CONCLUSIONS

Speech-language pathologists who work with children are encouraged to adopt EBP for clinical decision making.