The challenges in making speech pathology practice evidence based

Abstract

School of Human Communication Sciences, La Trobe University, The Royal Children’s Hospital, Murdoch Childrens ResearchInstitute, Melbourne, AustraliaIntroductionThe aim of this paper is to explore the challengesinvolved in making speech pathology practice evi-dence based. First, evidence-based practice (EBP) isdefined and discussed. Second, the reasons whyspeech pathologists should become Evidence Based(EB) practitioners are outlined. Third, the views ofproponents of EBP are highlighted. Finally, thechallenges facing the profession are summarizedand some strategies that might assist in the adoptionof EBP are suggested.Defining evidence-based practiceSome clinicians genuinely wonder at the fuss createdby EBP. Bury (1998) said EBP challenged cliniciansto answer a crucial question, ‘‘How do you knowthat what you do works?’’ While some cliniciansclaim they regularly ask this question about theirpractice, others do not. Although asking the questionis important, how the answer is derived is of greatersignificance. Perhaps what sets EBP apart is that itplaces a different emphasis on using scientificevidence to answer this question, rather thanopinion, past practice and past teaching. Instead,EBP demands that clinical decision-making isguided by research evidence. Sackett, Richardson,Rosenberg and Haynes (1997) defined EBP as the‘... conscientious, explicit and judicious use ofcurrent best evidence in making decisions aboutthe care of individual patients.’ (p. 2). In clinicalpractice, EBP provides the user with tools and aframework to help determine the benefits and therisks of different management strategies (Guyatt &Rennie, 2002).Is EBP another fad—here today and gone tomor-row? The principles of EBP have driven good healthcare for decades. Although the term EBP is relativelyrecent, the concept is not (for a historical review seeReilly, 2004a, and Sackett et al., 1997). Enderby andEmerson (1995, p. 1) stated that clinical practiceshould be based on research evidence and thatevidence about the efficacy of speech pathologyservices was vital in order to ‘offer an improvedquality of life to our client group, as effectively aspossible, to the maximum number of people’.It is worth briefly considering what has driventhe emergence and adoption of EBP. Imperativeshave included the need to provide efficient andeffective interventions, in other words to demon-strate that what we do works and to deliver healthservices in an efficient manner. In addition,accountability, both to those who receive the healthservices we deliver and to health care providers,has been an important factor. Finally, there is littledoubt that health expenditure has driven reforms.Regardless of individual beliefs about health care,health care is expensive and resources are limited.Policy makers and managers want increasinginformation about the efficiency and effectivenessof interventions. Can anyone argue against theneed to ‘ensure that the content and delivery ofclinical care ... is based on high quality researchrelevant to improving the health of the nation’(Department of Health, 1991). In the last twodecades, health care has moved towards a culturewhereby it is expected that all levels of clinicalservice delivery are informed by scientifically-derived findings. During this time the term EBPwas coined and procedures developed to assistclinicians to evaluate scientific evidence.Defining evidenceThere are many different types of evidence, originat-ing from numerous sources. These include clinicalobservations and clinical experience that may or maynot be supported by systematic observations. Be-cause all sources of evidence are not equal, it is