Semin Speech Lang 2019; 40(05): 370-393
DOI: 10.1055/s-0039-1694996
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Moving Beyond Traditional Understandings of Evidence-Based Practice: A Total Evidence and Knowledge Approach (TEKA) to Treatment Evaluation and Clinical Decision Making in Speech-Language Pathology

Arlene McCurtin
1   School of Allied Health, University of Limerick, Limerick, Ireland
2   Health Research Institute, University of Limerick, Limerick, Ireland
,
Carol-Anne Murphy
1   School of Allied Health, University of Limerick, Limerick, Ireland
2   Health Research Institute, University of Limerick, Limerick, Ireland
,
Hazel Roddam
3   University of Central Lancashire, Preston, Lancashire, United Kingdom
› Author Affiliations
Further Information

Publication History

Publication Date:
19 August 2019 (online)

Abstract

Evidence-based practice (EBP) is a well-established framework for supporting clinical decision making in the discipline of speech-language pathology. The benefits of using evidence to inform clinical practice are acknowledged by clinicians and researchers alike. Even so, after over two decades of EBP advocacy, much clinical uncertainty remains and models supporting the evaluation of interventions require review and reconsideration. The EBP model, while promoting positive principles, can be argued to be conceptually flawed because it suffers from a lack of attention to and explicit valuing of other forms of knowledge crucial to the formation of realistic and judiciously informed decisions. We propose that the evaluation of interventions would be better supported by an explicit knowledge management approach reflecting a range of evidence and knowledge. One worked example is presented to demonstrate what using such an approach can produce in terms of intervention information.

Disclosures

Financial: No relevant financial relationships exist for any of the authors.


Nonfinancial: No relevant nonfinancial relationships exist for any of the authors.


 
  • References

  • 1 McCurtin A, Roddam H. Evidence based practice: opportunities for growth or professionals under siege. Int J Lang Commun Disord 2012; 47 (01) 11-26
  • 2 Greenhalgh T. How to Read a Paper: The Basics of Evidence-Based Medicine. London: BMJ Books; 1997
  • 3 Reilly S, Douglas J, Oates J. Evidence Based Practice in Speech Pathology. London: Whurr; 2004
  • 4 Mykhalovskiy E, Weir L. The problem of evidence-based medicine: directions for social science. Soc Sci Med 2004; 59 (05) 1059-1069
  • 5 Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ 1996; 312 (7023): 71-72
  • 6 Dollaghan CA. The Handbook for Evidence-Based Practice in Communication Disorders. Baltimore, MD: Paul H Brookes; 2007
  • 7 ASHA. Available at: https://www.asha.org/Research/EBP/ . Accessed June 27, 2019
  • 8 McCabe PJ. Elizabeth Usher Memorial Lecture: How do we change our profession? Using the lens of behavioural economics to improve evidence-based practice in speech-language pathology. Int J Speech-Language Pathol 2018; 20 (03) 300-309
  • 9 Greenhalgh T, Howick J, Maskrey N. Evidence Based Medicine Renaissance Group. Evidence based medicine: a movement in crisis?. BMJ 2014; 348: g3725
  • 10 Stephens D, Upton D. Speech and language therapists' understanding and adoption of evidence-based practice including commentaries by Erickson S and McCurtin A. Int J Ther Rehabil 2012; 19 (06) 333-334
  • 11 Wren Y, Harding S, Goldbart J, Roulstone S. A systematic review and classification of interventions for speech-sound disorder in preschool children. Int J Lang Commun Disord 2018; 53 (03) 446-467
  • 12 Law J, Garrett Z, Nye C. Speech and language therapy interventions for children with primary speech and language delay or disorder. Cochrane Database Syst Rev 2003; 3 (03) CD004110
  • 13 Roulstone S. Evidence, expertise, and patient preference in speech-language pathology. Int J Speech-Language Pathol 2011; 13 (01) 43-48
  • 14 Hubble MA, Duncan BL, Miller SD. Introduction. In: Hubble MA, Duncan BL, Miller SD. , eds. The Heart & Soul of Change: What Works in Therapy. Washington, DC: American Psychological Association; 1999
  • 15 Moerman DE. Meaning, Medicine and the Placebo Effect. Cambridge: Cambridge University Press; 2002
  • 16 Plsek PE, Greenhalgh T. Complexity science: the challenge of complexity in health care. BMJ 2001; 323 (7313): 625-628
  • 17 McCurtin A, Clifford AM. What are the primary influences on treatment decisions? How does this reflect on evidence-based practice? Indications from the discipline of speech and language therapy. J Eval Clin Pract 2015; 21 (06) 1178-1189
  • 18 Law J. Evidence-based practice and its application to developmental language disorders. In: Law J, McKean C, Murphy CA. , et al., eds. Managing Children with Developmental Language Disorder. Theory and Practice across Europe and Beyond. London: Routledge Taylor and Francis; 2019: 6-29
  • 19 Murphy CA. The limits of evidence and the implications of context: considerations when implementing pathways to intervention for children with language disorders. Int J Lang Commun Disord 2019; 54 (01) 20-23
  • 20 Satterfield JM, Spring B, Brownson RC. , et al. Toward a transdisciplinary model of evidence-based practice. Milbank Q 2009; 87 (02) 368-390
  • 21 Berg H, Slaattelid R. Facts and values in psychotherapy—a critique of the empirical reduction of psychotherapy within evidence-based practice. J Eval Clin Pract 2017; 23 (05) 1075-1080
  • 22 Kastner M, Tricco AC, Soobiah C. , et al. What is the most appropriate knowledge synthesis method to conduct a review? Protocol for a scoping review. BMC Med Res Methodol 2012; 12: 114
  • 23 Tricco AC, Tetzlaff J, Moher D. The art and science of knowledge synthesis. J Clin Epidemiol 2011; 64 (01) 11-20
  • 24 Titler MG, Everett LQ, Adams S. Implications for implementation science. Nurs Res 2007; 56 (4, Suppl): S53-S59
  • 25 Olswang LB, Prelock PA. Bridging the gap between research and practice: implementation science. J Speech Lang Hear Res 2015; 58 (06) S1818-S1826
  • 26 Douglas NF, Burshinc VL. Implementation science: tackling the research to practice gap in communication sciences and disorders. Perspect ASHA Spec Interest Groups 2019; 4: 4-7
  • 27 Siminoff LA. Incorporating patient and family preferences into evidence-based medicine. BMC Med Inform 2013; 13 (Suppl. 03) S6
  • 28 Mackenzie C, Muir M, Allen C. Non-speech oro-motor exercise use in acquired dysarthria management: regimes and rationales. Int J Lang Commun Disord 2010; 45 (06) 617-629
  • 29 McCurtin A, Carter B. ‘We don’t have recipes; we just have loads of ingredients': explanations of evidence and clinical decision making by speech and language therapists. J Eval Clin Pract 2015; 21 (06) 1142-1150
  • 30 McCurtin A, Healy C, Kelly L, Murphy F, Ryan J, Walsh J. Plugging the patient evidence gap: what patients with swallowing disorders post-stroke say about thickened liquids. Int J Lang Commun Disord 2018; 53 (01) 30-39
  • 31 Stiggelbout AM, Van der Weijden T, De Wit MPT. , et al. Shared decision making: really putting patients at the centre of healthcare. BMJ 2012; 344: e256
  • 32 MacFarlane A, Galvin R, O'Sullivan M. , et al. Participatory methods for research prioritization in primary care: an analysis of the World Café approach in Ireland and the USA. Fam Pract 2017; 34 (03) 278-284
  • 33 Franklin S, Harhen D, Hayes M. , et al. Top 10 research priorities relating to aphasia following stroke. Aphasiology 2018; 32 (11) 1388-1395
  • 34 McCormack J, McLeod S, McAllister L, Harrison LJ. My speech problem, your listening problem, and my frustration: the experience of living with childhood speech impairment. Lang Speech Hear Serv Sch 2010; 41 (04) 379-392
  • 35 McCormack J, McAllister L, McLeod S. , et al. Knowing, having, doing: The battles of childhood speech impairment. Child Lang Teach The 2012; 28 (02) 141-157
  • 36 Lyons R, Roulstone S. Well-being and resilience in children with speech and language disorders. J Speech Lang Hear Res 2018; 61 (02) 324-344
  • 37 Connery A, McCurtin A, Robinson K. The lived experience of stuttering: a synthesis of qualitative studies with implications for rehabilitation. Disabil Rehabil 2019 Doi: 10.1080/09638288.2018.1555623. [Epub ahead of print]
  • 38 American Speech Language Hearing Association Evidence Maps. Available at: https://www.asha.org/evidence-maps/ . Accessed June 26, 2019
  • 39 Communication Trust. What Works? Available at: http://www.thecommunicationtrust.org.uk/whatworks . Accessed March 10, 2019
  • 40 Law J, Roulstone S, Lindsay G. Integrating external evidence of intervention effectiveness with both practice and the parent perspective: development of ‘What Works’ for speech, language, and communication needs. Dev Med Child Neurol 2015; 57 (03) 223-228
  • 41 Parahoo K. Barriers to, and facilitators of, research utilization among nurses in Northern Ireland. J Adv Nurs 2000; 31 (01) 89-98
  • 42 Hoffmann T, Bennett S, Del Mar C. Evidence-Based Practice across the Health Professions-E-Book. Elsevier Health Sciences/Churchill Livingstone Australia; 2013
  • 43 May C. Towards a general theory of implementation. Implement Sci 2013; 8: 18
  • 44 McAllister L, McCormack J, McLeod S, Harrison LJ. Expectations and experiences of accessing and participating in services for childhood speech impairment. Int J Speech-Language Pathol 2011; 13 (03) 251-267
  • 45 Ruggero L, McCabe P, Ballard KJ, Munro N. Paediatric speech-language pathology service delivery: an exploratory survey of Australian parents. Int J Speech-Language Pathol 2012; 14 (04) 338-350
  • 46 McCormack J, Baker E, Masso S. , et al. Implementation fidelity of a computer-assisted intervention for children with speech sound disorders. Int J Speech-Language Pathol 2017; 19 (03) 265-276
  • 47 Buetow S, Kenealy T. Evidence-based medicine: the need for a new definition. J Eval Clin Pract 2000; 6 (02) 85-92
  • 48 Gallacher K, Jani B, Morrison D. , et al; International Minimally Disruptive Medicine Workgroup. Qualitative systematic reviews of treatment burden in stroke, heart failure and diabetes - methodological challenges and solutions. BMC Med Res Methodol 2013; 13: 10
  • 49 Elwyn G, Frosch D, Thomson R. , et al. Shared decision making: a model for clinical practice. J Gen Intern Med 2012; 27 (10) 1361-1367
  • 50 Kamhi AG. A meme's eye view of speech-language pathology. Lang Speech Hear Serv Sch 2004; 35 (02) 105-111
  • 51 Creaghead NA. Evaluating language intervention approaches: contrasting perspectives. Lang Speech Hear Serv Sch 1999; 30 (04) 335-338
  • 52 Ludemann A, Power E, Hoffmann TC. Investigating the adequacy of intervention descriptions in recent speech-language pathology literature: is evidence from randomized trials useable?. Am J Speech Lang Pathol 2017; 26 (02) 443-455
  • 53 Rvachew S, Brosseau-Lapre F. Developmental Phonological Disorders Foundation of Clinical Practice. San Diego CA: Plural; 2012
  • 54 Better Communication Research Programme. Available at: https://www.gov.uk/government/collections/better-communication-research-programme . Accessed March 10, 2019
  • 55 Roulstone S, Wren Y, Bakopoulou I. , et al. Exploring interventions for children and young people with speech, language and communication needs: a study of practice. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/219627/DFE-RR247-BCRP13.pdf . Accessed July 11, 2018
  • 56 Kavanagh M, Roche C, Clifford A, Ryan J, Walsh C, McCurtin A. A systematic review of the evidence underpinning thickened liquid recommendations in stroke clinical practice guidelines. 6th European Society of Swallowing disorders Congress: Deglutology, from science to practice. Dysphagia 2019; 32: 170
  • 57 Finn P. Critical thinking: knowledge and skills for evidence-based practice. Lang Speech Hear Serv Sch 2011; 42 (01) 69-72 , discussion 88–93
  • 58 Wade C, Tavris C, Garry M. Psychology, 11th ed. NJ: Prentice Hall; 2014
  • 59 Finn P. Establishing the validity of stuttering treatment effectiveness: The fallibility of clinical experience. Perspect Fluen Fluen Disord 2004; 14: 9-12
  • 60 Finn P, Bothe AK, Bramlett RE. Science and pseudoscience in communication disorders: criteria and applications. Am J Speech Lang Pathol 2005; 14 (03) 172-186
  • 61 Turkstra LS, Norman R, Whyte J, Dijkers MP, Hart T. Knowing what we're doing: why specification of treatment methods is critical for evidence-based practice in speech-language pathology. Am J Speech Lang Pathol 2016; 25 (02) 164-171
  • 62 Vyse S. Where do fads come from?. In: Jacobson JJ, Foxx RM, Mulick JA. , eds. Controversial Therapies for Developmental Disabilities: Fad, Fashion, and Science in Professional practice. Mahwah, NJ: Lawrence Erlbaum Associates; 2005: 10-15
  • 63 McCurtin A, Healy C. Why do clinicians choose the therapies and techniques they do? Exploring clinical decision-making via treatment selections in dysphagia practice. Int J Speech-Language Pathol 2017; 19 (01) 69-76
  • 64 Jones O, Cartwright J, Whitworth A, Cocks N. Dysphagia therapy post stroke: an exploration of the practices and clinical decision-making of speech-language pathologists in Australia. Int J Speech-Language Pathol 2018; 20 (02) 226-237
  • 65 Biancone TL, Farquharson K, Justice LM, Schmitt MB, Logan JA. Quality of language intervention provided to primary-grade students with language impairment. J Commun Disord 2014; 49: 13-24
  • 66 Katz LA, Maag A, Fallon KA, Blenkarn K, Smith MK. What makes a caseload (un)manageable? School-based speech-language pathologists speak. Lang Speech Hear Serv Sch 2010; 41 (02) 139-151
  • 67 Pavelko SL, Owens Jr RE, Ireland M, Hahs-Vaughn DL. Use of language sample analysis by school-based SLPs: results of a nationwide survey. Lang Speech Hear Serv Sch 2016; 47 (03) 246-258
  • 68 Straus SE, Tetroe JM, Graham ID. Knowledge translation is the use of knowledge in health care decision making. J Clin Epidemiol 2011; 64 (01) 6-10
  • 69 Farr M, Cressey P. Understanding staff perspectives of quality in practice in healthcare. BMC Health Serv Res 2015; 15: 123
    • Additional References for Appendix

    • 70 Clavé P, de Kraa M, Arreola V. , et al. The effect of bolus viscosity on swallowing function in neurogenic dysphagia. Aliment Pharmacol Ther 2006; 24 (09) 1385-1394
    • 71 Newman R, Vilardell N, Clavé P, Speyer R. Effect of bolus viscosity on the safety and efficacy of swallowing and the kinematics of the swallow response in patients with oropharyngeal dysphagia: White Paper by the European Society for Swallowing Disorders. Dysphagia 2016; 31 (02) 232-249
    • 72 Finestone HM, Foley NC, Woodbury MG, Greene-Finestone L. Quantifying fluid intake in dysphagic stroke patients: a preliminary comparison of oral and nonoral strategies. Arch Phys Med Rehabil 2001; 82 (12) 1744-1746
    • 73 Steele CM, Alsanei WA, Ayanikalath S. , et al. The influence of food texture and liquid consistency modification on swallowing physiology and function: a systematic review. Dysphagia 2015; 30 (01) 2-26
    • 74 Cichero JA. Thickening agents used for dysphagia management: effect on bioavailability of water, medication and feelings of satiety. Nutr J 2013; 12: 54
    • 75 Vallons KJ, Helmens HJ, Oudhuis AA. Effect of human saliva on the consistency of thickened drinks for individuals with dysphagia. Int J Lang Commun Disord 2015; 50 (02) 165-175
    • 76 Beck AM, Kjaersgaard A, Hansen T, Poulsen I. Systematic review and evidence based recommendations on texture modified foods and thickened liquids for adults (above 17 years) with oropharyngeal dysphagia - An updated clinical guideline. Clin Nutr 2018; 37 (6, Pt A): 1980-1991
    • 77 Kaneoka A, Pisegna JM, Saito H. , et al. A systematic review and meta-analysis of pneumonia associated with thin liquid vs. thickened liquid intake in patients who aspirate. Clin Rehabil 2017; 31 (08) 1116-1125
    • 78 Andersen UT, Beck AM, Kjaersgaard A. , et al. Systematic review and evidence based recommendations on texture modified foods and thickened fluids for adults (18 years) with oropharyngeal dysphagia. e-SPEN J 2016; 8: e127-e134
    • 79 Foley N, Teasell R, Salter K, Kruger E, Martino R. Dysphagia treatment post stroke: a systematic review of randomised controlled trials. Age Ageing 2008; 37 (03) 258-264
    • 80 Garcia JM, Chambers IV E, Molander M. Thickened liquids: practice patterns of speech-language pathologists. Am J Speech Lang Pathol 2005; 14 (01) 4-13
    • 81 Brady R, Coffey K, Ryan J, Murphy F, Clifford A, Walsh C, McCurtin A.. Gathering evidence for decision aids: SLTs favorite dysphagia intervention - what does practice evidence/clinical experience tell us? 30th World Congress of the International Association of Logpedists and Phoniatrists. Dublin, Ireland; August 2016
    • 82 Colodny N. Dysphagic independent feeders' justifications for noncompliance with recommendations by a speech-language pathologist. Am J Speech Lang Pathol 2005; 14 (01) 61-70
    • 83 King JM, Ligman K. Patient noncompliance with swallowing recommendations: reports from speech–language pathologists. Contemp Iss Comm Sci Dis 2011; 38: 53-60
    • 84 Sharp HM, Bryant KN. Ethical issues in dysphagia: when patients refuse assessment or treatment. Semin Speech Lang 2003; 24 (04) 285-299
    • 85 Logemann JA, Gensler G, Robbins J. , et al. A randomized study of three interventions for aspiration of thin liquids in patients with dementia or Parkinson's disease. J Speech Lang Hear Res 2008; 51 (01) 173-183
    • 86 Macqueen C, Taubert S, Cotter D, Stevens S, Frost G. Which commercial thickening agent do patients prefer?. Dysphagia 2003; 18 (01) 46-52
    • 87 Swan K, Speyer R, Heijnen BJ, Wagg B, Cordier R. Living with oropharyngeal dysphagia: effects of bolus modification on health-related quality of life--a systematic review. Qual Life Res 2015; 24 (10) 2447-2456
    • 88 Lim DJH, Mulkerrin SM, Mulkerrin EC, O'Keeffe ST. A randomised trial of the effect of different fluid consistencies used in the management of dysphagia on quality of life: a time trade-off study. Age Ageing 2016; 45 (02) 309-312
    • 89 Sura L, Madhavan A, Carnaby G, Crary MA. Dysphagia in the elderly: management and nutritional considerations. Clin Interv Aging 2012; 7: 287-298
    • 90 O'Keeffe ST. Use of modified diets to prevent aspiration in oropharyngeal dysphagia: is current practice justified?. BMC Geriatr 2018; 18 (01) 167
    • 91 Pownall S, Taylor C. Use of thickening agents and nutritional supplements for patients with dysphagia following stroke. Br J Neurosci Nurs 2017; 13: 260-268
    • 92 Murray J, Doeltgen S, Miller M, Scholten I. A survey of thickened fluid prescribing and monitoring practices of Australian health professionals. J Eval Clin Pract 2014; 20 (05) 596-600
    • 93 Glassburn DL, Deem JF. Thickener viscosity in dysphagia management: variability among speech-language pathologists. Dysphagia 1998; 13 (04) 218-222
    • 94 Murray J, Miller M, Doeltgen S, Scholten I. Intake of thickened liquids by hospitalized adults with dysphagia after stroke. Int J Speech-Language Pathol 2014; 16 (05) 486-494
    • 95 Fraser S, Steele CM. The effect of the Chin-Down position on penetration aspiration in adults with dysphagia. Can J Speech-Lang Pat 2012; 36 (02) 142-148
    • 96 Saconato M, Chiari BM, Lederman HM, Gonçalves MI. Effectiveness of Chin-tuck maneuver to facilitate swallowing in neurologic dysphagia. Int Arch Otorhinolaryngol 2016; 20 (01) 13-17
    • 97 Sommerville P, Lang A, Nightingale S. , et al. Dysphagia after stroke and feeding with acknowledged risk. Br J Neurosci Nurs 2016; 12 (04) 162-169