Jeri A. Logemann
The following article is reprinted with permission from the March 14, 2000 issue of The ASHA Leader, a journal of the American Speech-Language-Hearing Association.
Professionals in a variety of disciplines are talking about evidence-based practice. So what is it?
Evidence-based practice means that clinicians use evaluation and treatment procedures for particular disorders and populations. Evidence-based practice also takes into account current understanding of the patho-physiology of the disorder(s) being treated, clinical expertise, and the client’s preferences for treatment.
Evidence-based practice means that clinicians are using procedures that have been studied carefully and those results have been reviewed and published. Even though our education as speech-language pathologists and audiologists has included the use of diagnostic and trial therapy, the latter does not mean that the evaluations and procedures we use with patients should not be based in evidence indicating their efficacy.
Sometimes clients, parents, and others, in desperation, “want to try anything.” For example, a patient approached me via email, desperate to return to eating after a severe skiing accident. This young man had tried a number of treatment approaches with good efficacy that were unsuccessful for him and requested my opinion about trying another procedure. I indicated that I knew of no evidence that the procedure he named was successful with any patient group, let alone for his problem as he had described it, since I had not seen him in person. He emailed back in a month to say that he had requested permission from his insurance company to receive this treatment procedure, but was told that they would not pay for it as it was experimental and had no evidence of effectiveness in any population.
If we provide treatments that lack evidence to support their usefulness in a particular population of patients, we risk wasting patients’ time and money, increasing their health risks, and not being paid for our services. In the educational setting, using procedures with no efficacy puts us at risk for slowing children’s progress and wasting time precious to their development and learning.
Some clinicians say, “I have good experience with a technique that has no efficacy data published in peer-reviewed journals. What do I do?” If you are using an unproven technique, you have a responsibility to collect and publish the data on its effectiveness. My advice is to collect data systematically. Be sure to control for confounding factors, such as spontaneous recovery. If you are inexperienced in designing and writing in a research mode, contact a researcher in one of our university programs who, I’m sure, would be interested in working with you.
Our professions’ futures depend on the effectiveness of our treatments, not on our impressions of their effectiveness. When you go to a workshop or continuing education experience or, better yet, before you go, it’s important to ask the presenter if data exist in the techniques being described and in what peer-reviewed journals you can read about the data. It is irresponsible for presenters to discuss and advocate screening, diagnostic, or treatment procedures that are not supported by such evidence. It’s important that we as clinicians question the kind of data available to support the usefulness of a technique. It’s critical our patients’ well-being and our professions.
Our professions are ahead of most in ever-strengthening our evidence base. Although we still don’t have every bit of evidence we would like, we should be proud of the evidence we do have available to sup-port our procedures and should consider these data as we care for patients. Each of us has a contribution to make in this area. Consider how you can collect data in the ASHA NOMS and Clinical Trials projects in your own setting. It’s time to care about evidence-based practice.
To learn more about how you can participate in NOMS, contact ASHA’s National Center for Treatment Effectiveness in Communications Disorders at 301-897-0101 or look on ASHA’s Web site at http://www.asha.org/NOMS/. Information on the Clinical Trials Project can be obtained by calling 301-897-5700, ext 4367.
Note: This article originally appeared in an issue of Science in Autism Treatment, the newsletter of the Association for Science in Autism Treatment (ASAT). It may not be republished or reprinted without advance permission from ASAT. Email us for reprint permission.