Speech Pathology & Audiology: Evidence-Based Practice
What is Evidence-Based Practice?
Evidence-based practice is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. That is, it integrates the best external evidence with individual clinical expertise and patients' choice.
Evidence-based practice involves 5 steps:
1. Ask a focused question to satisfy the health needs of a specific patient
- What is your clinical question? - use the P.I.C.O. model
- What type of clinical question is this?
- What is the best study design to answer this type of clinical question? Use the table to the right.
2. Find the best evidence by searching the literature
- What is the highest level of literature to support the question? See the pyramid to the right.
- Where should you look for this material? See the table to the right.
3. Critically appraise the literature: testing for validity, clinical relevance, and applicability
- What are the results of the study?
4. Apply the results in clinical practice
5. Evaluate the outcomes in your patient
Adapted from: the Centre for Evidence-Based Medicine and Sackett DL, Evidence based medicine: what it is and what it isn't. BMJ. 1996 Jan 13;312(7023):71-2.
Best Resources and Strategies for finding EBP research
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CINAHL Plus with Full TextCINAHL (Comprehensive Index to Nursing and Allied Health Literature) is the world's most comprehensive source of full text for nursing & allied health journals. Note: Limits for Evidence-Based Practice and Special Interest: Speech-Language Pathology/Audiology
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PubMedPubMed is the National Library of Medicine's (NLM) covers the fields of medicine, nursing, the health care system and more.
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Cochrane LibraryThe Cochrane Library is comprised of several databases that identify research at varying levels of evidence. The databases include:
- Cochrane Database of Systematic Reviews (CDSR)
- Database of Abstracts of Reviews of Effectiveness (DARE)
- Cochrane Central Register of Controlled Trials
- Cochrane Methodology Register
- Health Technology Assessment Database
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TRIP (Turning Research Into Practice) DatabaseSearches over 55 sites of high-quality medical information and gives you direct links to the largest collections of evidence-based material on the web as well as articles from premiere online journals such as BMJ, JAMA, and NEJM.
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ECRI Guidelines TrustGuideline repository that provides evidence-based clinical practice guidelines and systematic reviews summaries.
Note: not all guidelines meet standards for full inclusion; ensure that you review the TRUST algorithm. -
National Guideline Clearinghouse*Currently unfunded. See ECRI Guidelines Trust as replacement.
Part of the Department of Health & Human Services. A public resource for evidence-based clinical practice guidelines. Open advanced search filters to limit to Speech-Language Pathology and more. -
speechBITEA database of intervention studies in speech pathology practice.
Effectiveness of Reviews Pyramid
There is a range in quality of evidence available in the literature, with systematic reviews being the very highest quality. As you move up the pyramid, the amount of literature decreases but its clinical relevance increases.
![Pyramid hierarchy of evidence from bottom up: background information/expert opinion; case studies; cohort studies; randomized controlled trials; critically-appraised individual articles [article synopses]; critically-appraised topics [evidence syntheses]; systematic reviews](https://lgimages.s3.amazonaws.com/data/imagemanager/35181/ebm_pyramid.gif)
Sources of research may be either pre-appraised (summaries), primary literature or more anecdotal.
| Systematic Reviews or Meta-analysis | PubMed, MEDLINE, SumSearch, Cochrane Library |
| Critically-Appraised Topics | BMJ Clinical Evidence*, DynaMed*, UpToDate* |
| Critically-Appraised Articles | ACP Journal Club (included in MEDLINE) |
| Randomized Controlled Trials | Original articles |
| Cohort Studies | Original articles |
| Case-Controlled Studies etc. | Original articles |
| Background Info/Expert Opinion | Books, editorials |
* Miami does not have a paid subscription.
Type of Question / Methodology pairing
What is the best kind of evidence to support your research question?
| Type of Question / Domain | Type of Study / Methodology Methodologies defined |
| Therapy / Treatment |
Randomized Controlled Trial (RCT) |
| Diagnosis |
Controlled Trial |
| Prognosis |
Cohort Studies |
| Etiology / Harm | Cohort Studies |
| Prevention |
Randomized Controlled Trial |
| Quality of Life |
Qualitative Study |
Adapted from: Sackett et al.’s Evidence-Based Medicine: How to Practice and Teach EBM