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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

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

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)
      Systematic Review
      Meta-Analysis

Diagnosis

Controlled Trial
      Systematic Review
      Meta-Analysis of Controlled Trial

Prognosis

Cohort Studies
      RCT
      Case Control

Etiology / Harm Cohort Studies
Prevention

Randomized Controlled Trial
Cohort Studies

Quality of Life

Qualitative Study

 

Adapted from: Sackett et al.’s Evidence-Based Medicine: How to Practice and Teach EBM