JCPSLP Vol 14 No 1 2012

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Professional issues
JCPSLP Volume 14, Number 1 2012 37
Jade Cartwright
Unit. Your caseload is busy and complex with a strong push
for early discharge and reduced length of stay. Over the
past two years you have read extensively and attended a
number of continuing professional events in the areas of
aphasia and dysphagia rehabilitation and best practice;
however, you have not been able to implement much of
your new knowledge. As is typically the case in this setting
the assessment and management of dysphagia takes the
priority and most of your day is spent conducting bedside
swallowing examinations, while also fitting in regular team
and family meetings into your busy schedule. It is extremely
hard to find time to plan and complete new projects and
one of your greatest bugbears is the paucity of time you
have available to address your clients’ communication
needs. You constantly reflect on how best practice could
be achieved within the constraints of the system and how
you can get your strong knowledge about the current
evidence into practice. It is not a question of what the
evidence says or what you should be doing as you are well
aware of the research around the efficacy and effectiveness
of aphasia treatments; it concerns more the actual
translation of this evidence into practice. In other words:
how can service change be successfully implemented (and
sustained) to meet the recommended clinical guidelines and
bridge the divide between evidence and practice to enable
optimal client outcomes?
Response to this scenario
The clinical scenario is common across health areas and
one that may contribute to despondency and reduced job
satisfaction. I know that I have experienced frustration
myself many times in practice when you know the current
best evidence and expert opinion in the field but your ability
to translate this evidence is compromised by external
pressures on the service, such as caseload size and
complexity, availability of managerial support and/or
resources, and engrained service delivery models. Much of
the EBP literature in the speech pathology arena has
focused on critical appraisal of the research evidence as
opposed to the implementation of the ‘clinical bottom line’
or best practice recommendation to emerge. When a
clinician has the knowledge but doesn’t translate this
knowledge into routine practice it is called a “knowledge-to-
action” (KTA) gap (Molfenter, Ammoury, Yeates, & Steele,
2009) and this is the point where energy must be directed
to bridge the knowledge–practice divide. Research
supports the notion that transferring knowledge into action
is a time consuming process (Molfenter et al., 2009). As a
This column of “What’s the evidence?” follows on from
the “Ethical conversations” in this issue of the Journal
of Clinical Practice in Speech-Language Pathology
around the ethical and professional issues currently facing
clinicians in the workplace. Evidence based practice
(EBP) was a recurring theme throughout the discussion
with members of the Ethics Board acknowledging the
increasing trend for both clinicians and consumers to
endorse evidence based perspectives. A critical point
to emerge related to “how research findings are actually
interpreted and applied in the professional community”
(Leitão et al., this issue, pg 33) to ensure that the translation
of evidence to practice is appropriate and doesn’t restrict
access, choice, or outcomes for individual clients. This
caution is counterintuitive as through EBP clinicians strive
for “optimal practice”. However, it is not always clear
how effectively research actually does (and can) inform
professional practice at the coalface, where administrative
and system-level factors can significantly impede or restrict
this translation. In fact the “prevailing disconnect between
what we know to be effective and what we practice daily”
(Liang, 2007, p. w120) is widely reported in the health
sciences literature and many attempts to translate evidence
into clinical practice are unsuccessful or only partially
successful (Lizarondo, Grimmers-Somers, & Kumar, 2011;
Sales, Smith, Curran, & Kochevar, 2006; Small, 2005;
Sudsawad, 2007). Interestingly, a recent survey of 123
speech pathologists working for Ageing Disability and
Home Care (ADHC) in New South Wales revealed that
61.4% of speech pathologists surveyed either agreed or
strongly agreed that there was a definite divide between
the findings of research and application in clinical practice
(Togher, Trembath, & Brunac, 2011). Yet the vast majority
either agreed or strongly agreed that the application of EBP
is a necessary part of speech pathology practice (89.5%)
and guides decisions about client care (90.3%) (Togher et
al., 2011). This finding suggests that a specific skill-set is
perhaps required above and beyond EBP itself to ensure
successful implementation and service change in light
of strong evidence and practice guidelines. This “What’s
the evidence?” column reviews the current evidence for
“evidence translation” to offer clinicians some ideas for
demonstrating and proactively addressing evidence–
practice gaps.
Clinical scenario
Imagine you are a clinician working in a busy teaching
hospital. As a senior speech pathologist you are
responsible for covering the Neurology Ward and Stroke
What’s the evidence for
translating EBP into
clinical practice?
Jade Cartwright