ACQ Vol 12 no 1 2010

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ACQ Volume 12, Number 1 2010 43
clinical groups within this network include: paediatric feeding,
adult swallowing, and voice. Speech pathologists who are
interested in joining a clinical group must undertake a training
workshop in the principles and procedures of the network.
SpeechBITE™ (Speech Pathology Database for Best
Interventions and Treatment Efficacy;
com) was launched in 2008 and is an internet-based
resource designed to assist speech pathologists in evidence
based clinical decision making. With Dr Leanne Togher
as project leader and Kate Smith as project manager,
SpeechBITE™ provides abstracts of speech, language,
communication, and swallowing intervention papers that
have been published in scientific journals and then adds an
expert rating out of 10 for the paper based upon its design,
statistical methodology and other factors. SpeechBITE™ is
available free of charge on the internet. Look up your area
of interest on the website and find abstracted empirical
scientific evidence for or against your treatments.
The utility of the above resources was recently
demonstrated by a group of Speech Pathology Australia
Association members. While undertaking training in how
to evaluate the evidence, the efficacy of a number of
marketed child language therapy programs was considered.
After devising a relevant clinical question, a search of the
literature was undertaken using SpeechBITE™. A number of
relevant articles were identified and downloaded from major
databases for medical and educational articles: PubMed
),
Medline
medline.html) and Eric ). Following
evaluation of the articles it was agreed that there was
no sound evidence to support the use of these child
language programs. Attendees agreed that resources
such as SpeechBITE™ certainly made it easier to identify
and evaluate the available evidence, and thereby enabled
clinicians to provide advice and professional opinion to a
client that was informed by the best available evidence.
Next steps
To reduce the perceived gap between speech pathology
practice and research underpinning practice, more research
and increased numbers of researchers (especially clinical
researchers) are required. If you are interested in conducting
clinical research but do not have knowledge and/or
experience in the area, it is important that you access the
support of experienced researchers who will be able to guide
you along the research path. You might even consider
accessing the support of a mentor. This can be done
through undertaking a postgraduate course/ degree or
through enrolling in the mentoring program (http://www.
)
offered through Speech Pathology Australia. By accessing
appropriate support and mentoring when undertaking
research, the potential for your research to be conducted in
an appropriate manner will be heightened, and your research
findings and recommendations will not only be robust and
open to scrutiny but will contribute meaningfully to the
knowledge base and scientific basis of the profession. I look
forward to receiving your comments and engaging in
discussion regarding the issues that impact our ability to
incorporate the evidence into our clinical practice, and am
excited by the prospect these discussions may have in relation
to the evidence base that underpin our clinical practice.
References
Dollaghan, C. A. (2007). The handbook for evidence-based
practice in communication disorders. Baltimore: Paul H. Brookes.
Valuable information is also available by means other
than that provided through research projects. For example,
papers that describe hypotheses and theories will facilitate
understanding of theoretical frameworks underpinning
clinical interventions. They will also provide a first step in
designing future studies that aim to investigate the efficacy of
treatment interventions. Information provided in workshops
and seminars will also provide relevant information,
particularly when the information is underpinned by research
that is robust in design and interpretation.
A process for EBP in speech
pathology
An evidence based practice process has been described in
the speech pathology literature (Gillam & Gillam, 2006). The
steps in this process are defined as:
1) creating a general or specific clinical question;
2) finding external evidence that pertains to the question;
3) determining the level of evidence that the study
represents and critically evaluating the study;
4) evaluating the internal evidence related to client-patient
factors;
5) evaluating the internal evidence related to clinician-
agency factors;
6) making a decision by integrating the evidence, and
7) evaluating the outcomes of the decision (p. 304).
As an addition to the above seven steps, evaluating the
evidence relating to clinician-agency factors has been added
(Nelson & Steele, 2006). This extra step addresses the
importance of an intervention being effective and economical.
Specifically, should an intervention require a mode of service
delivery that may be difficult to implement and sustain (e.g.,
requiring support four times a day), it will likely not be
implemented. Consideration of clinician-agency factors
ensures that practical aspects of the intervention program
(such as frequency and duration) as well as its costs are
taken into account as part of the evidence based process.
Journals and websites for EBP in
speech pathology
There are journals devoted to systemic review of
interventions in our field, such as “Evidence-Based Practice
(EBP) Briefs”, published by Pearson (http://www.
). This journal has easy-to-read
reviews of the literature on topics of interest to working
clinicians. Another journal that is dedicated to EBP in speech
pathology is Evidence-Based Communication Assessment
and Intervention (Psychology Press; http://www.
).
Aside from international journals and publications, a
number of more hands-on resources exist to provide
information and support in relation to EBP. The NSW
Evidence Based Practice Network .
) was established
in 2002 to provide opportunities for speech pathologists
in NSW to learn about EBP and to evaluate the available
evidence in relation to clinical practice. Interested speech
pathologists meet to evaluate the evidence and write
summaries on specific clinical questions (called Critically
Appraised Topics [CATs]). For example, the child language
clinical group of the NSW EBP Network has been
considering the following clinical questions: 1) in school-
aged children with speech language impairment (SLI), is
an in-class school-based model better than a withdrawal
model in managing SLI in the classroom?; 2) in school-
aged children with SLI, is a school-based treatment model
an effective way of managing SLI in the classroom? Other