Scientifically Based Professional Practice Over the past several years, the need has grown for speech-language pathologists and audiologists to use evidence-based practice (EBP) in clinical decision-making, but for our discipline, like most others, the transition is not easy. One challenge we face is the scarcity of clinical practice research to guide clinical decisions and ... From the President
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From the President  |   November 01, 2008
Scientifically Based Professional Practice
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Professional Issues & Training / From the President
From the President   |   November 01, 2008
Scientifically Based Professional Practice
The ASHA Leader, November 2008, Vol. 13, 26-27. doi:10.1044/leader.FTP.13162008.26
The ASHA Leader, November 2008, Vol. 13, 26-27. doi:10.1044/leader.FTP.13162008.26
Over the past several years, the need has grown for speech-language pathologists and audiologists to use evidence-based practice (EBP) in clinical decision-making, but for our discipline, like most others, the transition is not easy. One challenge we face is the scarcity of clinical practice research to guide clinical decisions and policy. Even where relevant literature exists, professionals often lack the time to evaluate and synthesize the research.
ASHA is committed to expanding clinical practice research and helping members make a smooth transition to using EBP, which is why one of the four “pillars of excellence” in ASHA’s new strategic plan is “Scientifically Based Professional Practices.”
To accomplish this, ASHA is focusing three long-term objectives:
  • Increasing the generation of clinical practice research, which focuses on prevention, identification, assessment, intervention, and service delivery in audiology and speech-language pathology

  • Developing EBP guidelines across the scope of practice in audiology and speech-language pathology

  • Enhancing the transfer of knowledge into practice and dissemination of evidence to advocacy groups, policy makers, and third-party payers

What consequences do we face if communication sciences and disorders does not quickly become an evidence-based discipline? You need look no further than Rhode Island, where the Board of Regents and Department of Special Education interpreted the Individuals With Disabilities Education Act regulations to exclude eligible children who would receive only speech-language pathology services after they reached 9 years of age. Why? In part, because insufficient evidence existed to demonstrate the benefit for children over that age who received those services in the schools.
In an era of shrinking budgets, a strong base of clinical practice research will help secure services for those in need and the financial foundation of our discipline.
As Ray Kent, a leading researcher in our discipline, notes, “Evidenced-based practice is not only the standard of our profession—it is the policy of our organization, and we should accept nothing less.”
Although most in our discipline agree that grounding clinical practice in evidence is a good idea, EBP raises some challenging questions:
  • How can the volume and quality of clinical practice research be increased?

  • How can collaboration be enhanced between practitioners and researchers to achieve that goal?

  • How can practitioners incorporate external evidence to improve service delivery?

  • What type of data “counts” as external evidence?

  • What is the role of information sources other than external evidence in shaping clinical practice?

Types of Evidence
When considering these questions, it is helpful to keep in mind the four types of information on which EPB relies. External evidence refers to scientific research addressing the efficacy, efficiency, and cost-benefit ratio of services. Incorporating external evidence into professional practice is probably the most challenging aspect of EBP, but is valuable because it allows us to evaluate different approaches, avoid fads and bias, generate knowledge, and provide objective justification for clinical decisions and services to clients as well as to governmental agencies and third-party payers.
Professional wisdom is acquired through experience and from consensus-building among professionals, and allows us to provide services intelligently in areas where scientific evidence is insufficient. Perhaps most practice decisions are based on professional wisdom, but we must acknowledge that it is highly subject to bias.
Information about client values and preferences enables us to adapt our services to the individual by considering personal factors, which should always be respected. Incorporating client values and preferences in our decision-making also is key to delivering culturally competent professional services.
The service delivery context includes the policies, pressures, and practices of employment facilities and governmental and other regulatory agencies that have an unavoidable and profound effect on our practice patterns. Margaret Rogers, ASHA chief staff officer for science and research, says, “Influencing public policy, regulations, laws, and facility-level practices with evidence derived from clinical practice research may be the most important EBP activity that ASHA undertakes in the foreseeable future.”
ASHA is collaborating with government agencies on a number of important issues, including the development of a new tool to track resource utilization that may lead to an alternative payment system to the Medicare therapy caps.
Clinical practice research has already helped secure our scope of practice and expand payment for our services. Data from ASHA’s National Outcomes Measurement System (NOMS) were used successfully to gain the National Quality Forum’s endorsement for eight stroke-related functional communication measures (FCMs). Because of the endorsement and recent legislative changes, speech-language pathologists soon will be able to use these FCMs to report outcomes and receive bonus payments from the Centers for Medicare and Medicaid Services. ASHA also has initiated a collaborative effort with the American Academy of Audiology and other audiology organizations to develop a proposal to gain endorsement of quality reporting measures that would offer audiologists the same opportunity to receive bonus payments.
Another measure of our progress is the growing number of evidence-based “systematic reviews” developed by ASHA that provide the basis for EBP guidelines. “There is no question that research evidence generates respect for our professions and provides clinicians with the evidence they need in discussing our worth with employers and other professionals,” said Jeri Logemann, a highly regarded researcher and former ASHA president.
As an ASHA member, your involvement is critical, and there are many ways to get involved—by starting an EBP study group, visiting the National Center for Evidence-based Practice Web site, providing comments on systematic review documents during the peer-review phase, proposing a clinical question as a systematic review topic, or—if the opportunity arises—getting involved in research. If you’re already engaged in research, consider how your work might contribute to our discipline’s need for clinical evidence.
In the end, expanding our base of clinical practice research—focused on prevention, identification, assessment, intervention, and service delivery—is our highest priority. Let this serve as a clarion call to all members—EBP is our standard, our policy, and our future.
Submit Your Clinical Questions

Each year ASHA’s National Center for Evidence-based Practice (N-CEP) asks members to submit clinical questions about the value of a diagnostic or intervention approach to produce a specific type of outcome in a narrow population, and questions have poured in—more than 200 this year alone. N-CEP also facilitates quick access to a variety of EBP resources online.

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November 2008
Volume 13, Issue 16