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Speech-Language Pathology: Evidence-Based Practice: EBP

Defining EBP

Evidence-Based Practice (EBP) is the framework for your clinical decision-making process. It is the integration of

  • your knowledge, skills, and past experience (Clinical Expertise);
  • the unique preferences, concerns and expectations of your patient (Patient Characteristics); and
  • valid and clinically relevant research (Best Evidence).

 

      

 

Types of Clinical Questions

Therapy - What is the treatment for a disease?

Diagnosis - power of a test to differentiate between those with and without a disease?

Prognosis - a patient’s likely course over time due to factors other than interventions?

Etiology/Harm - effects of potentially harmful agents on the patient?

5 A's - Steps for Acquiring Information

                    

               - Review the Situation (Assess)

             - Define the clinical problem as a question (Ask)

             - Select resources, design a strategy, and search for the

               answer (Acquire)

             - Summarize the evidence yield (Appraise)

             - Apply the evidence (Apply)

Levels of Evidence

The Levels of Evidence is a hierarchy of the likely best evidence. The level of evidence can be defined by the type of question. Please review the Levels of Evidence Introductory Document and other information from The Centre for Evidence-Based Medicine at Oxford:

Level Description
Ia Systematic reviews
Ib Randomized controlled trials (RCTs)
II Controlled study without randomization
III Case-controlled trial
IV Case series or expert opinion, clinical experience of respected authorities

Study Design

 

Type of Question Suggested Best Type of Study
Therapy RCT > prospective cohort
Diagnosis Prospective, blind comparison to a gold standard
Etiology/Harm RCT > cohort > case control > case series
Prognosis cohort study > case control > case series
Prevention RCT > cohort study > case control > case series
Clinical Exam prospective, blind comparison to gold standard
Cost economic analysis

Questions of therapy and prevention which can best be answered by a RCT can also be answered by a systematic review or meta-analysis.