Using Evidence-Based Practice in Treatment Planning

1. Using Evidence-Based Practice in Treatment Planning

2. “It is far better to grasp the universe as it really is than to persist in delusion, however satisfying and reassuring.” Carl Sagan

3. The need for evidence-based practice Imagine that your own parent or grandparent has been diagnosed with dementia, and is receiving speech-language pathology services for cognitive rehabilitation. You are glad to hear they are receiving services, but when you observe one of their sessions, something seems off to you. The SLP’s treatment seems to consist of having your loved one do crossword puzzles and word searches from a workbook, and encouraging them by saying things like “The brain is a muscle you need to work out, just like going to the gym!” When you ask the SLP about her approach, she says “This is how I’ve been doing cog treatment for 20 years! Why should I change now?” She assured you she can tell her clients are making progress. • How would you respond to this SLP? • Why might she think her treatment is effective?

4. Cognitive biases affecting clinical practice (Source: Izzy & Lof, 2016)

5. EBP pyramid

6. EBP Step 1: Framing the question (PICO)

7. EBP Step 2: Finding the Evidence • Filtered vs. Unfiltered evidence • Learning to search databases: e.g. PsychNET, PubMED • http://psycnet.apa.org/search?fa=search.advancedSearchForm • ASHA Evidence Maps http://www.asha.org/Evidence-Maps/ • Many evidence-based clinical practice guidelines already exist • To search for a key word (e.g. NMES) in the evidence maps, use the search bar on the right (“Search the Evidence Maps”) • You can also click on individual topics

8. Some EBP resources • http://www.asha.org/Research/EBP/ • http://www.asha.org/Evidence-Maps/ (ASHA Evidence Maps) • http://speechbite.com/ • https://researchguides.uoregon.edu/cds • Scottish Intercollegiate Guidelines Network (SIGN) • The National Guideline Clearinghouse • U.S. Department of Veterans Affairs • Academy of Neurologic Communication Disorders and Sciences (ANCDS) • National Electronic Library for Health (National Health Service of the UK) • The Catalog of Bias https://catalogofbias.org/

9. Use ASHA Evidence Maps to Answer the Question https://www.asha.org/Evidence-Maps/

10. EBP Step 3: Assessing the Evidence • Systematic Reviews • Make sure to consider the specific population you are interested in • Notice who wrote and published the review • Individual studies • Consider level of evidence (see next slide) • Consider study quality

11. Levels of EvidenceAdapted from theScottish Intercollegiate Guidelines Network

12. EBP Step 4: Making the Clinical Decision • When guidelines exist for your clinical question, it is generally best practice to follow the guidelines • When no guidelines exist, you must evaluate the evidence you’ve found critically and make a decision for your client • There is no magic formula for determining how much evidence is "enough." Factors such as patient preference, potential for harm, and availability of alternative treatments all come into play in ultimately making the treatment decision

13. Critical thinking:Separating good science from bad

14. Your Assignment • Choose a client and approach you will be using for that client—see the Intervention Selection Table for example approaches. • Look for evidence-based treatment recommendations for using that approach with the population your client is in. • Read 2 articles summarizing the evidence for your treatment approach. • Make a Powerpoint presentation containing between 5-10 slides covering how you went through all 4 EBP steps to answer your specific PICO question, and presenting what you found out and what you decided to do for your client • Give an oral presentation to the group next week. • Your oral presentation should be between 5-8 minutes. Be prepared to answer questions from your peers.