Improving Research Literacy In Speech-Language Pathology

By Jessica Prebor, M.S., CCC-SLP

Speech-language pathologist

Providing speech-language pathologists appropriate strategies and resources to improve their ability to review and stay informed about the current literature may increase the use of high levels of clinical evidence into their practice.

Evidence-based practice encompasses a clinician’s expertise, their patients’ goals, and the best current research to support therapy methods. While clinicians find great value in evidence-based practice, research suggests current applications are based primarily on personal experiences and communication with colleagues rather than referencing the most up-to-date evidence in the scientific literature. With a greater emphasis placed upon clinical expertise and little use of recent research, comprehensive implementation of evidence-based practice is lacking. Reviewing the best current research is a challenge due to many barriers such as limited access to the literature, insufficient research literacy, and time constraints.

Research literacy– the ability to access, interpret, critically evaluate, and apply the literature– is not inherent for all clinicians. These skills are introduced within graduate programs and gain strength when explicitly practiced throughout one’s career. Continuing education courses allow clinicians to consume specific literature as summarized by a presenter with expertise in the educational area. Presenters provide research synopses supporting the targeted intervention for a specified patient population.

For speech-language pathologists to appropriately apply these presentations’ interventions to unique patients, the information must be more than just helpful. The ability to use the best current literature within practice requires thoughtful execution.  Staying current on available research must be a continuous process from graduation and beyond as these skills are perishable.

HOW TO START YOUR SEARCH FOR THE RIGHT INTERVENTION LITERATURE

Before beginning an evidence search, it is best to identify a question to answer including the patient population, targeted intervention, a comparison intervention, and the outcomes measured (i.e., PICO). Once the question is specified, searching systematic reviews and meta-analyses is perfect for retrieving a summary of relevant research.

Systematic reviews are structured reviews of original studies that use strategies to decrease bias in the collection, appraisal, and analysis of included studies. They involve a comprehensive plan, strategic search, and a structured synthesis in the research reporting. Systematic Reviews offer narrative descriptions and recommendations for practice. They may also include a meta-analysis which involves statistical analysis of the data to achieve a single quantitative estimate or effect size. Effect sizes measure the strength of the treatment results.

ASHA evidence maps offer systematic reviews, meta-analyses, clinical recommendations, and guidelines organized into a multitude of therapeutic areas. Articles are summarized with quality ratings, significant details, and conclusions. This information provides clinicians quick access to an abundance of applicable research; however, specific intervention techniques or protocols are not defined requiring further investigation into original articles within the reviews. Other useful sources for article access include speechBITE, PsychBITE, and PubMed.

TAKE YOUR RESEARCH UNDERSTANDING TO THE NEXT LEVEL

Once the evidence of interest is identified, interpreting the efficacy and applicability of the outcomes may be unclear. It’s important to recognize the difference between efficacy and effectiveness. That is, the difference between results under controlled research conditions versus real-world impact.

Interpreting the therapeutic context of a study design and how it can relate to practice is vital.  This includes the patient’s individual needs and the treatment setting.  Whether it is the theory behind an intervention or a single strategy, translating research results into clinical practice requires reflection.

A clinician’s personal perspective may bias their opinion of the conclusions of a study. This is why it is essential to evaluate articles using previously developed appraisal tools. Critical appraisal tools are often in the form of checklists used to determine the level of rigor in which a study was conducted, analyzed, and reported on. They are often available through a quick online search. Detailed instructions are provided to describe the scientific verbiage and scoring system.

A wide variety of appraisal resources are easily available, but it is important to use the appropriate tool for the article being assessed. For example, the Evidence in Augmentative and Alternative Communication (EVIDAAC) is an appropriate checklist to identify the quality of comparative single-subject experimental design studies while the Assessment of Multiple Systematic Reviews (AMSTAR) is appropriate in evaluating systematic reviews. ASHA evidence maps use the Appraisal of Guidelines Research and Evaluation (AGREE). Overall, using a critical appraisal checklist is a great way to improve research literacy through familiarity with scientific vocabulary and practice in identifying the strengths and weaknesses of articles.

CONTINUE TO BE A CRITICAL THINKER WHEN APPLYING INTERVENTIONS

Application of interventions identified as effective in rigorously done research is completed after locating, understanding, and assessing the quality of the evidence. Using scientifically sound techniques in treatment adds power to therapy methods but may not always result in expected outcomes. It’s important to always reflect on the effectiveness of the application.

Even when supported by clinician, patient, and science, knowledge translation is not always flawless. It is through trial and error that learning occurs. Through practice and reflection, patterns arise allowing new tools to be better applied.

The methodological process of evidence-based practice seems less than timely; however, there are ways to improve the speed and value. Developing strong research literacy through a systematic search, interpretation, evaluation, and application of research studies can improve the ability to effectively translate scientific evidence into clinical practice. It is not a skill that comes naturally to everyone but must be practiced.

Applying the evidence by using research results and personal experience with a patient’s values and the practice context in mind will lead to the best clinical outcomes.