Evidence based practice

A superpower of sorts

Evidence based practice (EBP) is one of the most important tools for a speech pathologist to make a clinical decision - and for all health professionals, for that matter. E4BP is a term used to outline a 4-pronged approach to clinical decision-making. This includes:

• Best research evidence

• Clinical expertise

• Patient or client’s preferences

• Practice context

Let’s take a further look at each of these to see why they are equally important and necessary to integrate.

Best research evidence

The research evidence is what most people associate with EBP. This can be found in peer-reviewed research papers, systematic reviews and randomised controlled trials. Gone are the days of sifting through physical or digital copies of research papers for hours to find the evidence. The internet and social media has made it much easier for health professionals to locate and implement the research in their practice. Nevertheless, a lot of published research must be examined closely to determine if the results are from a reliable and trustworthy source. Determining research quality can be a blog post for another day.

Why is research important? It outlines proven techniques (e.g., semantic feature analysis for a person with word finding difficulties after a stroke) to achieve a positive outcome for our clients.

Clinical expertise

Clinical expertise includes a combination of the speech pathologist’s experience, education, and clinical skills. It is true that years of experience make us better professionals, but we should also be flexible and open to changing the way we do things. This is why a good speech pathologist will seek regular supervision and professional development so they can stay on top of their game. Clinical skills are built from years of exposure to various clients and help us adapt or modify the way we approach things.

Why is clinical expertise important? The longer we work in a profession and commit to ongoing education, the better we get at understanding our clients and helping them in a more efficient way.

Patient or client’s preferences

The person we are helping should be at the centre of our decision-making. It can be easy to overlook the perspective of the people we help because we think the research evidence, or our opinion comes first. We should stop and ask the person:

• What do you want from me? What are your goals? What will have the biggest impact for you?

99% of the time, people know what they want from us because they have an unmet need that is important to them. We must listen to them first.

Why is client preference important? You will find it very hard to get your client and their family on board if they are not involved in the decision-making process. Speech pathologists need stakeholders on board because home practice and help from others is a sure way to accelerate therapy gains.

Practice context

This includes the physical place or situation where the speech pathologist is working with the person. This can impact how a session is run and if it is a positive experience for them. For example, a client may prefer to be seen in the community in order to work on social communication skills at the shops. Alternatively, they may be more comfortable being seen at home because it is a familiar environment. For many people with a disability, their home is an ideal environment because they are unable to travel to a clinic.

Why is practice context important? Our clients are all different and may prefer to be seen in a clinic, in their home or in the community. We should pay attention to their preference because we want the best outcomes for our clients.

Why do we need E4BP?

Each of these elements should not be used individually when making clinical decisions, rather, they should be integrated with each other. A clinician that uses research evidence, clinical expertise and client’s preference, but neglects to see a client in their home where they are comfortable may not be getting the most out of their therapy sessions. It can be true that one element of E4BP takes on a greater importance at times, but they all need to be present when making a clinical decision. One thing we can know for sure, E4BP will always provide us with a consistent framework to make our decisions so we can support our clients in the best possible way.