Evidence-based practice and speech-language pathology.

Review Panel: John Ashford, PhD; Tobi Frymark, MA; Daniel McCabe, DMA; Nan Musson, MA; Carol Smith Hammond, PhD; Karen Wheeler-Hegland, PhD Swallowing disorders are commonly seen among veterans as a result of stroke, traumatic brain injury, and head and neck cancer. These and other neurological and nonneurological conditions associated with dysphagia can lead to a number of adverse consequences, including malnutrition, aspiration pneumonia, immunocompromised health, and reduced quality of life. Department of Veterans Affairs (VA) speech-language pathologists (SLPs) are integral to the management of individuals with dysphagia, oftentimes employing one or more treatment approaches to improve deglutition for functional oral intake. These approaches can include dietary modifications, compensatory postures and maneuvers, tactile and thermal stimulations, and oral motor exercises. In recent years, SLPs have been called on to justify their treatment decisions with sound scientific evidence and have been seeking resources to effectively engage in evidence-based practice (EBP). Originating from a definition by Sackett and colleagues [1], EBP refers to “the integration of best research evidence with clinical expertise and client values.” EBP informs clinicians who seek the best treatment course based on a balance between research-based evidence, clinical expertise and experience, and the client’s wishes. Providers evaluate the scientific literature as it pertains to the choice of a specific diagnostic protocol or treatment approach. However, while the movement for evidence-based accountability from well-designed, methodologically sound research has garnered considerable attention, the practical application of EBP has not been easy for many, including SLPs working in the field of dysphagia. In 2008, the American Speech-Language-Hearing Association (ASHA) performed a Knowledge, Attitudes, and Practices Survey [2] and found that SLPs recognize the importance of EBP and are overall very or moderately confident in a number of its aspects. Specifically, most clinicians reported confidence in using MEDLINE and other electronic online databases to identify and retrieve scientific literature (68.9%), identify types of study designs used in research (70.2%), and assess the quality of the research (74.4%). Unfortunately, insufficient time to perform literature searches, limited resources, and the sparse literature base were reported as major barriers hindering their ability to successfully engage in EBP. SLPs are not alone in the struggle to fully engage in evidence-based decision-making, because these same trends have been reported across the spectrum of healthcare providers [3–6]. In an effort to overcome these barriers and better equip SLPs engaging in EBP, numerous organizations have taken the lead in helping clinicians become more evidence-based. Organizations such as the Academy of Neurologic Communication Disorders and Sciences, The Cochrane and Campbell Collaborations, The Agency for Healthcare Research and Quality, ASHA’s National