Evidence based practice (EBP) in any profession is very important, including speech language pathology. Yet, like many other professions, the specification of evidence based speech therapy treatments is too general.
For instance, while stuttering therapy is designed to improve stuttering, this in itself does not guide EBP as there is no definition of how the treatment was provided. Nor is there a justification of why a particular treatment was chosen. Therefore, how can an effective measurement and outcome be determined that might also be replicated for future practice?
It can’t be.
Being a therapist requires that you provide treatment based on evidence of effectiveness. And with CMS value-based care now in place, applying evidence based principles to clinical practice is more important than ever.
EBP can also be useful in communicating choices and goals to other parties. For example, when communicating to parents about a child. Reason being, it provides a way to describe why and how your chosen course of treatment works.
Evidence-Based Practice in Speech-Language Pathology (SLP)
A study, published in the American Journal of Speech-Language Pathology, discusses a framework for improved EBP for SLPs called the Rehabilitation Treatment Taxonomy (RTT). At the core of RTT are three elements of treatment theory:
Targets – the specific functional outcomes that will change as a result of treatment.
Ingredients – the specific actions taken by therapists to reach the targets.
Mechanisms of action – the evidence, clinical experience, or hypothesis that suggests the ingredients being used will reach the targets.
Common Ingredients used in Speech-Language Pathology
Instructional methods – the teaching and reteaching of knowledge and skills to help the patient learn new information.
Behavioral methods – the use of cues, prompts, feedback, modeling, rehearsal and so forth.
Forms of Measurement
In principle, ingredients are always measurable. So too are targets.
However, the targets need to be selected carefully or they can lead to an irrelavent outcome.
For instance,
Target: Verb retrieval
Ingredient: Questions about verbs
While this seems like a good target, verb retrieval doesn’t necessarily aid a person’s ability to engage in everyday conversation. Therefore, a more relevant target is: “to improve everyday conversation.”
Within this target, verb retrieval is really just one aim. As a therapist you also need to consider other ingredients that meet additional aims involved in reaching the true target, which is “to improve everyday conversation.” Therefore, your plan of treatment may include multiple aims.
The authors make a point in defining the difference between aims and targets because in order to reach effective outcomes, the comparison really matters.
You may also need to set new targets or aims as patients progress along the course of treatment.
Mechanisms of action
While both ingredients and targets can be measured, mechanisms of action often can’t. There are still many unknowns in terms of the way learning and processing information occurs. So, in many cases, mechanisms of action can’t be clearly defined but are based on hypothesis.
Theories that explain knowledge, skill and attitude changes are still valid. They help inform the targets and ingredients selected for treatment. And having some understanding of theories behind the mechanisms of action helps inform treatment strategies for specific patients.
Goals of the Evidence Based Speech-Language Pathologist
Identify relevant targets, making sure they result in outcomes that will make a difference to everyday living.
Map appropriate ingredients, trying to understand the aims and mechanisms so that you are able to replicate your results with future patients.
Engage in systematic thinking to determine treatment methods and ingredients – for instance, follow the 5 step process for implementing evidence based practice.
Further resources
- Evidence-Based Practice: An Examination of Its Ramifications for the Practice of Speech-Language Pathology
- EBP briefs