Evidence Based Practice (EBP) is something we’ve all heard of, but what is it and what does it mean for my child? Let’s break it down.
Levels of Evidence – Not all evidence is equal!
As Speech Pathologists we base our therapy and practises on the best evidence available to us however not all evidence is created equally. We must think critically about the claims being made and determine whether or not they fit the criteria for good evidence. To be good evidence there must be little to no bias and there are ratings scales that determine this. The danger of acting without good evidence is at best, time is wasted on ineffective therapies. At worst, therapies may even be harmful.
‘Good’ Levels of Evidence
Level I: Systematic Reviews. This is a review of all the Randomised Controlled Trials available. This is the best level of evidence as it looks at the results of a number of randomised controlled studies that are well designed and have large numbers of participants. This is the level we like to base our therapeutic decisions on.
Level II: Randomised Controlled Trials. This is one, well designed experiment with random assignment to treatment groups. The groups are then treated the same with the exception of the intervention they receive. Clinical measures are taken regularly throughout the experiment and are discussed in great detail.
Level III: Well-designed trials. These are experiments such as non-randomised trials or time series design. They have large numbers and reliable designs however are not randomised or cannot be randomised.
Level IV: Non experimental studies. These studies are usually from research groups or centres or are based on case reports. They are still well designed however do not offer as much un-biased evidence as those of higher level studies.
Level V: Opinion of well-respected authorities. This includes authorities such as Speech Pathology Australia, Raising Children Network, Universities (Macquarie University, University of Newcastle etc), regulatory bodies and hospitals. These opinions are based on clinical research, recommendations of expert committees or descriptive studies.
Not so good ‘evidence’
It is worth noting that social media, most parenting websites, blogs etc. may be useful for providing a starting point for research or handy hints however they are not an authority on therapy or interventions and any advice they provide regarding intervention must be taken with caution. Be very wary of any product claiming to “cure”.
So what does that mean for my child accessing therapy?
As Speech Pathologists at Early Start Speech Pathology, EBP is what we base all our therapy goals and clinical decisions upon. Early Start’s Speech Pathologists are constantly expanding their knowledge on different topics whether this be going to seminars, reading journal articles on specific research, or discussing with colleagues their experiences. As members of Speech Pathology Australia, we have to ensure we do a certain amount of additional training each year to continue to be a Certified Practicing Speech Pathologist.
The process which research projects go through is extensive. With new research being published on a regular basis it means that your child can receive the most effective and valuable therapy techniques dependant on their needs.
There are always new therapy approaches and “miracle” treatments advertised. Unfortunately, not all of these approaches will have strong evidence supporting them. Quite often when research is advertised with amazing results, a deeper analysis of this research and their results is needed to ensure that the results are representative of the population they say they represent.
Early Start Speech Pathology we pride ourselves on providing EBP to all our clients. So far this year we have had a number of clinicians travel to Sydney and around Newcastle to attend a variety of training days in the latest courses in different assessment and therapy approaches. Some of these have included a literacy workshop presented by researchers at Macquarie University, an assistive technology seminar, and a number of online training courses. Aside from these external workshops, we also have regular staff meetings which address a range of topics including getting advice from each other about a particular question or therapy.
At Early Start Speech Pathology we use a number of EBP approaches including the Lidcombe program for stuttering, Hanen techniques for early language stimulation, Superflex and Social Thinking programs for social skills, and the research from Caroline Bowen regarding speech sounds work.