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Speech Language Pathology - Dallas

Speech Pathology research for TWU students, faculty, and staff.

EBP/SLP Databases

EBP

3 Pillars of Evidence-Based Practice

    1. EVIDENCE derived from rigorous scientific research found in literature.

    2. EXPERTISE derived from clinical experience and skill.

    3. PATIENT PREFERENCE concerning personal health decisions.

Steps in the EBP Process

Steps in the EBP process

Asking for and locating evidence depends upon asking an effective clinical question.
Use the PICO mnemonic to build that question.

P =   Patient     Population     Problem  (includes demographic information)

I   =  Intervention   Treatment    Therapy     Prognostic Factor    Exposure

C  =  Comparison  (could be placebo or no treatment)

O  =  Outcome       (what you hope to accomplish; measurable)

 

P I C O

     P -- patient, population, participant, problem (diagnosis)
     I -- intervention, therapy, treatment
     C -- comparison  (not always required)
     O -- outcome

P I C O T

     P -- patient, population, participant, problem (diagnosis)
     I -- intervention, therapy, treatment
     C -- comparison  (not always required)
     O -- outcome
     T  -- time

P I C O (T)

     P -- patient, population, participant, problem (diagnosis)
     I -- intervention, therapy, treatment
     C -- comparison  (not always required)
     O -- outcome
     T  -- type of studies or questions

P I C O T T

     P -- patient, population, participant, problem (diagnosis)
     I -- intervention, therapy, treatment
     C -- comparison  (not always required)
     O -- outcome
     T  -- type of question 
              (therapy/treatment, diagnosis, prognosis, harm/etiology)
     T  -- type of study 
              (research method/design)

 5 Types of PICO Questions

     1. Diagnosis
     2. Therapy (treatment / intervention)
     3. Etiology (cause)
     4. Prognosis (future / forecast)
     5. Prevention

Diagnosis PICO:
In children with respiratory infection, is the respiratory rate as effective as chest x-ray in detecting pneumonia?

Prognosis PICO:
In premature infants (compared to full-term infants), what is the lifetime prevalence of hearing deficit?
 
Therapy PICO:
In patients with recurrent infection, do antibiotics, compared to no treatment, reduce recurrence rate?
 
Etiology PICO:
In post-menopausal women, does hormone replacement therapy increase the risk of breast cancer?

EBP

3 Essential Elements of Evidence-Based Practice

     EVIDENCE derived through rigorous scientific research.

     EXPERTISE from the healthcare practitioner's clinical experience.

     PATIENT preferences concerning personal healthcare decisions.

PICO/Evidence-Based Practice (EBP)

“Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” (Sackett et al, 1996)

 

EBP as a Speech-Language Pathologist Using the acronym PICO which stands for:

 

1. Definition of the problem/formulate a clinical question

Problem

  • [Disease], e.g., “panic disorder”
  • [Behavior], e.g., “oppositional behaviors”
  • [Symptom], e.g., “leg cramps”

Population

  • [Age], e.g., “40-year- old”
  • [Gender], e.g., “male”
  • [Treatment Status], e.g., “delayed treatment”
  • [Physical Condition], e.g., “healthy”
  • [Medical History], e.g., “with prior attacks”
  • [Treatment & Drug], e.g., “taking hormone replacement therapy”
  • [Disease], e.g., “nonvalvular atrial fibrillation”
  • [Symptom], e.g., “chronic cough”

Intervention & Comparison

  • [Treatment & Drug], e.g., “warfarin”
  • [Procedure], e.g., “transvaginal ultrasound”
  • [Diagnostic Test], e.g., “Pap smear”
  • [Exposure], e.g., “maternal smoking”
  • [Disease], e.g., “a flare-up of the Crohn’s”
  • [Symptom], e.g., “a very low serum iron”

Outcome

  • [Treatment Outcome], e.g., “fibroid volume reduction”
  • [Patient Outcome], e.g., “decreased mortality”

2. Literature search by evaluating and assessing the evidence.

  • Systematic Review/Individual studies
  • Meta-Analysis/Statistical analysis

3. Assessing the Evidence

The table below is one example of a hierarchy of levels of evidence.

Level Description
Ia Well-designed meta-analysis of >1 randomized controlled trial
Ib Well-designed randomized controlled study
IIa Well-designed controlled study without randomization
IIb Well-designed quasi-experimental study
III Well-designed non-experimental studies, i.e., correlational and case studies
IV Expert committee report, consensus conference, clinical experience of respected authorities

Adapted from the Scottish Intercollegiate Guidelines Network

4. Making the Decision

 

References:

1. http://speechbite.com/ebp/what-is-it/

2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1839740/

 

 

 

 

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