Clinical evidence in speech-language pathology (Fissel Brannick et al., 2022)

Purpose: Two disparate models drive American speech-language pathologists’ views of evidence-based practice (EBP): the American Speech-Language-Hearing Association’s (2004a, 2004b) and Dollaghan’s (2007). These models discuss evidence derived from clinical practice but differ in the terms used, the definitions, and discussions of its role. These concepts, which we unify as clinical evidence, are an important part of EBP but lack consistent terminology and clear definitions in the literature. Our objective was to identify how clinical evidence is described in the field.

Method: We conducted a scoping review to identify terms ascribed to clinical evidence and their descriptions. We searched the peer-reviewed, accessible, speech-language pathology intervention literature from 2005 to 2020. We extracted the terms and descriptions, from which three types of clinical evidence arose. We then used an open-coding framework to categorize positive and negative descriptions of clinical expertise and summarize the role of clinical evidence in decision making.

Results: Seventy-eight articles included a description of clinical evidence. Across publications, a single term was used to describe disparate concepts, and the same concept was given different terms, yet the concepts that authors described clustered into three categories: clinical opinion, clinical expertise, and practice-based evidence, with each described as distinct from research evidence, and separate from the process of clinical decision making. Clinical opinion and clinical expertise were intrinsic to the clinician. Clinical opinion was insufficient and biased, whereas clinical expertise was a positive multidimensional construct. Practice-based evidence was extrinsic to the clinician—the local clinical data that clinicians generated. Good clinical decisions integrated multiple sources of evidence.

Conclusions: These results outline a shared language for SLPs to discuss their clinical evidence with researchers, families, allied professionals, and each other. Clarification of the terminology, associated definitions, and the contributions of clinical evidence to good clinical decision-making informs EBP models in speech-language pathology.

Supplemental Material S1. Corpus references. 

Supplemental Material S2. Clinical evidence terms and sources. 

Supplemental Material S3. Operational definitions and counts for clinical expertise categories and codes (N = 68).

Supplemental Material S4. Operational definitions and counts for good clinical decision-making categories and codes (n = 53). 

Fissel Brannick, S., Wolford, G. W., Wolford, L. L., Effron, K., & Buckler, J. (2022). What is clinical evidence in speech-language pathology? A scoping review. American Journal of Speech-Language Pathology. Advance online publication. https://doi.org/10.1044/2022_AJSLP-22-00203