What Is Clinical Evidence in Speech-Language Pathology? A Scoping Review

Abstract

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: https://doi.org/10.23641/asha.21498546

Evidence-based decision-making in speech-language pathology via video-based telepractice—A qualitative video interaction analysis

“…Alternatively, the diamond model (Higginbotham and Satchidanand, 2019) can explain the different reasons for the decisions made by the SLPs very well. In a review, Fissel Brannick et al (2022) pointed out the difference in terms and definitions for clinical evidence. They argue that clinical opinion, clinical expertise, and practice-based evidence should be clearly defined and used unambiguously in professional and interprofessional communication and in discussions with patients and their families (Fissel Brannick et al, 2022).…”

“…In a review, Fissel Brannick et al (2022) pointed out the difference in terms and definitions for clinical evidence. They argue that clinical opinion, clinical expertise, and practice-based evidence should be clearly defined and used unambiguously in professional and interprofessional communication and in discussions with patients and their families (Fissel Brannick et al, 2022). The clinical evidence provided by the SLPs in the present study can be described as clinical expertise.…”

“…In the cross-case analysis, it was found that the SLPs used different types of knowledge (e.g., previous experience with the patient, the patient's self-perception, knowledge of the therapy method) to make decisions such as "determine to repeat action, " "determine modified target action, " or "determine new target action." Two essential attributes of good clinical decisionmaking are the use of multiple sources of knowledge and the needs of the patients (Fissel Brannick et al, 2022). However, it was not possible to reconstruct whether consensus recommendations, research findings or clinical expertise from other SLPs were used in the decision-making process.…”

“…However, it was not possible to reconstruct whether consensus recommendations, research findings or clinical expertise from other SLPs were used in the decision-making process. These are three more important aspects of clinical expertise in decision-making (Fissel Brannick et al, 2022).…”

“…They also propose combining clinical expertise and clinical opinion as one expression (Higginbotham and Satchidanand, 2019). Fissel Brannick et al (2022) noted in their scoping review that there is still no consistent distinction or conflation of internal evidence, clinical expertise, clinical opinion, or evidence internal to clinical practice in the literature, which can lead to uncertainty for therapists in evidence-based decision-making.…”