SLHS 457 Exam 2

Internal Evidence

Evidence obtained from the case/client, including assessment and, case history, and environmental/contextual factors

External Evidence

Evidence from research articles/studies. Must be evaluated by type of research, quality of research (peer-reviewed?), level of evidence, research design

6 Steps of EBP

1) Develop a PICO question

2) Find the internal evidence

3) Find the external evidence

4) Critically evaluate the external evidence

5) Integrate internal and external evidence

6) Apply and evaluate the outcome of the decision

Step 1 of EBP

Develop a PICO Question (Population, Intervention, Comparison, Outcome)

Step 2 of EBP

Find the Internal Evidence (clinical knowledge and experience, client preference, contextual factors)

Step 3 of EBP

Find the External Evidence (finding research articles, refining by PICO question)

Step 4 of EBP

Critically Evaluate External Evidence (evaluate relevance, quality, type, design)

Step 5 of EBP

Integrate Internal and External Evidence

Step 6 of EBP

Apply and Evaluate Outcome of the Decision

PICO Question

Population/Problem

Intervention

Comparison

Outcome

Research Design

Vary in controlling randomization, causality vs. correlation, etc

Experimental vs. Non-Experimental Research Study

Experimental research manipulates one or more control variables, while non-experimental research focuses more on observation

Peer-Review

A process by which scholarly articles are evaluated by other experts in the field to ensure scientific quality

Levels of Evidence: Ia

• Well-designed systematic review of experimental/control study

• Controlled, groups, experimental

• It is shown that…

Levels of Evidence: Ib

• Well-designed RCT

• Controlled, groups, experimental

• It is likely that…

Levels of Evidence: IIa

• Well-designed control study without randomization

• Controlled, group study, experimental

• It is likely that…

Levels of Evidence: IIb

• Well-designed quasi-experimental study, single subject study design (SCED)

• No control (or control within subject), no groups, experimental

• There are signs that…

Levels of Evidence: III

• Well-designed non-experimental study (case studies, group studies, cross-sectional design)

• No control, sometimes groups, non-experimental

• There are signs that…

Levels of Evidence: IV

• Expert committee reports, clinical experience of respected professionals

• No control, no groups, non-experimental

• Experts of the opinion that….

Expert Report

Answers, “what do experts think?”, may use data from other studies

Case Study

What occurred in an individual case, no control/experiment

Cross-Sectional Study

A non-experimental study observing groups (what is occurring)

Single Case Experimental Design (SCED)

Quasi-experimental (controlled within subject), established baseline, observe change (A/B)

Quasi Experimental Study

An experimental study without control/randomization (pre/post intervention design)

Randomized Control Trial (RCT)

A randomized, controlled experiment that can show outcome is a result of treatment

Systematic Reviews

Big statistical analysis of multiple studies, “study of studies”, requires a lot of previous research

Barriers to EBP

• Lack of time to find, read, and critique research articles

• Disconnect between intervention procedures in controlled research environment vs clinical settings

Importance of Research Design

Study design alone is not enough to assess the credibility of a study. Even study designs that are associated with a high level of evidence like RCTs can produce lower quality research based on issues internal to the study.

ICF-CY Framework

ICF-CY is a holistic framework for intervention, which integrates social, personal, and environmental factors WITH body structure/function to provide a view of the client as a whole, rather than in terms of their impairment.

This is important because SLP’s goals for intervention can often be limited to the specific context of therapy, rather than creating goals with the client’s life and environment in mind.

Factors Influencing Difficulty Generating a Clinical Decision

• There is an abundance of evidence supporting multiple intervention approaches.

• When one intervention has more high-level research evidence, but it is not realistically applicable to your real-life clinical scenario

Long-Term Goal

What you expect your client to be able to do by the end of intervention

Short-Term Objective

Steps that lead up to achieving LTG.

Session Objective

What you expect your client to do by the end of the session

Cumulative Treatment Intensity

Dosage, calculated by length of intervention, frequency of sessions, and number of learning opportunities

Continuous Dosage

Maintaining the same dosage over intervention (slow, long)

Sprint/Variable Dosage

Varying the frequency and intensity of dosage (may be to see more kids)

Treatment Strategy

How you set up teachable moments

Antecedent

What we do BEFORE to encourage a targeted behavior

Consequence

What we do to let them know if they hit the targeted behavior, and why.

Importance of Treatment Goals

• Progress monitoring

• Accountability

Zone of Proximal Development

The area between what a child can do independently and what they need support with. Goals should be in this zone.

Additive Objectives

Working on multiple skills at once

Sequential Objectives

Stepping stones, one goal must be achieved before moving on to the next

Vertical Attack Strategies

Working on one goal at a time in isolation

Horizontal Attack Strategies

Gradually adding new skills to work on at the same time, layering

Cyclical Attack Strategies

Working on skills a little bit at a time, cycling through each target

Consulting

Gathering and sharing information

Collaborating

Working together to achieve some goal

Coaching

Helping someone to achieve some goal (teaching, giving feedback)

Moving towards Independence

1. High dosage, high support, feedback from others

2. Less support, self-reflection, intermittent dosage and feedback

3. Little to no support and feedback, self-reflection

Qualitative Data

Observations, interview, or reported information

Frequency Data

Percentage or fraction, information about performance out of ‘x’ trials

Duration Data

How long did it take (ex: holding a sound out)?

Interval Data

Assessing if a behavior occurred within a given time frame

SOAP Notes

Subjective - what was observed/reported

Objective - data collected in session

Analysis - interpretation of data

Plan - recommendations for next session