Investigating the Adequacy of Intervention Descriptions in Recent Speech-Language Pathology Literature: Is Evidence From Randomized Trials Useable?

PURPOSE

To evaluate the completeness of intervention descriptions in recent randomized controlled trials of speech-language pathology treatments.

METHOD

A consecutive sample of entries on the speechBITE database yielded 129 articles and 162 interventions. Interventions were rated using the Template for Intervention Description and Replication (TIDieR) checklist. Rating occurred at 3 stages: interventions as published in the primary article, secondary locations referred to by the article (e.g., protocol papers, websites), and contact with corresponding authors.

RESULTS

No interventions were completely described in primary publications or after analyzing information from secondary locations. After information was added from correspondence with authors, a total of 28% of interventions was rated as complete. The intervention elements with the most information missing in the primary publications were tailoring and modification of interventions (in 25% and 13% of articles, respectively) and intervention materials and where they could be accessed (18%). Elements that were adequately described in most articles were intervention names (in 100% of articles); rationale (96%); and details of the frequency, session duration, and length of interventions (69%).

CONCLUSIONS

Clinicians and researchers are restricted in the usability of evidence from speech-language pathology randomized trials because of poor reporting of elements essential to the replication of interventions.

Tyranny of the randomised clinical trial

Researchers and clinicians often disagree about what it means to provide the best possible care. This paper's purpose is to propose ways of resolving the disagreements. The first is to have both groups re-examine the three equal components of evidence-based practice, a re-examination that begins with rejection of the randomised clinical trial's tyranny. The second is for researchers to design rehabilitation research based on a biopsychosocial rather than a biomedical model. The third is for both groups to redefine translational research so that it means both translation from the laboratory to the clinic and from the clinic to the laboratory. The fourth is to advocate for a science of dissemination that is as robust as rehabilitation's present science of discovery. Most examples are drawn from the literature on acquired neurologic speech and language disorders.

A Scoping Review of Clinical Practice Improvement Methodology Use in Rehabilitation

Context

The Clinical Practice Improvement (CPI) approach is a methodological and quality improvement approach that has emerged and is gaining in popularity. However, there is no systematic description of its use or the determinants of its practice in rehabilitation settings.

Method

We performed a scoping review of the use of CPI methodology in rehabilitation settings.

Results

A total of 103 articles were reviewed. We found evidence of 13 initiatives involving CPI with six different populations. A total of 335 citations of determinants were found, with 68.7% related to CPI itself. Little information was found about what type of external and internal environment, individual characteristics and implementation process might facilitate or hinder the use of CPI.

Conclusion

Given the growing popularity of this methodological approach, CPI initiatives would gain from increasing knowledge of the determinants of its success and incorporating them in future implementation.

Evidence-Based Practice & Practice-Based Evidence Applied to Adult, Medical Speech-Language Pathology

In this paper, we review concepts of evidence-based practice (EBP), and provide a discussion of the current limitations of EBP in terms of a relative paucity of efficacy evidence and the limitations of applying findings from randomized controlled clinical trials to individual clinical decisions. We will offer a complementary model of practice-based evidence (PBE) to encourage clinical scientists to design, implement, and evaluate our own clinical practices with high-quality evidence. We will describe two models for conducting PBE: the multiple baseline single-case experimental design and a clinical case study enhanced with generalization and control data probes. Gathering, analyzing, and sharing high-quality data can offer additional support through PBE to support EBP in speech-language pathology. It is our hope that these EBP and PBE strategies will empower clinical scientists to persevere in the quest for best practices.

Telehealth applications in speech-language pathology: a modified narrative review

We conducted a modified narrative review of the literature on telehealth applications used in speech-language pathology assessment and treatment. The following databases and information resources were used: MEDLINE, CINAHL, PSYCInfo, ERIC, Digital Dissertations, CSA Social Services Abstracts, CSA Sociological Abstracts, On-line ASHA publications and personal contacts. Sixty-two full-text documents were located. Twenty-eight provided sufficient detail to be reviewed using a checklist adapted from the Scottish Intercollegiate Guideline Network (SIGN) recommendations for level of evidence rankings and quality assessment ratings. Five of the 28 studies received a ranking indicating a high level of evidence (larger sample sizes, assessed outcomes with valid and reliable measures, performed statistical analysis of study results, measured reliability of study results, ensured internal and external validity, and ensured randomization of participants to groups). These five studies concluded that the service delivery results from telehealth were equivalent to traditional face-to-face results. However, telehealth was not a complete replacement for face-to-face service delivery and further research is required.