10/6/2015 OVERVIEW RESEARCH SKILLS FOR CLINICIANS: WHERE DOES THE EVIDENCE COME FROM? HOW DOES IT GET PUBLISHED? AND HOW CAN I CONTRIBUTE?

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1 RESEARCH SKILLS FOR CLINICIANS: WHERE DOES THE EVIDENCE COME FROM? HOW DOES IT GET PUBLISHED? AND HOW CAN I CONTRIBUTE? JoAnn P. Silkes, Ph.D., CCC-SLP University of Washington Dept. of Speech and Hearing Sciences jsilkes@uw.edu OVERVIEW Motivation The traditional research pipeline The role of Practice-Based Research What does it take to do research? Types of clinical research Steps in the research process Writing for publication The manuscript submission process WHY SHOULD CLINICIANS THINK ABOUT THE RESEARCH PROCESS? 1

2 THE SYSTEM AS IT CURRENTLY STANDS Research pipeline THE SYSTEM AS IT CURRENTLY STANDS TIME FROM RESEARCH TO IMPLEMENTATION Green,

3 THE EMPTY VESSEL FALLACY IS THERE A WORLD IN WHICH RESEARCH MIGHT HOW TO HARNESS THE POWER OF THE CLINICIAN? Practice-based research (Epstein, 2011; Crooke and Olswang, in press) 3

4 TYPES OF RESEARCH Observational vs. experimental Group vs. single-subject Robey s phases of clinical research TYPES OF RESEARCH Observational studies Report on what happened - no intervention Surveys Case reports Clinical data mining (Epstein, 2011) Experimental studies Involve manipulation of variables Ideally involve some control to help with interpretation TYPES OF RESEARCH Group studies Groups may be based on: Diagnoses Treatments Treatment intensities Single-subject studies Case studies Single-subject experimental designs 4

5 ROBEY S HIERARCHY OF CLINICAL RESEARCH Phase I Highly exploratory Choose what effect you re looking for See if it s present Estimate magnitude of effect Make preliminary estimates of population, dosing Liberal type 1 error tolerance (saying there s an effect when there s not) May encompass: Case studies Single-subject experimental designs Small group pre-/post- studies Retrospective studies Robey, 2004 ROBEY S HIERARCHY OF CLINICAL RESEARCH Phase II Explore dimensions of therapeutic effects Moderately liberal error tolerance Make preparations for conducting a clinical trial Refine population, dosage, treatment protocol, outcome measures, etc. Develop administration manual Determine discharge criteria May encompass: Case studies and some single-subject designs (early Phase 2) Single-subject experimental designs Small-group within-effect, case-control studies, and cohortcontrol studies Robey, 2004 ROBEY S HIERARCHY OF CLINICAL RESEARCH Phase III Clinical trial to test treatment efficacy Conservative tolerance for type 1 error Typically a large sample size May also involve single-subject research (see Chambless and Hollon, 1998) Needs replication for clear confirmation Robey,

6 ROBEY S HIERARCHY OF CLINICAL RESEARCH Phase IV Field research How does this treatment work in the real world? Test effectiveness in the target population or subpopulations, and in different settings. Test variations in treatment protocol Meta-analyses Robey, 2004 ROBEY S HIERARCHY OF CLINICAL RESEARCH Phase V Determine who benefits, and at what cost Cost-effectiveness studies Cost-benefit analyses Directed more at policy-makers, regulators, and legislators Robey, 2004 WHY DO THESE PHASES MATTER? 6

7 RELIABILITY AND VALIDITY Reliability Validity Internal External WHAT DOES THE RESEARCH PROCESS LOOK LIKE? Research topic Background/Literature search Research question Study design IRB approval/permission Recruitment Consent Data collection Data analysis Dissemination CHOOSING A RESEARCH TOPIC 7

8 BACKGROUND/LITERATURE SEARCH Resources: PubMed, for initial searches: ASHA journals are available online to all ASHA members: HEALWA - licensed SLPs in WA have access to UW Health Sciences Library resources: Google scholar, or look up authors CVs often have articles linked DEVELOPING A RESEARCH QUESTION Focused Contrast with a Research Topic Includes: What? For whom? Under what circumstances? Measured how? HOW NOT TO WRITE A RESEARCH QUESTION 8

9 BYOQ DESIGN YOUR STUDY IRB APPROVAL / INSTITUTIONAL PERMISSION IRB = Insitutional Review Board 9

10 RECRUITMENT CONSENT DATA COLLECTION 10

11 DATA ANALYSIS WRITING IT UP APA format: WRITING IT UP Abstract Background Research Question(s) Method 11

12 WRITING IT UP Results Discussion Conclusion References THE PUBLICATION PROCESS Editors, Associate Editors, and Reviewers THE PUBLICATION PROCESS 12

13 RESOURCES TO BUILD RESEARCH COLLABORATIONS x?articleid= ASHA s Clinicians and Researchers Collaborating: Practice-Based Research Networks: Contact published researchers Get to know your local university faculty! REFERENCES Chambless, D. L. and Hollon, S. D. (1998). Defining Epirically Supported Therapies. Journal of Consulting and Clinical Psychology, 66: Crooke, P. J. and Olswang, L. B. (In press). Practice-based research: Another pathway for closing the research-practice gap. Journal of Speech Language and Hearing Research. Epstein, I. (2011). Reconciling evidence-based practice, evidence-informed practice, and practice-based research: the role of clinical data-mining. Social Work, 56: Green, L. W. (2008). Making research relevant: if it is an evidence-based practice, where's the practice-based evidence? Family Practice, 25 Suppl 1: i20-4. doi: /fampra/cmn055. Robey, R. R. (2004). A five-phase model for clinical-outcome research. Journal of Communication Disorders, 37: