Title of Course: Evidence Based Practice in Communication Disorders CE Credit: 6 Hours (0.6 CEUs) Learning Level: Advanced Author: Christine A. Dollaghan, PhD, CCC SLP Abstract: With this landmark textbook, speech language pathologists will learn to apply current best evidence as they make critical decisions about the care of each individual they serve. The first text that covers this cutting edge topic for the communication disorders field, this book introduces SLPs to the principles and process of evidence based practice, thoroughly covering its three primary components: "external" evidence from systematic research, "internal" evidence from clinical practice, and evidence concerning patient preferences. SLPs will get the in depth guidance they need to: construct the right questions about best evidence; find the reliable information they need to answer these questions; evaluate the validity of both internal and external evidence; weigh the importance of empirical evidence, whether from a research study or from an individual patient; help patients fully understand clinical options and express their preferences; conduct systematic, critical appraisals of treatment evidence, diagnosis and screening evidence, and evidence from systematic reviews or meta analyses. Developed by Christine A. Dollaghan, one of the most highly respected researchers in the field of language acquisition and disorders, this text makes complex concepts understandable with its clear, reader friendly language, vivid step by step examples of key processes, and illuminating figures and tables. SLPs will come away with a solid, practical understanding of evidence based practice knowledge they'll use throughout their careers to make sound clinical decisions about the screening, diagnosis, and treatment of communication disorders. Brookes Publishing 2007 24 posttest questions Course #60 84 Learning Objectives: 1. Define evidence based practice (EBP) within the context of speech language pathology and audiology 2. Describe methods of determining the validity of evidence that may be used in EBP 3. List factors to be considered in determining the importance of evidence used in EBP 4. Identify procedures for appraising treatment or diagnostic evidence 5. List key issues that should be considered in appraising systematic reviews, meta analyses, or patient/practice evidence 6. Identify trends that are emerging in the use of EBP in clinical decision making in communication disorders Posttest: The posttest questions for this course are on the following pages. You can submit your answers online in your account on our website for free, or you can return this completed posttest along with the attached payment form for processing via mail or fax for a $10 per test fee. Professional Development Resources www.pdresources.org 60 84 Evidence Based Practice in Comm D/Os Page 1 of 6
Instructions: This is a multiple choice test circle the answer of your choice. There is only one correct response to each item. 1. Which of the following negative reactions to Evidence Based Practice (EBP) has emerged in the professional community of those who treat Communication Disorders? a. The movement toward EBP suggests that practitioners had previously failed to base clinical decisions on evidence. b. EBP involves only evidence; therefore clinical decisions will no longer involve a clinician s knowledge gained from their own professional background. c. Patients perspectives can no longer be considered in clinical decisions. 2. Which of the following are the three best types of evidence (E 3 ) as defined in this textbook? a. Available evidence from systematic research and clinical practices, as well as best available evidence concerning preferences of a fully informed patient or client. b. The most current scientific research that includes long term studies of clinical treatment paradigms. c. The clinician should primarily rely upon patients preferences, family requests, and even if there is evidence in the literature that contraindicates a patient s choice. d. A clinician who has at least 20 years of professional experience should use their own professional knowledge without any need to refer to evidence in professional literature. 3. How does the author of this text differentiate between internal and external evidence? a. External evidence refers to clinical practice information and internal evidence refers to evidence from systematic research. b. External evidence refers only to recent information obtained from publications or presentations from the previous three years. c. External evidence is gleaned from systematic review of the literature and internal evidence is based in clinical practice. d. Internal evidence is that which comes directly from the client/patient while external evidence comes from the objective measures (such as baseline, or standardized test results) that a clinician obtains. 4. The author s expanded definition of E 3 BP does not specifically refer to clinical expertise, although the author considers clinical expertise essential to effective E 3 BP. a. True b. False 5. Which of the following are preconditions necessary to successful E 3 BP? a. Clinician is not sure that a certain clinical action is optimal for a client. b. The clinician s professional integrity, including awareness of one s biases, honesty, respectfulness, and openness to the need to change one s mind. c. The clinician must maximize benefit, minimize harm, have self determination, and be fair; these are the underpinnings of clinical ethical reasoning. 6. Which of the following is the principle of beneficence? a. That we are obligated to avoid harming clients or patients. b. The obligation to respect the right of patients who fully understand their options to determine what happens to them. c. That we must practice in a manner that is maximally beneficial to our clients or patients. d. The obligation to practice in a fair, nondiscriminatory manner. Professional Development Resources www.pdresources.org 60 84 Evidence Based Practice in Comm D/Os Page 2 of 6
7. Which of the following are components of a Foreground Question (FQ)? a. A type of patient or problem, an intervention, comparison or contrast to the intervention, and a class or type of patients. b. An individual patient, their baseline diagnostic information, and an intervention plan. c. Prognosis, Intervention, Collaboration, and Operational Definitions. 8. Which of the following are uses of Foreground Questions (FQ)? a. Clinicians may use FQ s in their search for external evidence that helps in determining screening or diagnostic procedures or tools. b. An FQ may be used to compare rate or extent of improvement of clients/patients who already have already been assessed, diagnosed, and have treatment goals. c. Using the four PICO components, an FQ may be written to assist a clinician in determining whether a patient is progressing as rapidly as expected. 9. Which of the following is not a recommended method for finding current high quality external scientific evidence? a. Workshops, presentations, and textbooks. b. Review findings of groups who have appraised evidence using explicit, transparent criteria, such as the Cochran Collaboration. c. Do an internet search that facilitates your access to rapid electronic evidence resources (e sources) of current literature that focuses on publications that have been peer reviewed. 10. PubMed, a web based system for searching literature is not useful to those who work with Communication Disorders, since it focuses on medical experimentation and has very few studies from the fields of speech language pathology or audiology. a. True b. False 11. Internal and external validity are synonyms for internal and external evidence. a. True b. False 12. Which of the following should be considered to determine if evidence from a research study is sufficiently credible to use in E 3 BP? a. Review to determine if there was subjective bias. b. Look at research design and quality of measurement used in studies. c. Consider whether there are any nuisance variables that might also explain a study s outcome, and examine indications of statistical significance to assure that researchers have not made a Type Two error. 13. Interrelated concepts that contribute to evaluating the importance of evidence include: a. Sample size, location of study, and number of subjects in a control group. b. Null hypothesis, credentials of experimenters, and length of study. c. Effect size (ES), precision, practical significance, and clinical significance. d. Statistical evidence that has been collected to indicate the prevalence of communication disorder. 14. The term forest plot, when used in research means: a. A visual display of Effect Size and Confidence Intervals. b. A bar graph of Experimental Subjects and Cohort Information. c. Graphic display of External Significance and Calculated Intervals. Professional Development Resources www.pdresources.org 60 84 Evidence Based Practice in Comm D/Os Page 3 of 6
15. The format developed by the authors to guide Critical Appraisal of Treatment Evidence (CATE) addresses which of these? a. The single source of external evidence (i.e., a treatment study). b. Appraisal points to reflect key influences on validity and importance of evidence to clinical practice. c. Whether the p value of statistical findings is high enough to provide confidence that the results would be unlikely if the null hypothesis (i.e., no treatment effect) is true. d. Both A & B 16. How is the term cost benefit advantage used in clinical treatment studies? a. The benefits of a treatment must substantially exceed known or potential harms, and the benefits are consistent with costs. b. The cost of conducting a study is minimal enough to allow clinicians to develop clinical studies with their practices. c. The benefits of a treatment must result in a low enough cost for insurance companies to cover the therapy, or clinical procedure. 17. To evaluate the importance of evidence, how does the author distinguish compelling, suggestive, and equivocal? a. Compelling evidence is virtually incontrovertible. b. Suggestive evidence is open to debate on a few points. c. Equivocal evidence is debatable on many points to the extent that unbiased experts might reach opposite conclusions. 18. The Critical Appraisal of Diagnostic Evidence (CADE) can be used for which of these purposes? a. To determine of a client or patient meets eligibility guidelines for enrollment in treatment, as set forth by schools or hospitals. b. To critically appraise evidence concerning screening, diagnosis, and differential diagnosis. c. To critically appraise a patient/client s symptoms in order to assign a level of severity. d. To critically appraise standardized, published screening and examination tools. 19. When using a nomogram to appraise diagnostic evidence, what are you calculating? a. The probability that the score of a person who has completed a diagnostic test has the disorder for which you are examining. b. The Standard Error of Measure that would be significant for the patient. c. Evidence to determine if the patient s score falls within specified eligibility guidelines for enrollment in treatment. 20. What differentiates meta analyses and systematic reviews from traditional literature reviews? a. Traditional literature reviews only include the information that the author wishes to include or highlight. b. Systematic reviews and meta analyses share the goal to use more objective criteria that leads to a more valid, less biased view of the entire body of evidence. c. Meta analyses and systematic reviews provide tangible indications of the importance of evidence. 21. Using the Critical Appraisal of Systematic Review or Meta Analysis (CASM), what ratings are used for validity and importance? a. Conclusive, Inductive, and Hypothetical c. Compelling, Suggestive, and Equivocal b. Subjective, Biased, and Arbitrary d. Numerical, Qualified, and Descriptive Professional Development Resources www.pdresources.org 60 84 Evidence Based Practice in Comm D/Os Page 4 of 6
22. The model for examining evidence on which clinical practice should be based is described in this text as E 3 BP; what are the three types of evidence? a. External evidence from systematic scientific research. b. Evidence from clinical practice and evidence on patient preferences. c. Evidence from a practitioner s academic and clinical background. d. Both A & B 23. An appropriate focus of a Foreground Question (FQ) to obtain evidence about a particular patient should: a. Address a Patient and/or Problem, an Intervention, a Comparison or contrast to the intervention, and an Outcome. b. Address whether the patient s cognitive level is at the appropriate level expected for language and/or speech development. c. Describe how a particular patient is different from subjects included in research studies of a particular communication disorder. 24. What information does the author discuss as factors for the future of E 3 BP in Communication Disorders? a. There will be increased accuracy in testing individual patients as computer technology improves. b. New sources such as Internet Based Evidence Networks, and Practice Based Evidence Networks will increase importance and relevance of evidence available for clinical decision making. c. There will likely be a significant increase in Evidence Wars, in which individuals argue there point of view by citing only the research information that supports their point of view. d. It is likely that there will be fewer studies that yield high quality evidence concerning the cost benefit ratio of E 3 BP. Affidavit: I attest that I completed this course and CE test personally & without assistance PRINT NAME as it appears on professional license: Profession: *State of Licensure: License #: * Florida Licensees: mandatory for reporting to CE Broker. *FL SLP/A s must self submit to CE Broker. Address: City: State: Zip: Phone: ( ) Email: Signed: Date: Speech Language Pathologists & Audiologists: Do you want us to report your credits to ASHA? Yes (must provide ASHA #) No (no further info required) 8 Digit ASHA Membership #: Professional Development Resources www.pdresources.org 60 84 Evidence Based Practice in Comm D/Os Page 5 of 6
Course Evaluation: Course content and level of difficulty were described accurately in the course abstract. This activity had clearly stated learning objectives. The organization and format of this activity facilitated learning. Visuals, links and support materials were appropriately designed and used. Information resources included scientific evidence substantiating course information. Test questions were clearly written & at an appropriate level of difficulty. This activity increased my knowledge and/or skill in the topic area. This activity will contribute to my professional growth. The process of ordering was easy & efficient. The customer service I received addressed my questions and concerns to my satisfaction. I achieved learner objective #1: Define evidence based practice (EBP) within the context of speech language pathology and audiology I achieved learner objective #2: Describe methods of determining the validity of evidence that may be used in EBP I achieved learner objective #3: List factors to be considered in determining the importance of evidence used in EBP I achieved learner objective #4: Identify procedures for appraising treatment or diagnostic evidence I achieved learner objective #5: List key issues that should be considered in appraising systematic reviews, metaanalyses, or patient/practice evidence I achieved learner objective #6: Identify trends that are emerging in the use of EBP in clinical decision making in communication disorders Professional Development Resources www.pdresources.org 60 84 Evidence Based Practice in Comm D/Os Page 6 of 6