Moving Evidence-based Practice Forward

Welcome to the first issue of Evidence-based Communication Assessment and Intervention, a journal designed to help clinicians, educators, and other stakeholders stay up to date with the best available evidence so that they are in a better position to engage in evidence-based practice (EBP).

EBP requires the integration of the best available and most current research evidence with clinical/educational expertise and client preferences/relevant stakeholder perspectives (Dollaghan, 2004; Sackett, Strauss, Richardson, Rosenberg, & Haynes, 2000; Schlosser & Raghavendra, 2004). This integration of these three cornerstones is in and of itself quite an undertaking, even after the individual cornerstones are known. It is thus not surprising that surveys have indicated time and time again that professionals face considerable barriers to EBP implementation (e.g., Zipoli & Kennedy, 2005). For one, many practicing professionals and pre-service level graduate students have a beginning knowledge and skill base related to the efficient searching for evidence. The consequences are that they may be relying on only a portion of the available evidence. While this is a problem in any field, the ramifications of this situation are even more pronounced in our area where the literature is scattered across dozens of journals and disciplines. Further, many professionals may not feel entirely competent or comfortable in tackling the various considerations that are part and parcel of an appraisal of evidence. In addition, these activities can be very time-consuming and many professionals have indicated that their employment arrangements often do not provide dedicated time to engage in EBP-related activities. So, even when knowledge and skill levels are adequate or excellent, the lack of time may still prevent clinicians and educators from using evidence to inform their practice. Given this as a backdrop, about four years ago, the two editors had a conversation in a pub in Austin, Texas. We pondered how great it would be to develop a resource where professionals and others could find critical appraisals of the best available evidence to inform their practice. This initial conversation sparked our curiosity about how other fields have dealt with this and we began to search the scientific publishing houses for the answer. Surely, we were thinking, we could not have been the first ones to think about this issue. This led us to the concept of evidence-based journals, that is, secondary journals that appraise already published research through value-added structured abstracts. To our surprise we found quite a few of these journals (and there seemed to be more emerging every time we looked) including the following: Evidence-based Nursing, ACP Journal Club, Evidence-based Medicine, and Evidence-based Mental Health. We began studying the structure and processes of these journals, and before we knew it were developing a proposal for an evidence-based journal in our field. The result is Evidence-based Communication Assessment and Intervention.

We would like to thank Drs. Gordon Guyatt and Brian Haynes of McMaster University, Canada, for their generosity in answering our numerous questions about running this type of “evidence-based” journal. We also gained much from the advice and example set by Dr. Johnny L. Matson at Louisiana State University. His editorial skills and efficiency are the gold standard that we are aiming for in Evidence-based Communication Assessment and Intervention.

The experiences of these individuals and many others of our colleagues have been invaluable to us. We also extend thanks to Mara Conner for reviewing an initial proposal, for strategizing, and for being supportive of the general idea. Most of all, we owe thanks to Kathryn Spiller of Informa Healthcare for her wisdom to support our proposal and help us turn our initial brainstorming into concrete action. And so, here we are today with the first issue. Now, let us share with you how Evidence-based Communication Assessment and Intervention can assist with minimizing the aforementioned barriers to EBP implementation.

First, the editorial staff regularly scan 60+ journals to find the best research related to communication assessment and intervention. We then select for abstracting only those studies and reviews that meet pre-defined relevance criteria and minimal quality criteria. For example, studies that use pre-experimental designs to evaluate the effects of a treatment do not qualify for abstracting. Similarly, for prognosis, we require an inception cohort that is assembled at a uniform point in the development of the disorder/disability (or first onset), which are initially free of the outcome of interest (for a complete listing see Quality Checklist). Professionals can therefore be confident that the studies abstracted in this journal are of the highest quality. Second, in order to be included, studies and reviews need to have practical implications related to assessment/diagnosis, treatment, or prognosis. Practitioners therefore get to read abstracts relevant to their professional work without having to sift through research that bears little or no practical implications.

Third, our knowledgeable commentators summarize the study/review, appraise the evidence in terms of how sound the evidence really is, and uncover the practical bottom-line. Pre-filtered evidence is established when “an individual or group of individuals with expertise in a substantive area has reviewed and presented the methodologically strongest data in the field (see Melnyk & Fineout-Overholt, 2002, p. 263). Pre-filtering allows clinicians and other stakeholders not only to save considerable time, but also benefit from experts in the specific field. The format of the structured abstracts is aimed to ease readability and uptake. For instance, the titles of the abstracts are carefully worded to convey the practical bottom-line in light of the appraised evidence. Next, the question of the original study/review is restated, and this is followed by the Methods section. The subheadings in the Methods box vary to some degree depending on the kind of study (assessment/diagnosis, prognosis, treatment, qualitative) or review in question. The methodological quality indicators also differ across study types, but show consistency within the same study type. That is, what is important to a sound diagnostic study is not the same as what makes a treatment study credible. All abstracts include the main findings as well as the original authors’ conclusions. Finally, the commentary addresses the appraisal and clinical bottom-line. The brevity of the entire abstract (1–2 journal pages) should aid readability and uptake as well.

We hope that Evidence-based Communication Assessment and Intervention will also provide a forum for the exchange of ideas and advancement of EBP. Hence, in the EBP Advancement Corner we seek to publish tutorials, synthesis, systematic reviews, critically appraised topics, discussions, and original research articles related to the EBP process (for specifics see the Purpose and Procedures section in this issue). In this inaugural issue, Dr. Sharon Straus, a leading expert in evidence-based health care, provides a discussion article concerning the challenges and limitations of evidence-based health care. Among other things, her article will draw attention to the fact that EBP may be practiced in various modes, and we are confident that many, if not all, practitioners will be able to relate to these modes, and perhaps, even find them comforting. Drs. Laura Justice and Martha Snell propose a method for determining whether manualized treatments are indeed empirically supported. This piece is exemplary for the kinds of articles we seek for the EBP Advancement Corner because it speaks to one way of appraising evidence, a key step in the EBP process.

To ensure that EBP is a dialogic process whereby not only researchers inform practice but also practitioners and other stakeholders inform research (and practice), we have designed the EBP Speakers Corner, which will appear in future issues. Here, we seek to publish brief experiential accounts by practitioners, other relevant stakeholders as well as researchers who wish to reflect on their experiences with evidence, clinical/educational expertise, relevant stakeholder perspectives, and the integration thereof. These articles may take the form of anecdotes, reflections, or case studies (see Purpose and Procedures).

Evidence-based Communication Assessment and Intervention is decidedly interdisciplinary. The aim is to transcend artificial disciplinary boundaries in order to abstract the best and most relevant research from various sources and authors. We recognize that communication-related issues are addressed by a variety of professionals including speech–language pathologists, special educators, teachers, occupational therapists, physical therapists, applied behavior analysts, school psychologists, etc. who all play a role in meeting the needs of individuals with communication impairments.

We wish to gratefully acknowledge our Associate Editors (see Introductions) and Commentators/Reviewers, without whose belief in and support of our efforts, we would not have been able to get there. Our Associate Editors and Commentators are carefully selected not only for their content expertise but particularly for their track-record in appraising research evidence. We believe that writing of structured abstracts constitutes an act of scholarship that advances the field by improving practice as well as future research. It is our hope that these commentaries will make their way into the literature of our fields. Please consult the column “How to cite materials published in EBCAI.” Finally, we extend our heartfelt thanks to our Editorial Assistants and our respective institutions for supporting the day-to-day operation on our editorial activities.

Sincerely

Ralf W. Schlosser, PhD

Jeff Sigafoos, PhD