The Prof Is In

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Re: opinion of evidence based therapy

From: Ken St. Louis
Date: 08 Oct 2010
Time: 15:30:40 -0500
Remote Name: 157.182.15.31

Comments

Dear John, Greetings from the other side of the Atlantic. Let me offer just one perspective on Evidence Based Practice (EBP)--mine alone. If I understand your query, that's what you want. I am absolutely sure that everyone on this esteemed panel would not agree with me, although some may. EBP is one of those concepts that virtually all sane people would agree with. It's like "Should only good teachers be promoted in our schools?" or "Should only solid research be published?" So..."Yes, we should move more from opinion-based clinical decisions to evidence-based decisions." But how do we do that? First, what evidence to we consider? Take research. Should the evidence be taken entirely from peer-reviewed research journals? Should those research studies include "old" studies (e.g., 20-30 years old) or should they be restricted to "recent" studies (e.g., within the past 5 years)? Should the evidence be considered only after it has been incorporated into mainstream practice (i.e., translational research findings as well as bench research findings)? Should the studies be restricted to phase 2 or 3 clinical trials (of which there are relatively few in stuttering treatment), or should they include careful case studies (from which, strictly speaking, one should not generalize)? It is obvious to me that there are no clear cut answers to any of these questions. Next, consider clinical opinion. Should an experienced clinician's past positive or negative results from a given therapy approach be used in clinical decisions? Should clinicians constantly change their approaches based on the most recent published or unpublished research? Should the desires, previous successes, or previous failures of the client be taken into account in therapy? If so, what should be done if some or many of these factors indicate that the best "evidence" perhaps should not be used? All this is to say that I believe we definitely should promote and personally participate in EBP. But I would say that good clinicians have always done that and always will. Some poor clinicians often do not keep up in their fields and therefore persist in strategies that might not be optimal for the clients. Other poor clinicians often jump on every bandwagon that comes along and apply strategies without considering the big picture. In short, I believe that EBP, if used by 3rd party reimbursers, by administrators, or by professional associations like a hammer will ultimately do as much damage as benefit to clients and the field. On the other hand, if EBP means keeping up as best as one can, using good judgment, keeping good records and using the results of those record, and being sensitive to the hundreds of intangible variable that are part and parcel of working with other human beings, then I'm all for it. Ken


Last changed: 10/23/10