Turning the tide: Putting acute aphasia management back on the agenda through evidence-based practice

Abstract

Background: The role of speech pathologists working in the acute hospital setting has evolved away from service provision to people with aphasia and their families towards a stronger focus on dysphagia. Evidence-based practice (EBP) can be conceptualised as the integration of four streams of evidence: research-based clinical evidence, clinical expertise, patient preferences and values, and the practice context. EBP is an important tenet in current healthcare. However, it is not clear whether speech pathologists in the acute setting are using EBP to support their aphasia management. Not adopting evidence-based approaches to care has the potential to result in a negative impact on people with aphasia and their families, healthcare services, and speech pathologists, who experience a sense of dissonance related to their current service provision This paper explores acute aphasia management through an EBP lens in an attempt to better understand this dilemma. Aims: This paper applies the conceptual framework of EBP to acute aphasia management. An extensive, systematically conducted review of the international literature relating to health professionals was undertaken. The findings are presented as a narrative literature review. Main Contribution: This paper describes and evaluates how the different streams of research evidence, clinical expertise, patient preferences and values, and the practice context contribute to speech pathologists' management of acute aphasia. Further, the paper identifies current gaps in the literature and suggests a research agenda for the field. Conclusions: Little is known about how speech pathologists integrate and implement the different streams of evidence in EBP, and how these contribute to acute aphasia practice. Speech pathologists report that clinical guidelines containing low-level evidence are the main source of research information. Other sources of knowledge include colleagues, professional development events, and websites. Additional challenges to the management of people with aphasia in the acute hospital setting may be posed by the physical environment, the culture of the acute hospital setting, and the provision of leadership to support evidence-based approaches to care. The challenge of using a person-centred approach to care for people with aphasia is acknowledged. Further research exploring speech pathologists' perceptions of their role in acute aphasia management, the clinical decision-making process of speech pathologists in relation to acute aphasia management, and the experiences of people with aphasia and their families in the acute setting is required. This will

Evidence-based intervention for preschool children with primary speech and language impairments: Child Talk – an exploratory mixed-methods study

“…Most people are now familiar with the notion of evidence-based practice (EBP) and the seminal definition of Sackett et al, 50 which suggests that EBP occurs when external research evidence is applied with expertise and in the light of patient preferences; others have also emphasised the role of context in framing EBP. 51 Various barriers to the implementation of EBP have been identified including the time needed to search out research and, in particular, research that is relevant and appropriate to the particular context of an individual patient. 52 There is also a lack of research that attempts to advance our understanding of the process of integration of the three elements.…”

‘That doesn't translate’: the role of evidence‐based practice in disempowering speech pathologists in acute aphasia management

“…This is supported by a review of the literature which concluded that little is known about how speech pathologists understand, integrate and implement the different streams of evidence in EBP in the management of acute aphasia (Foster et al . ). In addition, we have little knowledge of the barriers and facilitators to achieving EBP in specific clinical contexts.…”

“Communication is taking a back seat”: An exploration of aphasia management in acute hospital settings

“…This chapter was published in the journal Aphasiology (Foster, Worrall, Rose, & O'Halloran, 2013). Using an evidence-based practice model, this chapter provides a description and evaluation of how the different streams of evidence contribute to the management of aphasia by speech pathologists in the acute hospital setting.…”

“…Firstly, because a review of the literature found that context -represented in both the country and the clinical setting in this research -is an important variable in the implementation of EBP (see Background section). Secondly, because research has revealed an evidence-practice gap in the provision of aphasia services in the acute hospital setting (Foster et al, 2013). In addition, participants with recent clinical experience were required given the nature of enquiry which required reflection upon and analysis of personal experiences.…”

“…A systematically conducted review of the international literature applying the conceptual framework of EBP to acute aphasia management was recently conducted (Foster et al, 2013) Speech pathologists have expressed dissonance regarding the disparity between current clinical practice and the research evidence in aphasia management (Byng et al, 2002;Rose et al, 2013).…”