Evidence-Based Practice and Controversy Over My Work

By Pam Marshalla

Q: The lead SLP at my agency will not allow me to attend Pam Marshalla’s workshop on R therapy. She feels that Pam’s book suggests an oral motor approach that is not evidence-based. I think there is some confusion in our profession about the difference between placement techniques and oral motor exercises as a isolated activity. I work for a progressive educational agency that seems to be running scared of any controversial terms.

Honestly, the amount of misunderstanding about oral motor techniques is unbelievable. Ask your supervisor if you can no longer use mirrors in therapy because there is no evidence to support their use as an aid to articulation therapy.

Seriously, most of what I teach in the class is traditional articulation therapy. And the bare fact is that there is almost no evidence whatsoever to back up any of the traditional techniques either. So does that mean we have to quit doing articulation therapy altogether?

Remind your supervisor that the ASHA website proposes that evidence comes from three sources: 1) Laboratory research, 2) Clinical experience, and 3) Client values. My class combines all three.

Asha Definition of EBP

The following four paragraphs are quoted directly from the ASHA website, 2008:

There is an abundance of definitions of evidence-based practice (EBP). Fortunately, most of them say essentially the same thing. The most well-known definition is that put forth by David Sackett and colleagues:

“Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values.”

– Sackett D et al. Evidence-Based Medicine: How to Practice and Teach EBM, 2nd edition. Churchill Livingstone, Edinburgh, 2000, p.1

In 2004, ASHA’s Executive Board convened a coordinating committee on evidence-based practice. This committee, charged with assessing the issue of evidence-based practice relative to planning needs and development opportunities for ASHA, used a variation of this definition:

The goal of EBP is the integration of: (a) clinical expertise, (b) best current evidence, (c) client values to provide high-quality services reflecting the interests, values, needs, and choices of the individuals we serve.

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