Can evidence-based practice be disempowering for allied health clinicians? An exploration of the experiences of speech pathologists working in acute aphasia management

Dr Abby Foster1,2, Professor Linda  Worrall2, Associate Professor  Miranda Rose1, Dr Robyn O’Halloran1

1La Trobe University, Melbourne, Australia, 2The University of Queensland, Brisbane, Australia

 

Aim:

To provide an understanding of speech pathologists’ conceptualisation of evidence-based practice for acute post-stroke aphasia, and its implementation.

Method:

An interpretive phenomenological approach was adopted by the research team. Single, semi-structured in-depth interviews were conducted with fourteen purposively sampled speech pathologists working with people with acute post-stroke aphasia. Thematic analysis was undertaken, leading to the generation of key themes across all cases.

Results:

Participants demonstrated a sense of disempowerment in their acute aphasia management as a result of their relationship with evidence-based practice. This formed a single, overarching theme: The disempowering influence of EBP on acute aphasia management. Three sub-themes were identified:

(1) “To me EBP means…”: Speech pathologists’ restricted conceptualisation of evidence-based practice;

(2) “That doesn’t translate”: Speech pathologists’ relationship with the research literature and other streams of evidence; and,

(3) “[EBP] is in the back of your mind but there’s nothing I can do about it”: Conflict between a desire to provide optimal service to people with aphasia and the perceived barriers to implementing evidence-based practice recommendations clinically.

Significance of the findings to allied health:

Speech pathologists place significant emphasis on evidence from the research literature, resulting in a restricted conceptualisation of evidence-based practice. In addition, there is disengagement between clinicians and the research literature. Given the knowledge-practice gap in aphasia management and the increasing emphasis on evidence-based care at an organisational level, evidence-based practice has become a disempowering concept for some speech pathologists. The implications of these findings for speech pathology and other allied health disciplines will be discussed