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- Problem Formulation in Evidence-based Practice and Systemic Reviews
- Information Retrieval: Where's Your Evidence?
- Selecting Studies for Systemic Review: Inclusion and Exclusion Criteria
- Grading Study Quality in Systemic Reviews
- The Art (and Science) of Building an Evidence Portfolio
- Calculating and Synthesizing Effect Sizes
- Interpreting and Maintaining the Evidence
- Effectiveness of Behavioral Stuttering Treatment: A Systemic Review and Meta-Analysis
- Lessons Learned: The Student Experience
- Translating Systemic Reviews Into Policy and Practice: An International Perspective
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1. Problem Formulation in Evidence-based Practice and Systemic Reviews
Ralf W. Schlosser
Therese M. O'Neil-Pirozzi
Abstract: Problem formulation, or the asking of well-built questions, is the first step in the evidence-based practice (EBP) process. Often it is the first stumbling block for clinicians as the success of subsequent steps hinges on how well the problem is formulated. Templates for asking well-built questions can assist clinicians in this process. In this article, we will introduce the PESICO template—person, environments, stakeholders, intervention, comparison, outcomes (Schlosser, Koul, & Costello, 2006)—apply it to the field of fluency disorders, and illustrate it with several well-built questions. Problem formulation is also relevant in the development of systematic reviews, which provide the clinician with timesaving access to prefiltered evidence. The second aim of this article is to offer practitioners considerations in formulating problems in their own review efforts and to discuss the impact of this problem formulation on the use of systematic reviews for informing practice. This is accomplished by reflecting on the problem formulation done by C. Herder, C. Howard, C. Nye, and M. Vanryckeghem (2006), this volume, in their systematic review of behavioral stuttering interventions.
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2. Information Retrieval: Where's Your Evidence?
Jane Dennis
Jo Abbott
Abstract: Creating and implementing a good search strategy is an essential part of conducting a systematic review. In this article, we review the background, rationale, and mechanics of constructing strategies suitable for a review on interventions for stuttering, with particular attention to planning and executing replicable searches within a variety of electronic databases. We also describe other pertinent parts of an overall search strategy (including handsearching of journals and approaches to relevant experts and professional bodies within speech therapy) and emphasize the importance of careful documentation and clear reporting.
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3. Selecting Studies for Systemic Review: Inclusion and Exclusion Criteria
Timothy Meline
Abstract: The process of selecting studies for systematic review and meta-analysis is complex, with many layers. It is arguably the most important and perhaps the most neglected aspect in the process of integrating research on a specific topic. It is also a contentious process with opposing schools of thought as regards critical issues surrounding study selection. The debate that centers on the selection process is important because the inclusion/exclusion of studies determines the scope and validity of systematic review results. The development of inclusion/exclusion criteria is discussed, and steps in the study selection process are followed from initial evaluation to the final acceptance of studies for systematic review.
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4. Grading Study Quality in Systemic Reviews
James Law
Charlene Plunkett
Abstract: There is a growing need for the development of a research base in stammering intervention research. Systematic review is one among a number of tools that can be used. The key to a useful systematic review is the use of explicit quality criteria. This article discusses the application of the Oxford Centre for Evidence-based Medicine levels of evidence to the field of stammering and tests it by applying it to two recent articles (M. Jones et al., 2005 and M. C. Franken, K. van der Schalk, and H. Boelens, 2005).
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5. The Art (and Science) of Building an Evidence Portfolio
Jamie B. Schwartz
Sandra Jo Wilson
Abstract: A critical step in developing an "evidence portfolio" is the formulation of a coding scheme for extracting and coding relevant data from primary research studies. A coding scheme provides a transparent organizational framework for recording pertinent study characteristics. Four broad categories of information that are typically coded include study identification, participants, treatment(s), and study design characteristics. In this article, we will (a) describe each of the categories along with variables that are important for assessing the quality of studies in an evidence portfolio, and (b) discuss some important issues surrounding data extraction for systematic reviews.
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6. Calculating and Synthesizing Effect Sizes
Herbert M. Turner, III
Robert M. Bernard
Abstract: The effect size is a standardized, scale-free measure of the relative size of the effect of an intervention, and it has important and practical implications for clinicians in the speech and hearing field who are interested in estimating the effects of interventions. This article develops a conceptual interpretation of the effect size, makes explicit assumptions for its proper use in estimating the size of the effect of behavioral-based stuttering interventions, and explains how to compute the most commonly used effect sizes and their confidence intervals. The focus is on effect sizes for experimental studies on behavioral-based stuttering interventions that produce outcomes measured on a continuous scale. Also explained is how to synthesize these effect sizes across multiple studies to arrive at an average effect size and its confidence interval through a process called meta-analysis. Key assumptions that underlie the use of meta-analysis are explored, as are techniques for assessing whether the average effect size is representative of the multiple effect sizes from which it was derived. The article concludes with a summary of main points and enumerates additional resources for speech and hearing clinicians and practitioners to access and learn more about practical applications of effect sizes and their synthesis through meta-analysis.
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7. Interpreting and Maintaining the Evidence
Chad Nye
Jennine Harvey
Abstract: The purpose of this article is to describe how the effect size can be interpreted to gain insight into the nature of effective intervention. The of an intervention measures the impact resulting from an intervention, ranging from low (.2), to moderate (.5), to high (.8). The basic interpretation of the ES provides a relative standard reflecting the magnitude of the intervention effect. A portfolio of evidence consisting of multiple studies is necessary for the development of clinical guidelines. The collection, summary, analysis, and interpretation of intervention effects are all important functions in the development of an evidence-based portfolio.
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8. Effectiveness of Behavioral Stuttering Treatment: A Systemic Review and Meta-Analysis
Carl Herder
Courtney Howard
Chad Nye
Martine Vanryckeghem
Abstract: The objective of this study was to conduct a systematic review and meta-analysis of the research relating to behavioral stuttering treatment. Detailed descriptions of the information retrieval, inclusion criteria, study coding, and effect size computations are provided. A total of 375 citations were identified for potential inclusion using electronic and hand-search strategies. Of the 12 included studies, six reported outcomes for treated versus nontreated participants, yielding a significant effect size of 0.91. The remaining six studies compared the effectiveness of two different treatments and yielded a nonsignificant effect size of 0.21. These data support the claim that intervention for stuttering results in an overall positive effect. Additionally, the data show that no one treatment approach for stuttering demonstrates significantly greater effects over another treatment approach.
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9. Lessons Learned: The Student Experience
Elizabeth Owens
Melanie Baez
Sarah Tillman
Abstract: Within the field of communication sciences and disorders, there is a need for systematic reviews. This need is driven by the demand for accountability of the quality of intervention that is provided by speech-language pathologists. Systematic reviews offer a summary of what is known about a given intervention and suggest the supporting research that might serve to advance the delivery of high-quality services. As insurance companies, families, researchers, and clinicians seek scientific evidence of effective therapy techniques, the need for systematic reviews will increase. R. J. Light and D. B. Pillemer (1984) argued that as more research is conducted, systematic reviews can help both the clinician and the researcher understand procedures, trends, and results that will not likely be found in any single study.
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10. Translating Systemic Reviews Into Policy and Practice: An International Perspective
Merete Konnerup
Jamie Schwartz
Abstract: When it comes to investing time and money in services, governments, social service agencies, public service providers, and consumers all want to know what works. What harms? Based on what evidence? The impetus for basing policy and practice decisions on the best available evidence had its origins in the United Kingdom three decades ago. Since that time, there has been an increased demand for researchers to provide high-quality research on the effects of interventions that can be incorporated into the decision-making process for what works and for whom. This article will provide background for the evidence-based practice movement as well as address the implications of systematic reviews for decision making for policymakers, professionals, and consumers.
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